Clinical Trials Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2017; 8(2): 163-169
Published online Feb 18, 2017. doi: 10.5312/wjo.v8.i2.163
Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger
Vasileios S Nikolaou, Michael-Alexander Malahias, Maria-Kyriaki Kaseta, Ioannis Sourlas, George C Babis
Vasileios S Nikolaou, Michael-Alexander Malahias, Maria-Kyriaki Kaseta, Ioannis Sourlas, George C Babis, 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, 15124 Athens, Greece
Author contributions: Nikolaou VS analyzed data and edited the manuscript; Malahias MA conducted ultrasound exams and wrote the manuscript; Nikolaou VS and Malahias MA have contributed equally to this work; Kaseta MK and Sourlas I assisted during the operations; Babis GC had the final checking and proof editing of the manuscript.
Institutional review board statement: The study was reviewed and approved by Konstandopoulion General Hospital Scientific Committee.
Clinical trial registration statement: This study has been registered to US Clinical trials protocol and results System: ClinicalTrials.gov ID: NCT02830672.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest related to the present study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vasileios S Nikolaou, MD, PhD, MSc, Orthopaedic Surgeon, Assistant Professor of Orthopaedics, 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, 21 Dimitriou Ralli Str, Maroussi, 15124 Athens, Greece. vassilios.nikolaou@gmail.com
Telephone: +30-693-2543400 Fax: +30-210-8020671
Received: July 4, 2016
Peer-review started: July 21, 2016
First decision: September 5, 2016
Revised: October 31, 2016
Accepted: November 21, 2016
Article in press: November 23, 2016
Published online: February 18, 2017
Processing time: 210 Days and 14.4 Hours
Abstract
AIM

To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique.

METHODS

In this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade II-IV according to Green classification system, were recruited. Two groups were formed; Group A (16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B (16 patients) underwent an open surgical release of the A1 pulley, through a 10-15 mm incision. Patients were assessed pre- and postoperatively (follow-up: 2, 4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering (primary variable of interest) was expressed as the “success rate” per digit. The time for taking postoperative pain killers, range of motion recovery, QuickDASH test scores (Greek version), return to normal activities (including work), complications and cosmetic results were assessed.

RESULTS

The success rate in group A was 93.75% (15/16) and in group B 100% (16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean QuickDASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickDASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5% (14/16) of group A patients, while in 56.25% (9/16) of group B patients were evaluated as fair or poor.

CONCLUSION

Treatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better cosmetic results, in comparison with the open surgery technique. It is a promising method that represents excellent results without major complications, so that it could be possibly be established as a first-line treatment in the trigger finger’s disease.

Keywords: Ultrasound-guided; Trigger finger; A1 release; Comparative; V-lance knife; Percutaneous; Minimally-invasive

Core tip: In this randomized, prospective clinical trial, of 32 patients with trigger finger or trigger thumb, ultrasound assisted treatment of the A1 pulley, revealed better outcome in comparison with the open technique. Patients had fewer work absence days and improved surgical scar. To the best of our knowledge this is the first randomized trial in this field. These promising results have to be further confirmed with larger trials in the future.