The use of a graft from the second extensor compartment to reconstruct the A2 flexor pulley in the long finger.

A 10 mm wide ring graft from the second extensor compartment with periosteum from the floor of the sheath was used to correct bowstringing in six patients who sustained an isolated rupture of the A2 pulley. It was attached to the lateral rims of the sheath. Periosteum was used for additional graft fixation. Bowstringing was assessed by magnetic resonance imaging and ultrasound preoperatively and 19.5 months after surgery. It was corrected in five patients and improved in one. Pain was reduced from 35 to 7 points on a visual analogue scale. Digital circumference decreased from 76 to 71 mm. Flexion at the PIP joint increased from 88 degrees to 116 degrees. Pinch grip improved from 28 to 56 N.