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PubMed2003

Tendon transfer fixation in the foot and ankle: a biomechanical study evaluating two sizes of pilot holes for bioabsorbable screws.

The purpose of this study was to compare the initial fixation strengths of bioabsorbable screws for tendon transfers in the foot and ankle when the pilot hole size varied. A 7 x 20 mm screw was used with 5.5 mm and 6.5 mm drill holes, and a 5 x 20 mm screw was used with 3.9 mm and 4.5 mm drill holes. Biomechanical testing was performed on each tendon transfer in cadaver specimens. A paired t-test showed no significant difference in pullout strength when pilot hole size varied between 79 to 93% of the screw size for the 7 mm screw and 78 to 90% of the screw size for the 5 mm screw. Previous studies have found a critical value of tendon tension equaling 50 N with passive dorsiflexion of the foot. With an average value of approximately 170 N, the 7 mm screw provided three times the requisite strength. The 5 mm screw provided 1.5 times the requisite strength, but the transfer was technically more difficult.

Absorbable Implants↗
PubMed1985

Reconstruction of a balanced thumb through tendon transfers.

The ability to use the thumb determines its functional relation to the fingers and the resulting dexterity of the hand. Median palsy results in a failure of abduction and pronation. Ulnar palsy results in loss of adduction and flexion at the metacarpophalangeal joint. Following median, ulnar, and even radial palsy, the thumb can develop adduction deformity. Thumb contracture must be released prior to tendon transfers. Abduction and pronation are best substituted by transfer of the extensor indicis proprius. Adduction is best substituted by transfer of the extensor carpi radialis brevis and arthrodesis of the metacarpophalangeal joint. Median cutaneous sensibility should be reconstructed after appropriate tendon transfers are functional.

Arthrodesis↗
PubMed1984

The effect of tenotomy and tendon transfers on muscle fiber types in the dog.

Different muscle groups have been shown to have variable muscle-fiber type patterns that may be, in part, due to function and use. In an attempt to identify any changes in fiber composition following surgical alteration of function, eleven beagle dogs had the fibularis longus tendon severed. Four dogs had the tendon reattached 6-24 weeks later. After 6-24 weeks, four dogs had the tendon surgically transferred to the tendon of the tibialis anterior, a functionally different muscle. Three dogs had the tendon immediately transferred to the tendon of the tibialis longus. Biopsies were performed after each procedure to assess fiber changes, and late biopsies were performed in one dog from each group at 27-29 months. Fiber characteristics in the biopsy specimens were identified using histochemical staining. In the first group (tenotomy-reattachment), variable atrophy occurred early but disappeared following reattachment. In the second group (tenotomy and tendon transfer), variable atrophy occurred along with an increased percentage of Type I and Type IIB fibers. Early biopsies performed in the third group (direct transfer) revealed mild Type II hypertrophy. In the late biopsy specimen, an increase of Type I and Type IIB fibers was noted and was similar to the fiber composition of the tibialis anterior to which it was transferred. These findings indicate that muscle-fiber remodeling does occur and that multiple operative procedures are not intrinsically harmful to the muscles. The best evidence from this and previous studies suggests that changes in muscle-fiber type are manifestations of functional adaptation.

Adaptation, Physiological↗
PubMed1998

Tendon transfers to restore elbow flexion after traumatic paralysis of the brachial plexus in adults.

Loss of elbow flexion after traumatic brachial palsy produces significant functional and cosmetic problems. Although a direct approach to the neurological lesion with an attempt to reinnervate the biceps has given some encouraging results, these can be incomplete and for this reason tendon transfers still have an important role. We report the results of our series of 60 patients (54 men and 6 women) who have undergone tendon transfer between 1984 and 1994. The transfers were performed during or after nerve surgery, and we used the muscles arising from the medial epicondyle, the pectoralis minor and the triceps. Our results were judged on any improvement in shoulder stability and in the power of lateral rotation, together with the power and range of active and passive flexion of the elbow. Good results were achieved in 74% of the patients in our study, with more than 120 degrees of elbow flexion and an ability to support at least 1 kg with the elbow flexed to 90 degrees.

Adult↗
PubMed2004

Neglected rupture of the Achilles tendon: reconstruction with peroneus brevis tendon transfer.

The management of acute and neglected subcutaneous tears of the Achilles tendon by peroneus tendon transfer is safe but technically demanding. It affords good recovery, even in patients with a long-term neglected rupture. Patients with a neglected rupture are at a slightly greater risk of post-operative complications and may never fully recover their ankle plantar flexion strength.

Achilles Tendon↗
PubMed1995

Flexor to extensor tendon transfers in the hand.

We reviewed 49 cases of flexor to extensor tendon transfer following injury to the radial nerve (22) or brachial plexus (27). Post-operative follow-up average 5.6 years (0.5-12.5). Function was improved in 84% (41) of patients. 16% (8) reported no improvement; of these, four (50%) had associated vascular injuries. In those with improvement, impaired coordination and dexterity were reported by 79% (15 of 19) of the plexus injuries and in 64% (14 of 22) of the radial nerve palsies. Premature fatigue was noted by 89% (17 of 19) of plexus injuries and in 82% (18 of 22) of radial nerve palsies. The power of wrist extension averaged 22% of the contralateral side (8% to 80%), power of digital extension was 31% (5% to 130%), and power grip was reduced to 40% (5% to 86%).

Adolescent↗
PubMed2002

[Palliative tendon transfer for reanimation of the wrist and finger extension lag. Report of 14 transfers for radial nerve palsies and ten transfers for brachial plexus lesions].

This retrospective study is based on 23 males and one female, of an average age of 36.2 years that presented to us between 1982 and 2000 with an average follow up of 61 months, with fully established paralysis of wrist and fingers extension. Fourteen patients had isolated radial nerve palsy, while ten patients had brachial plexus lesions. 1) The tendon transfer for radial nerve palsy was: PT to ECRB, FCU to ED + EPL and PL to APL + EPB; 2) for brachial plexus injury, the tendon transfer was: PT (n = 4) or FDS III or IV (n = 5) to ECRB, FCU (n = 8) or FDS IV (n = 1) to ED + EPL, PL to APL + EPB and wrist arthrodesis with transfer of FDS IV to ED + EPL and PL to APL + EPB. The results were evaluated according to the degree of wrist movement, MP extension of long fingers, opening of first commissure, thumb opposition, grip power and the subjective evaluation of results. Concerning the radial nerve palsy: results are excellent in nine cases and good in one case. An active extension of the wrist of 38 degrees was obtained as well as MP extension of 0 degree with the wrist straightened. Thumb oppositioned was conserved (Kapandji = 8.2), opening of the first commissure 40 degrees and grip power was 20 kg. Concerning the brachial plexus lesions: results are excellent in five cases and good in the other five. An active wrist extension of 32 degrees was obtained, as well as MP extension deficit of 16 degrees with wrist straightened. Opposition was concerned (Kapandji = 7.2), opening of first commissure of 38 degrees and grip power of 13 kg. The functional results are satisfactory, but the analytic study shows some effect of tenodesis of MP extension.

Adolescent↗
PubMed1997

Developmental adaptation of rat nociceptive withdrawal reflexes after neonatal tendon transfer.

Nociceptive withdrawal reflexes (NWRs) were studied in adult rats in which the movement patterns produced by single muscles had been altered by neonatal tendon transfer. NWRs evoked by cutaneous noxious mechanical and thermal (CO2-laser) stimulation were recorded using electromyography in a decerebrate spinal preparation. The sensitivity distribution within the receptive fields of the NWRs of the extensor digitorum longus and the peronei muscles exhibited changes corresponding to the altered movement patterns. No detectable change of NWRs was found in normal muscles whose receptive fields overlapped that of the modified muscle. Furthermore, NWRs of muscles that regained an essentially normal function after neonatal tendon transfer did not differ from normal. It is proposed that a developmental experience-dependent mechanism, which takes into account the hindlimb movement pattern caused by contraction of single muscles, underlies the functionally adapted organization of adult NWRs.

Adaptation, Physiological↗
PubMed1994

Flexor digitorum superficialis lasso tendon transfer in isolated ulnar nerve palsy: a functional evaluation.

Twelve patients (23 digits) with isolated ulnar nerve palsy underwent flexor digitorum superficialis lasso tendon transfers for correction of claw deformity, weakness, and asynchronous digital flexion. The average follow-up period from date of injury was 5 years (range, 2-11 years) and from surgery was 3 years (range, 15 months to 7 years). Transfers successfully corrected the claw deformity in 19 of the 23 digits. Three of the four failures occurred in the small finger. Two of the four failures had uncorrected preoperative proximal interphalangeal joint flexion contractures. In 9 of the 12 patients with pre- and postoperative grip strength measurements no significant improvement in grip strength was noted. While this procedure is effective and predictable in correcting deformity and restoring synchronous pattern of finger flexion, it should be used with caution in patients requiring an increase in grip strength.

Adolescent↗
PubMed1980

[Paralysis of the inner thumb muscles. Treatment by tendon transfer].

The management of paralysis of the intrinsic muscles of the thumb by tendon transfers cannot be realized by indiscriminate application of standard operations. For each of the three types of paralysis i. e.: -- paralysis of the external muscles of the thumb -- paralysis of the internal muscles of the thumb and -- combined paralysis of the external and internal muscles of the thumb, exists a different indication and for each one of the three elements of the procedure, namely: -- choice of the motor-muscle, -- location of the pulley and -- fixation of the transfer, the operative modalities must be adapted to each type of paralysis.

Humans↗
PubMed1993

Extensor digiti minimi tendon transfer to prevent recurrent ulnar drift.

Thirty percent of patients with rheumatoid arthritis develop ulnar drift. Although numerous operations have been described, recurrence of the deformity is frequent. We recommend use of the extensor digiti minimi tendon transfer to prevent recurrent ulnar deviation. The tendon insertion is moved from a dorsal location to a dorsal-radial position. In this new location, the tendon produces both extension and radial deviation. Moreover, this transfer is maximally effective in extension when ulnar drift is greatest. We have used this transfer 28 times during the past 6 years. In evaluating patients more than 1 year after surgery, metacarpal phalangeal joint extension averaged 52 degrees and there was no evidence of recurrent ulnar drift of the little finger. The only problem was slight hyperextension of less than 5 degrees in approximately half of the patients. However, in no patient was this functionally a problem. We recommend the use of this tendon transfer in all patients with ulnar drift undergoing metacarpal phalangeal joint replacement for rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1989

Blood supply of the upper extremity muscles as related to functional tendon transfers.

For a given function to be restored, we feel that a "low risk" muscle should be employed in preference to a "high risk" muscle. If a "high risk" muscle must be used, a knowledge of its segmental blood supply should lead one to proceed with careful dissection (even under magnification), wider exposure, and preservation of every possible distal pedicle. We would strongly discourage blind "stripping" of the muscle belly in "high risk" muscles. This technique could be employed almost with impunity in the "low risk" muscles. We realize that this is a static, purely anatomic study with a new, theoretical viewpoint of tendon transfer techniques. Other factors must be considered (expendability, muscle strength, synergism, and amplitude). However, we feel that results may be improved through application of these detailed anatomic data. We have attempted to better delineate the blood supply to the muscles of the upper extremity. This knowledge may help improve our results in functional tendon transfer procedures.

Arm↗
PubMed1984

Tendon transfer for the restoration of upper limb function after a cervical spinal cord injury.

During the past 22 years, 68 patients with cervical spinal cord injuries had 142 tendon transfers and tenodeses. The procedures were performed to provide improved upper limb control, including elbow extension, finger grasp, and thumb pinch for better prehension. The operations were effective in increasing function in all but four patients, who did not improve because of insufficient muscle strength. The educational, vocational, recreational, and social aspects of life improved for many patients. Tendon surgery should be considered for all tetraplegics 1 year after injury, provided that they have undergone an effective rehabilitation program and that their neurologic examination is stable.

Arm↗
PubMed1996

Tendon transfers and functional electrical stimulation for restoration of hand function in spinal cord injury.

Spinal cord injury at the C5 and C6 level results in loss of hand function. Electrical stimulation of paralyzed muscles is one approach that has demonstrated significant capacity for restoring grasp and release function. One potential limitation of this approach is that key muscles for stimulation may have lower motor neuron damage, rendering the muscles unexcitable. We have used surgical modification of the biomechanics of the hand to overcome this limitation. Tendon transfer of paralyzed but lower motor neuron intact muscles can compensate for potential function lost owing to muscles with lower motor neuron damage. Such procedures have been performed to provide finger extension, thumb extension, finger flexion, and wrist extension. Additional surgical procedures have been performed to enhance the function provided with electrical stimulation. These are side-to-side synchronization of the finger flexor and extensor tendons, the flexor digitorium superficialis Zancolli-lasso procedure, and thumb interphalangeal joint arthrodesis. These procedures have been performed in 11 patients with C5 and C6 level spinal injuries and functional electrical stimulation neuroprostheses. In these patients, 41 different functional electrical stimulation-related procedures were performed and 38 gave the desired result after surgery. One procedure resulted in no increase or decrease in function or muscle output, and two procedures resulted in a decrease in muscle force or joint range of motion. The issues that must be considered in performing functional electrical stimulation-related tendon transfers are discussed.

Electric Stimulation Therapy↗
PubMedDate not supplied

Split tibialis posterior tendon transfer in the treatment of spastic equinovarus foot.

Sixteen patients with cerebral palsy causing equinovarus deformity were treated surgically. All of these patients underwent preoperative gait analysis by using a CODA-3 motion analyzer. The equinus deformity was assessed by using sagittal kinematics, and in particular, the range of movement of the ankle during stance phase and the maximal dorsiflexion during swing. The varus deformity was assessed by the degree of varus of the foot at prepositioning. The degree of varus was obtained by measuring the angle generated between the plane of progression and a line joining a marker on the heel to a marker on the fifth metatarsal in the transverse plane. All patients underwent split tibialis posterior tendon transfer and, in 13, this was combined with tendo calcaneus lengthening. Clinical assessment and gait analysis repeated 1 year postoperatively confirmed good outcome after split tibialis posterior tendon transfer in combination with gastrocnemius lengthening. This was confirmed by using sagittal kinematic analysis and quantitative assessment of the degree of varus of the foot at the time of prepositioning.

Ankle Joint↗
PubMed1988

Resultant forces and angles of twist about the wrist after ECRL to ECU tendon transfer.

This paper describes an experimental investigation to determine the biomechanical efficacy of the extensor carpi radialis longus (ECRL) to extensor carpi ulnaris (ECU) tendon transfer procedure used in rheumatoid hand reconstruction. Six normal cadaver specimens were tested in an apparatus that measured (a) the forces acting on the hand to restrain it in seven characteristic wrist configurations, and (b) the amount of hand pronation/supination that occurred as a result of loads applied to the tendons of the six major wrist muscles. Each specimen was tested with the ECRL tendon intact, surgically released, and transferred to the insertion point of ECU. In the intact and transferred states, the ECRL tendon was loaded sequentially while the remaining five wrist tendons were subjected to equal constant loads. In all three experimental ECRL test states, forces were also applied to all intact wrist tendons in a manner designed to represent physiologic load sharing. When the ECRL tendon was loaded sequentially, the transfer resulted in the predictable increase in the radially directed restraining force and the predictable supination of the hand relative to the forearm. When all intact tendons were loaded physiologically, the transfer also resulted in an increase in the radially directed restraining force. Significant differences between test states occurred generally only between the intact and release states of the ECRL tendon and not between release and transferred states.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Forearm muscles of man can reverse their function after tendon transfers: an electromyographic study.

In patients suffering from paralysis of a major synergistic muscle group tendon transfers can be considered the therapy of choice in restoring the mobility of the affected joint(s). In order to study the mechanisms underlying the subsequent reversal of function in the transferred muscles, we have recorded the EMG of several forearm muscles in parallel and compared their activation periods with control data from healthy volunteers. Slow and fast extension-flexion movements of the wrist were evaluated. The findings demonstrated a 'new' phasic EMG activity within the transferred muscles, which correlated to their new mechanical function. However, the 'old' EMG pattern was not lost. In some muscles it was present in fast and slow wrist movements, in others only in fast ones. The results indicate that the reversal of function observed in the transferred muscles can be adjusted to meet the specific needs of the movement to be performed.

Adaptation, Physiological↗