Revision Pulley Reconstruction in a Rock Climber for Phalanx Bone Resorption With Extensor Retinaculum Slip: A Case Report and Technique Review

We report this case of a rock climber who sustained a right ring-finger grade-III A2 pulley rupture. After failed nonoperative management, the patient underwent pulley reconstruction with ipsilateral palmaris longus autograft using a double-loop technique. The immediate postoperative course was uncomplicated, and the patient returned to painless rock climbing six months after the index procedure. One year postoperatively, the patient developed discomfort on the dorsum of the proximal phalanx which progressed to baseline pain at rest. Radiographs and MRI taken 16 months postoperatively demonstrated intact palmaris graft with underlying bone osteitis and resorption of the proximal phalanx. The range of motion remained full without bowstringing. The patient was indicated for revision A2 pulley reconstruction with ipsilateral extensor retinaculum autograft. Six months following revision pulley reconstruction, the patient was pain-free and radiographs demonstrated improvement in cortical density. The patient was able to return to rock climbing. Our case suggests pulley reconstruction with an extensor retinaculum slip sutured to the ever-present fibrous rim is a viable option with successful short-term outcomes in the setting of post-reconstructive bone resorption.