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Fig S1 Desmotomy of the palmar/plantar annular ligament (PAL) performed with a slightly curved custom made hook knife. Distal to proximal view, arthroscopic portal distal to the PAL. The hook knife is positioned half way between the intersesamoidean ligament (ISL) and mesotendon (MT) of the superficial digital flexor tendon (SDFT). The curved angle of the shaft of the hook knife facilitates a good grip of the hook within PAL.

Fig S2 Desmotomy of the palmar/plantar annular ligament (PAL) in a distal to proximal direction. Distal to proximal view, arthroscopic portal distal to the PAL. Note the thickening of the PAL (arrow) and how the edges of the cut PAL separate after cutting. SDFT = superficial digital flexor tendon.

Fig S3 (a), Large torn tendon fibre floating in the irrigation fluid between the deep digital flexor tendon (DDFT) and the superficial digital flexor tendon (SDFT) indicating the presence of a tear of the DDFT. Arthroscopic portal distal to the PAL (palmar/plantar annular ligament), distal to proximal view. (b), Typical view of a longitudinal tear of the lateral border of the deep digital flexor tendon (DDFT) where it emerges from underneath the manica flexoria. Note the torn tendon fibres along the lateral edge of the DDFT. Distal to proximal view, arthroscopic portal distal to the PAL (palmar/plantar annular ligament). ISL = intersesamoidean ligament, SDFT = superficial digital flexor tendon. (c), Large torn piece of tendon (X) separated from the lateral edge of the deep digital flexor tendon (DDFT) distal to the palmar/plantar annular ligament (PAL). Note also the fibrillation of the adjacent lateral border of the SDFT (superficial digital flexor tendon). Proximal to distal view, arthroscopic portal proximal to the PAL.

Fig S4 Tenoscopic view with the arthroscope positioned in the tear of the lateral edge of the deep digital flexor tendon (DDFT). The bulk of torn tendon tissue is removed with a motorised synovial resector. Distal to proximal view, arthroscopic portal distal to the palmar/plantar annular ligament. MF = manica flexoria.

Fig S5 Shaver positioned within a deep longitudinal tear (LT) (>5 mm) in the lateral border of the deep digital flexor tendon (DDFT). Note how the LT continues proximally beneath the manica flexoria (MF). Distal to proximal view, arthroscopic portal distal to the palmar/plantar annular ligament. SDFT = superficial digital flexor tendon.

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