Comparative effectiveness of ulnar superficialis slip resection versus isolated A1 pulley release for trigger finger: a systematic review and meta-analysis

Purpose: This study aimed to compare clinical outcomes between ulnar superficialis slip resection (USSR) combined with A1 pulley release and isolated A1 pulley release for trigger finger management, with particular emphasis on patients presenting with proximal interphalangeal joint flexion contracture or persistent triggering. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, with literature searches performed in PubMed, Embase, the Cochrane Library, and Scopus through November 2025. Study quality and risk of bias were assessed using the ROBINS-I tool.Results: Five retrospective studies involving 454 patients (USSR combined, 185; isolated A1 release, 269) were included in the analysis. Isolated A1 pulley release and combined USSR demonstrated comparable outcomes with respect to functional improvement (qDASH, p=0.52), pain reduction (VAS, p=0.93), and correction of flexion contracture (extension lag angle, p=0.07). Notably, the combined USSR group exhibited superior grip strength recovery (p=0.03), whereas complication rates were similar between the two groups (p=0.14).Conclusion: Although isolated A1 pulley release and combined USSR yielded comparable overall outcomes, the USSR cohorts frequently comprised patients with more severe pathology, suggesting that USSR effectively equalizes prognosis in high-risk presentations. In addition, USSR demonstrated superior functional recovery with respect to grip strength. Therefore, while isolated A1 pulley release remains the standard approach for primary cases, USSR should be actively considered as a definitive intervention for recurrent disease or severe flexion contractures to achieve functional recovery comparable to that of the general population.