Patient-reported outcomes and complications of flexor tendon tenolysis following prior A1 pulley release: A cohort of 139 patients.

BACKGROUND

Following surgical A1 pulley release, approximately 0.5% of patients require reoperation due to flexor tendon adhesions. However, literature evaluating outcomes following flexor tendon tenolysis is scarce.

OBJECTIVE

This study assessed the effectiveness and safety of tenolysis following prior A1 pulley release.

METHODS

This is a cohort study of patients who underwent tenolysis following A1 pulley release. We included patients who completed baseline questionnaires, the Michigan Hand outcomes Questionnaire (MHQ), and Satisfaction with the Treatment Result questionnaire at 3 months postoperatively. Additionally, we retrospectively reviewed medical records to identify postoperative complications.

RESULTS

Our cohort of 139 patients demonstrated an improvement in self-reported hand function and pain from baseline to 3 months postoperatively, although individual outcomes varied considerably. For example, 60% of patients demonstrated an improvement exceeding the minimally important change, whereas 20% demonstrated a deterioration in MHQ scores. Furthermore, 10% of patients underwent reoperation, the majority of which were repeat tenolysis.

DISCUSSION: This study shows that tenolysis, on an average, resulted in a clinically relevant improvement in hand function and pain in short- and long-term, although individual outcomes varied considerably. Additionally, 10% of patients underwent another reoperation, the majority of which were repeat tenolysis. These findings underscore the challenges associated with tenolysis procedures. Further insight into factors contributing to the failure of tenolysis procedures is needed to improve the selection of patients that may benefit from tenolysis following A1 pulley release.

LEVEL OF EVIDENCE: III.