Efficacy of a Percutaneous A1 Pulley Release Technique With Identification of Anatomic Differences Between Genders

Abstract

This cadaver study investigates the efficacy and safety of the Biomet knife and technique for percutaneous A1 pulley release. We also evaluate the anatomic relationship between specific palmar surface landmarks and relevant underlying structures and identify differences between genders. Eighty percutaneous A1 pulley releases, excluding the thumb, were performed on 20 fresh human cadaver hands (10 male, 10 female). Complete release was obtained in 60 of 80 fingers. Success rates for each surgeon improved markedly as the study progressed. There were no significant differences between males and females regarding the distance between a standardized incision site and the proximal edge of the A1 pulley. A learning curve exists for percutaneous A1 pulley release using the Biomet knife and technique. The extended distal palmar crease is a reasonable incision site for percutaneous release of the index, middle, and ring A1 pulleys in both men and women as the A1 pulley begins just distal to this surface landmark.