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Tendon Transfer - Principles

Definition

  • A tendon transfer is a procedure in which the tendon of insertion or of origin of the functioning muscle is mobilised, detached or divided and reinserted into a bony part or onto another tendon, to supplement or substitute for the action of the recipient tendon

 

Indications for tendon transfers

  1. Irreparable nerve damage

  2. Loss of function of a musculotendinous unit due to trauma or disease

  3. In some nonprogressive or slowly progressive neurological disorders

 

Basic principles of tendon transfer

1. Mobile Joints / Correction of joint, skin and soft tissue contractures

  • If necessary, capsulotomy, or free flap may be necessary prior to tendon transfer

 2. Adequate power of transferred tendon

  • Power of a muscle is determined by its cross sectional area

  • Only muscles with power of 4+ should be considered donors as they always lose 1 MRC grade of power

 3. Sufficient amplitude (excursion / freedom of movement) in the transferred  tendon

  • The amplitude of a muscle is a function of the sarcomere length

  • It is a fixed value for any muscle, but can be increased by

  • Freeing the muscle from its fascial attachments

  • Changing a muscle from monoarticular to  biarticular, the amplitude is increased by  movement of the  extra joint that the tendon crosses

  • Amplitude can be limited by scarring and adhesions

  • As a guide, amplitudes are as follows

    • Wrist motors     33mm

    • Finger extensors            50mm

    • Finger flexors     70mm



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