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At least 19 recordsLinked to original sources
PubMed1984

Opposition of the thumb: an anatomic and biomechanical study of tendon transfers.

Tendon transfers for opposition of the thumb were anatomically and biomechanically studied to help determine the optimal criteria for selecting the best motor unit for a transfer. Forearm and hand muscle volume, mean fiber length, and cross-sectional area were measured in eight fresh specimens of the upper extremity to determine which muscles best replace lost thenar muscle strength. In a separate group of 18 specimens, the effective moment arms for abduction and flexion of the first metacarpal were calculated in vitro and from biplanar radiographic techniques to determine the effect of eight different opposition transfers on thumb abduction, rotation, and strength. Results of these studies demonstrate that the transfers of flexor digitorum superficialis (FDS) of the long finger and extensor carpi ulnaris best replaced lost thenar muscle strength and provided maximal abduction and near full thumb rotation. The transfers of the extensor carpi radialis longus and the FDS of the ring finger replaced 60% and 40% of required thenar muscle strength, respectively. The palmaris longus was the least effective transfer, having good abduction but weak flexion and opposition. Motion, balance, and strength of tendon transfers must be considered for effective thumb opposition.

Forearm↗
PubMed1979

Determination of muscle-tendon unit properties during tendon transfer.

Data on passive lengthening and active shortening from electrical stimulation to give a total functional excursion are presented. Length-tension characteristics of certain muscles used for transfer are given. Electrical stimulation of the newly transferred tendon gives useful information that is reproducible. This new knowledge obtained at operation is an important adjunct to the traditional techniques and provides helpful information in performing better procedures.

Adult↗
PubMed1988

Tendon transfers in muscle and tendon loss.

Tendon transfers in muscle and tendon loss offer some of the most gratifying results to both patient and surgeon. Poor results do occur at times in tendon transfer. When patients whose results were found to be less than expected were studied, the following problems were identified: 1. Acceptance of less than full passive range of motion before transfer. In some instances, this will be unavoidable. The use of pretransfer hand therapy techniques may improve the situation; or, if possible, pretransfer capsulotomies may better prepare the patient for the tendon transfer. 2. Adhesions along the course of the transfer. At times the transfer route can be better prepared by the use of skin grafts adding subcutaneous tissue to the transfer bed. The use of a staged technique in which a silicone rubber tendon implant is installed along the transfer route, to prepare for a later transfer, is occasionally indicated. 3. Technical failures: a. juncture breakdown, b. transfer put in under too little tension. 4. Patient noncompliance. A recent experience in which a patient removed his postoperative cast and came in 2 weeks later with his transfer disrupted is an extreme example. Many other patients are not prepared to undertake what may be a rigorous and time-consuming postoperative transfer program. Adequate preoperative evaluation, including patient selection as well as careful attention to the details of the procedure during surgery, along with attentive postoperative care, should eliminate most of these problems.

Adult↗
PubMedDate not supplied

Training of muscle excursion after tendon transfer.

In tendon transfer (TT) surgery there is usually a discrepancy in excursion between the muscle(s) to be replaced and the transferred muscle(s). For example, in patients with radial palsy the pronator terres (PT) muscle is frequently used to replace the wrist extensors. However, the excursion of the PT is less than the extensor of the wrist and therefore needs to double its length to allow for full wrist movement. Questions arise about whether or not the PT will increase its fiber length after transfer for wrist extension and how therapy can positively influence usable excursion of the transferred muscle-tendon unit. Most classifications of results accept the flexion of the wrist will remain limited after TT of the PT. This article presents a patient with TT of the PT who accomplished a wrist total active range of motion (TAM) of 125 degrees (wrist extension 0-60 degrees, flexion 0-65 degrees). Based on this observation, the authors assume that the PT muscle has indeed increased its excursion after TT. The authors conclude that limited wrist excursion should not be accepted too soon, but therapists have to familiarize themselves with methods for "excursion training" and possibly change the existing methods of evaluating the results of TT of the PT.

Adult↗
PubMed2003

Tendon transfer fixation: comparing a tendon to tendon technique vs. bioabsorbable interference-fit screw fixation.

Tendon transfer techniques in the foot and ankle are used for tendon ruptures, deformities, and instabilities. This fresh cadaver study compares the tendon fixation strength in 10 paired specimens by performing a tendon to tendon fixation technique or using 7 x 20-25 mm bioabsorbable interference-fit screw tendon fixation technique. Load at failure of the tendon to tendon fixation method averaged 279N (Standard Deviation 81N) and the bioabsorbable screw 148N (Standard Deviation 72N) [p = 0.0008]. Bioabsorbable interference-fit screws in these specimens show decreased fixation strength relative to the traditional fixation technique. However, the mean bioabsorbable screw fixation strength of 148N provides physiologic strength at the tendon-bone interface.

Absorbable Implants↗
PubMed1994

A fixational method of tendon transfer in foot surgery.

Tendon transfer has been used for correcting foot deformities and improving foot function in paralytic and spastic foot problems. The traditional fixational method by Cole's pull-out button often induces pressure sores which make the button sink and loosens the transferred tendon, leading to poor surgical results. By using a metal eye cover and pull-out wire instead of button and suture material, the transferred tendon can be firmly fixed. Moreover, the concavity of the metal eye cover is suitable for the arch of the foot that provides a large contact surface & even pressure distribution to prevent the most common complications of the pull-out button method, the pressure sore.

Female↗
PubMed1998

Biomechanical study of tibialis anterior tendon transfer.

The tibialis anterior tendon transfer has been used in the treatment of recurrent congenital clubfoot and paralytic equinovarus foot deformities in cerebral palsy. This study attempts to determine the optimal site of tibialis anterior tendon insertion for ankle and foot motion and to compare the split and whole tendon transfer. Ten fresh normal anatomic leg specimens were used. The lateral half of the tibialis anterior tendon was detached from its insertion, passed beneath the extensor retinaculum, and anchored to the appropriate tarsal bone by a barbed staple. Tension was applied, and ankle and foot motions were measured. The experiment was done by anchoring the tendon to the tarsal bones along the axis of the second metatarsal and serially through to the axis of the fifth' metatarsal. The entire experiment was repeated using the whole tibialis anterior tendon. For split tendon transfer, insertion onto the fourth metatarsal axis was the most effective route; it produced maximal dorsiflexion with minimal supination and pronation. For whole tendon transfer, the ideal site of insertion was along the third metatarsal axis. However, the difference between the average maximum dorsiflexion achieved by the split tendon transfer and that of total tendon transfer is not statistically significant.

Ankle↗
PubMed2006

Variability in surgical technique for brachioradialis tendon transfer. Evidence and implications.

BACKGROUND: Transfer of the tendon of the brachioradialis muscle to the tendon of the flexor pollicis longus restores lateral pinch function after cervical spinal cord injury. However, the outcomes of the procedure are unpredictable, and the reasons for this are not understood. The purpose of this study was to document the degree of variability observed in the performance of this tendon transfer. METHODS: The surgical technique used for the brachioradialis tendon transfer was assessed in two ways. First, the surgical attachment length of the brachioradialis was quantified, after transfer to the flexor pollicis longus, with use of intraoperative laser diffraction to measure muscle sarcomere length in eleven individuals (twelve limbs) with tetraplegia. Second, ten surgeons who regularly performed this procedure were surveyed regarding their tensioning preferences. Using a biomechanical model of the upper extremity, we investigated theoretically the effect of different surgical approaches on the active muscle-force-generating capacity of the transferred brachioradialis in functionally relevant elbow, wrist, and hand postures. RESULTS: The average sarcomere length (and standard deviation) of the transferred brachioradialis was 3.5 +/- 0.3 mum. That length was significantly correlated to the in situ sarcomere length (r(2) = 0.53, p < 0.05). Surgical tensioning preferences varied considerably; however, six of the ten surgeons positioned the patient's elbow between full extension (0 degrees of elbow flexion) and 50 degrees of flexion when selecting the attachment length, and six of the ten stated that their goal was to tension the transfer slightly tighter than its resting tension. The computer simulations suggested that a "tighter" brachioradialis transfer would produce its peak active force in an elbow position that is more flexed than the elbow position in which a "looser" transfer would produce its peak active force. CONCLUSIONS: This study provides evidence that experienced surgeons perform this tendon transfer differently from one another. Biomechanical simulations suggested that these differences could result in substantial variability in the active force that the transferred brachioradialis can produce in functionally relevant postures. CLINICAL RELEVANCE: The surgical attachment length and the position of the patient's limb at the time of tendon transfer are both controllable and measurable parameters. Understanding the relationship between surgical technique and postoperative muscle function may provide surgeons with more control of clinical outcomes.

Biomechanical Phenomena↗
PubMed2003

Restoration of pinch grip in ulnar nerve paralysis: extensor carpi radialis longus to adductor pollicis and abductor pollicis longus to first dorsal interosseus tendon transfers.

A double tendon transfer was used to restore thumb pinch in nine consecutive patients. The extensor carpi radialis longus was transferred to the adductor pollicis tendon and one slip of the abductor pollicis longus was transferred to the first dorsal interosseus tendon. The patients were followed for 6 (range, 2-10) years and there were no instances of transfer rupture. Selective recruitment of the motors of the transfers was possible in all cases. Their amplitude was considered adequate for all the cases of adductor transfers but was limited in all of the first dorsal interosseus ones. Key pinch was 73% (range, 41-104%), the pulp-to-pulp pinch was 72% (range, 50-95%) and the power grip was 73% (range, 35-91%) of the opposite hand. The force of thumb adduction was 63% (range, 27-132%) and of index finger abduction was 58% (range, 21-104%) of the unaffected side.

Adult↗
PubMed2004

Three-dimensional muscle-tendon geometry after rectus femoris tendon transfer.

BACKGROUND: Rectus femoris tendon transfer is performed in patients with cerebral palsy to improve knee flexion during walking. This procedure involves detachment of the muscle from its insertion into the quadriceps tendon and reattachment to one of the knee flexor muscles. The purpose of the present study was to evaluate the muscle-tendon geometry and to assess the formation of scar tissue between the rectus femoris and adjacent structures. METHODS: Magnetic resonance images of the lower extremities were acquired from five subjects after bilateral rectus femoris tendon transfer. A three-dimensional computer model of the musculoskeletal geometry of each of the ten limbs was created from these images. RESULTS: The three-dimensional paths of the rectus femoris muscles after transfer demonstrated that the muscle does not follow a straight course from its origin to its new insertion. The typical muscle-tendon path included an angular deviation; this deviation was sharp (>35 degrees ) in seven extremities. In addition, scar tissue between the transferred rectus femoris and the underlying muscles was visible on the magnetic resonance images. CONCLUSIONS: The angular deviations in the rectus femoris muscle-tendon path and the presence of scar tissue between the rectus femoris and the underlying muscles suggest that the beneficial effects of rectus femoris tendon transfer are derived from reducing the effects of the rectus femoris muscle as a knee extensor rather than from converting the muscle to a knee flexor. These findings clarify our understanding of the mechanism by which rectus femoris tendon transfer improves knee flexion.

Adolescent↗
PubMed1986

Therapist's management of tendon transfers.

Rehabilitation of the tendon transfer patient is a challenge to the hand therapist, given the variety of transfers performed and the level of skill, knowledge, and creativity needed to treat them adequately. Careful preoperative evaluation and treatment increase the prospects for a successful result. The postoperative care of the tendon transfer is a team effort by the surgeon, therapist, and patient; each must have a clear understanding of the goals and precautions of each stage of treatment. Restrictions are initially placed upon the patient's mobility to allow healing; these are then reduced as he activates the transfer and then begins to incorporate the new motion into daily activity. Resistance is added gradually to the patient's tolerance, and care is taken throughout the rehabilitation process not to overwork the muscle in its new function. Tendon transfer is never completely restorative, but often makes a striking difference in the patient's functional abilities. The outcome can be very gratifying for the patient and for those who collaborate in his treatment.

Hand Injuries↗
PubMedDate not supplied

In situ tibialis posterior to flexor digitorum longus tendon transfer for tibialis posterior tendon dysfunction: a simplified surgical approach with outcome of 11 patients.

Outcomes for 11 patients who underwent an in situ tibialis posterior tendon to flexor digitorum longus tendon side-to-side anastamosis as the sole procedure for stage 2 tibialis posterior tendon dysfunction were reviewed. The average follow-up was 34.4 months. Using the American Orthopedic Foot and Ankle Society hindfoot rating scale, a mean improvement of 39.3 points was achieved, with preoperative scores of 38.8 improving to 78.1 postoperatively. Good to excellent results were achieved in nine patients. The in situ side-to-side anastamosis is technically easier to perform, has less tissue trauma, and compares favorably with other soft-tissue procedures and reconstructions for stage 2 tibialis posterior tendon dysfunction. Performing this transfer alone, while leaving the flexor digitorum longus tendon intact, theoretically provides a stronger transfer as the length-tension relationship of the flexor digitorum longus tendon is maintained near its physiologic level. The procedure can consistently restore inversion ability to the rearfoot and stop the progression of tibialis posterior tendon dysfunction.

Adult↗
PubMed1999

Asymmetry of hindlimb muscle activity and cutaneous reflexes after tendon transfers in kittens.

The mechanical actions of various ankle muscles were changed by surgically crossing or transferring the tendons in kittens. After the kittens grew to adults, both hindlimbs were implanted with multiple electromyogram (EMG) recording and cutaneous nerve stimulation electrodes to compare the activity of altered and normal muscles. The tendon transfers showed a remarkable tendency to regrow toward normal or only slightly altered mechanical action. In these animals and in the sham-operation controls, the patterns of muscle activity and reflexes were symmetrical in corresponding muscles of the two legs, although they could differ substantially between animals, particularly for the cutaneous reflexes. Eleven animals had at least some persistent alterations in muscle action. Their cutaneous reflex patterns tended to be asymmetric, in some cases quite markedly. EMG activity during unperturbed locomotion and paw-shaking was more symmetrical, but there were some changes in altered muscles and their synergists. The central pattern generators for locomotion and paw-shaking and particularly for cutaneous reflexes during locomotion appear to be at least partially malleable rather than entirely hardwired. This may provide a tool for studying their development and spinal plasticity in general.

Animals↗
PubMedDate not supplied

Upper extremity tendon transfers in cerebral palsy: electromyographic and functional analysis.

This study was undertaken to evaluate tendon transfers in a group of children with spastic hemiplegia. Muscle grading, video recordings of function, and electromyographs were performed on 12 patients preoperatively. Postoperative electromyograms were obtained on 16 transferred tendons in eight patients as the children performed assigned tasks. Clinical evaluation demonstrated improvement in all patients at follow-up, which averaged 20 months. Four of the 16 muscles showed changes in their electrical activity postoperatively. Three muscles that fired continuously became phasic, and one muscle changed phase to match its recipient. Pre- and postoperative electromyography with video analysis provided a more complete understanding of the characteristics of tendon function with tendon transfers in cerebral palsy.

Adolescent↗
PubMed2006

[Intramuscular lengthening and range of motion after local tendon transfer for repair of retracted supraspinatus tendon defects. A biomechanical study].

BACKGROUND: The current cadaver study was performed to evaluate and compare infraspinatus (ISP) vs. subscapularis (SSC) tendon transfer used for the repair of a large supraspinatus (SSP) rotator cuff defect. The main outcome measures were the range of motion and intramuscular length changes during motion. METHODS: Thirteen fresh-frozen cadaver shoulders were used in the study. A supraspinatus defect extending to the apex of the humeral head (Patte size II) was created. Transosseous repair was then attempted with the ISP and with the SSC in all cases; intramuscular length changes were measured by Hall effect transducers during motion of the arm in steps of 30 degrees. RESULTS: Repair was successful in all cases when the ISP was used, while use of the SSC resulted in a successful repair in only 8 of the 13 (61.5%). Passive range of motion did not differ between ISP and SSC. ISP was shortened during flexion and abduction in contrast to the SSC that was lengthened during flexion (p<0.05) and shortened to a lesser degree (p<0.05). Length changes during rotation were not significantly different. CONCLUSIONS: In this cadaver model the ISP proved more favorable than the SSC for covering a Patte size II SSP defect if the assumption is true that lengthening of a muscle is less favorable than shortening because of the vascularization of the tendon.

Aged↗
PubMed2001

Intermediate follow-up on the double osteotomy and tendon transfer procedure for stage II posterior tibial tendon insufficiency.

26 patients with 28 pes planovalgus feet secondary to Johnson stage 2 posterior tibial tendon insufficiency were treated with flexor digitorum longus tendon transfer, lateral column lengthening, medial displacement calcaneal osteotomy, and heel cord lengthening. The mean patient age at surgery was 48.5 years. The AOFAS ankle-hindfoot scale was applied postoperatively to assess clinical outcome. Preoperative and postoperative standing radiographs of the foot and ankle were analyzed to determine radiographic correction of the pes planovalgus deformities. The mean follow-up to date is 5 years. The mean ankle-hindfoot score was 90 postoperatively. The medial cuneiform to fifth metatarsal distance improved from -0.2 mm preoperatively to 7.6 mm postoperatively. Similarly, the talonavicular distance improved from 19.4 mm preoperatively to 10.9 postoperatively. There were no nonunions. Four feet (14%) displayed radiographic signs of calcaneocuboid arthritis at follow-up. Only one was symptomatic requiring calcaneocuboid joint fusion. The double osteotomy technique provides symptomatic relief and lasting correction of the pes planovalgus deformity associated with stage 2 posterior tibial tendon insufficiency at intermediate follow-up. It has a high patient satisfaction based on the AOFAS ankle-hindfoot scale and radiographic measurements demonstrate maintenance of correction of the adult acquired flatfoot.

Adult↗