Direct suturing of flexor tendon pulley rupture in elite rock climbers

Closed traumatic ruptures of the finger flexor tendon pulleys are common injuries in sport climbers. In cases of complete rupture, surgical repair using graft material is the current standard to restore pulley function. Although these techniques provide good outcomes, recovery often exceeds six months and graft-related morbidity may occur. Surprisingly, the option of direct suture repair has been little explored, despite its potential advantages. We retrospectively reviewed six cases of isolated closed traumatic pulley rupture and two cases of multiple pulley ruptures treated by direct suture combined with early active postoperative rehabilitation. Postoperative outcomes were assessed using the Buck-Gramcko score and by comparing the postoperative climbing level with the preinjury level. Tendon-bone distance, functional impairment, and hand strength were also evaluated. Ultrasound examination of the repaired pulley was performed in three patients at three years postoperatively. Patients recovered their preinjury climbing level after a mean of 5.8 months (range, 3-8 months), a shorter timeframe than that typically reported after graft-based reconstruction. Ultrasound confirmed pulley continuity and adequate mechanical behavior in the three examined patients. All injured fingers achieved an excellent Buck-Gramcko score. Hand strength was comparable to preoperative measurements, functional complaints were minimal, and tendon-bone distance remained within normal limits. These encouraging clinical results suggest that direct suture repair of flexor tendon pulley ruptures in high-level climbers may represent a valuable alternative to graft-based reconstruction, enabling a faster return to climbing with minimal morbidity.