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The comparative safety and clinical effectiveness of percutaneous A1 pulley release versus open surgical release for trigger finger (stenosing tenosynovitis) remain topics of ongoing debate.
Percutaneous and open release both effectively treat trigger finger, but percutaneous release enables quicker recovery, faster return to daily activities, and less pain medication use with similar safety.
The comparative safety and clinical effectiveness of percutaneous A1 pulley release versus open surgical release for trigger finger (stenosing tenosynovitis) remain topics of ongoing debate. This systematic review and meta-analysis evaluated outcomes between these two surgical techniques and explored the added value of ultrasound-guided percutaneous release in enhancing precision and patient outcomes.
Randomized controlled trials (RCTs) issued up to 11 August 2025 were analyzed. Key databases, including Embase, PubMed, and the Cochrane Library, were explored for studies comparing percutaneous trigger finger release with open surgery. Key outcome measures encompassed functional recovery (Quick Disabilities of the Arm, Shoulder, and Hand; Q-DASH scores), pain (visual analog scale; VAS), complication rates, revision rates, grip strength, range of motion, and time to return to work.
Endpoints were determined across multiple follow-up intervals: immediate (one week), short-term (<one month), mid-term (three months), and long-term (six months). Subgroup analysis determined ultrasound-guided versus non-guided percutaneous techniques.
A total of 14 RCTs involving 996 patients were incorporated. Percutaneous A1 pulley release illustrated substantially superior outcomes in early recovery phases, including improved Q-DASH functional scores at immediate (mean difference; MD: 24.94), short-term (MD: 15.08), and mid-term follow-up (MD: 7.27).
Additionally, those undergoing percutaneous release experienced faster return to work (MD: 12.82 days) and shorter duration of post-surgery analgesic usage (MD: 4.66 days). However, long-term outcomes, including DASH scores, grip strength, joint mobility, pain scores, complication rates, and need for revision surgery, were comparable between both techniques.
Both percutaneous and open trigger finger release surgeries proved to be safe and effective treatment options. However, percutaneous release offered faster functional recovery, reduced postoperative pain medication use, and earlier return to daily activities, without compromising long-term outcomes or safety.
Journal of Orthopaedic Science
Comparative effectiveness of open versus percutaneous release for trigger fingers: A systematic review and meta-analysis of randomized controlled trials
Kuan-Chen Huang et al.
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