Abstract
The flexor tendon pulley mechanism causes the tendons to work with maximum efficiency. Without its competency,flexor tendons will bowstring causing significant losses of digital motion and strength. Without an intact pulley system, increased flexor tendon excursion is required to affect joint motion and flexion contractures may develop over time. Recent investigators have described the properties of the intact flexor pulley system as well as those of flexor pulley reconstructive techniques. Reconstruction of the flexor pulley system should take into account both strength and length of the construct and in most cases a loop of either flexor tendon graft or wrist extensor retinaculum is used. Other methods are available including the use of the palmar plate as well as the superficialis tendon.
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