A1 pulley cutting potential and safety of three ultrasound-guided percutaneous A1 pulley release techniques for...

There is no consensus as to the best technique for percutaneous trigger finger release.

This assessor-blinded study compared three ultrasound-guided percutaneous trigger finger release techniques using a needle (N), a needle-knife (NK), and a specially designed knife (K). Three physicians simulated A1 pulley release surgery on 56 fingers of 14 fresh-frozen hand cadaver body donors. Both the physicians and the fingers included were randomly selected.

The results of repeated-measures ANOVA revealed significantly longer cuts for the NK and K techniques, than for the N technique, both absolute (mean ± SD) (NK = 5.55 ± 3.07 mm, K = 6.29 ± 4.07 mm, and N = 2.02 ± 3.46 mm; N vs. NK p = 0.015, N vs. K p = 0.002, and NK vs. K p = 1.000), and cut percentage in relation to the total pulley length (NK = 51.61 ± 28.34%, K = 54.63 ± 33.72% and N = 18.24 ± 31.09%; N vs. NK p = 0.008, N vs. K p = 0.003, and NK vs. K p = 1.000). No neurovascular bundle injuries were found upon dissection. The overall complication rate was 11%, with no significant differences among the three techniques. Only one major tendon injury occurred in the NK group.

In this cadaveric study, the NK and K techniques were more effective at releasing the A1 pulley than the N technique. All three techniques have emerged as equally safe.