Cadaveric biomechanical study using 36 digits from 9 hands to quantify the effect of progressive partial excision (25%, 50%, 75%) of the A2 and A4 digital pulleys — individually and combined — on total finger angular rotation and work of flexion. The goal was to establish safe thresholds for pulley excision during zone 2 flexor tendon surgery.
When zone 2 flexor tendon repair requires improved exposure or risks postoperative impingement at a pulley edge, you can excise up to 25% of the A2 or A4 pulley — alone or together.
Without measurable kinematic cost; even 75% combined excision produces only ~15° total arc loss, which may be acceptable when weighed against the surgical benefit.
Cadaveric biomechanical study using 36 digits from 9 hands to quantify the effect of progressive partial excision (25%, 50%, 75%) of the A2 and A4 digital pulleys — individually and combined — on total finger angular rotation and work of flexion. The goal was to establish safe thresholds for pulley excision during zone 2 flexor tendon surgery.
When zone 2 flexor tendon repair requires improved exposure or risks postoperative impingement at a pulley edge, you can excise up to 25% of the A2 or A4 pulley — alone or together.
Without measurable kinematic cost; even 75% combined excision produces only ~15° total arc loss, which may be acceptable when weighed against the surgical benefit.