# Biomechanical Evaluation of a Novel V-Shaped A2 Pulley Reconstruction Technique Using a Free Palmaris Longus Tendon Graft Tenodesis

## TL;DR

This study tested a new V-shaped technique for repairing A2 pulley injuries in the hand and found it to be stronger and safer than existing methods.

## Contribution

A novel V-shaped graft tenodesis technique for A2 pulley reconstruction with superior biomechanical performance is introduced.

## Key findings

- The V-shaped technique had a higher load at failure (299 N) compared to other methods.
- The new technique failed only due to screw extrusion, not suture cut-out.
- The method avoids suture-related complications and preserves extensor structures.

## Abstract

Background: The aim of this biomechanical investigation was to evaluate a V-shaped three-point graft tenodesis technique using a free palmaris longus (PL) tendon for reconstructing traumatic A2 pulley lesions and to compare its biomechanical performance with two previously described reconstruction techniques. Methods: After A2 pulley lesion simulation in 27 fingers (index, middle and ring finger) from nine human anatomical hand specimens, reconstructions were performed using the innovative V-shaped graft tenodesis technique, a double-loop encircling technique and a suture anchor graft fixation technique. Load at failure and the failure mechanisms were evaluated. Results: The V-shaped graft tenodesis technique was superior biomechanically (p = 0.004) considering load at failure (mean: 299 N). The only observed failure mechanism in this group was the extrusion of the central tenodesis screw. In contrast, reconstructions in the other two groups failed due to suture cut-out. Conclusions: Patients may benefit from the new technique’s high load tolerance during early mobilization. Furthermore, a reduction in complications may be anticipated due to an absence of sutures and the sparing of extensor structures.