The A1 pulley in rheumatoid flexor tenosynovectomy. To retain or divide?

We report a detailed comparative evaluation of flexor tenosynovectomy in 55 fingers in which the A1 pulley was divided and 45 fingers in which the A1 pulley was retained. The metacarpophalangeal joint subluxed volarly in 49% when the A1 pulley was divided, compared to 11% when the pulley was preserved. Bowstringing occurred in 7% and only when the A1 pulley was divided. Ulnar deviation was 7 degrees worse when the pulley was divided. Active range of movement was limited in both groups. It was 11 degrees less when the A1 pulley was divided.