Background: The aim of our study is to investigate the preoperativeerative risk factors of the necessity of ulnar slip recection (USSR) in addition to A1 pulley release in patients with proximal interphalangael (PIP) joint flexion contracture. Methods: Patients were divided into two groups. The patients who underwent A1 pulley release in group 1, and patients who underwent USSR in addition to A1 pulley release in group 2. Demographic characteristics, preoperativeerative Visual Analog Scale (VAS), Quick Disabilities Of The Arm, Shoulder, and Hand (qDASH), contracture degree, symptom duration, comorbidities, PIP joint tenderness, comorbidities, postoperative VAS and qDASH score information at the 6th month were obtained from the patient files. Results: There were 13 male and 31 female patients in group 1 and 7 male and 24 female patients in group 2. The mean age was 61.67 years in group 1 (p = 0.506). PIP joint tenderness was present in 27 patients in group 1 and 37 patients in group 2 (p = 0.717). The average time from symptom onset to operation was 2.65 months in group 1 and 3.87 months in group 2 (p = 0.002). The mean preoperativeerative VAS was 3.34 in group 1 and 4.34 in group 2 (p = 0.001). The mean preoperativeerative qDASH score was 21.89 in group 1 and 25.14 in group 2 (p = 0.926). Preoperativeerative mean contracture degree was 17.02 degrees in group 1 and 22.18 degrees in group 2 (p = 0). Conclusion: Higher preoperative VAS score, preoperativeerative symptom duration, PIP joint contracture and lower qDASH score lead to the need for USSR. Patients should be informed accordingly and surgery plans should be made accordingly.