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The consequences of the division of the pulley of the flexor hallucis longus are described. This division may be necessary for the repair of tendon or in the treatment of trigger thumb. After division, the pulley cannot be sutured and the flexor tendon remains displaced anteriorly. The authors describe a technique of repair using a flap detached from the tendon of the adductor pollicis. 6 cases have been operated on with good results.

The authors report their experience in dealing with 43 cases of secondary surgery on the flexor pollicis longus tendon between 1970 and 1982. After an anatomical and biomechanical survey, the results of the different techniques used are analyzed: tenolysis (12 cases). tenodesis (one case), one- (3 cases) or two-stage (4 cases) grafts, flexor digitorum superficialis (FDS) transfer (11 cases) and secondary sutures (12 cases). The overall outcome was very disappointing, with 50 per cent poor results. Compared with the other techniques, secondary suture fared best, and it can be combined, if need be, with tendon lengthening at the wrist and metacarpo-phalangeal pulley reconstruction. Considering these results, therapeutic indications are proposed. The functional requirements of the patient may lead to prefer simple interphalangeal fusion to any dynamic method.