PURPOSE: This study aims to compare the postoperative clinical outcomes of open A1 pulley release with and without flexor tendon traction tenolysis. Outcomes assessed include finger range of motion, hand function (Disabilities of the Arm, Shoulder, and Hand [ METHODS: A prospective study was conducted from January 2018 to June 2019, involving patients with grade II-III trigger finger requiring surgical intervention. Patients were randomized into two groups: group I (open A1 pulley release with flexor tendon traction tenolysis) and group II (open A1 pulley release without flexor tendon traction tenolysis). Postoperative assessments were conducted at 2 weeks, 2 months, and 4 months, documenting finger range of motion, RESULTS: A total of 50 patients met the selection criteria, with 46 completing the study. The majority were women, with an average age of 56 ± 9.6 years. The patients were predominantly diabetic with the condition affecting the left hand and middle finger and presenting as grade III trigger finger. Baseline characteristics, including age, gender (female/male), ethnicity, occupational status, diabetes status, and trigger finger severity, were comparable between the two groups. Preoperative CONCLUSIONS: Open A1 pulley release with flexor tendon traction tenolysis resulted in better early postoperative (2 weeks) finger flexion range of motion and TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic Ib.