This chapter makes a significant and unique contribution to the field of orthopedic biomechanics by focusing on the application of finite element analysis (FEA) in pulley repair. FEA has emerged as a critical tool, allowing researchers to rapidly simulate complex mechanical behavior. The chapter provides an overview of FEA principles, tracing its evolution from ex vivo cadaveric studies to modern computational models. Building accurate geometric models based on medical imaging data such as CT (computed tomography) and MRI (magnetic resonance imaging) is central to developing subject-specific FEA models. The chapter details essential steps in FEA model creation, including meshing, material property assignment, and boundary condition application. These techniques offer valuable insights into joint kinematics, tendon-pulley interactions, and the effects of surgical interventions on biomechanical outcomes. This chapter focuses on applying FEA in flexor tendon pulley repair, particularly in simulating different repair configurations following A2 pulley injuries. Using validated FEA models, the chapter examines stress distribution, grip force changes, and von Mises stress analysis to evaluate single-, double-, and triple-loop reconstructions. The findings highlight the trade-offs between restoring joint kinematics and minimizing mechanical stress at the tendon-pulley interface and underscore the practical implications of these findings in optimizing surgical planning and improving clinical outcomes in hand surgery.