Tendon transfer surgery: clinical implications of experimental studies.

Tendon transfers commonly are used to restore arm and hand function after injury to the main motor nerves or after spinal cord injury. Surgeons traditionally use passive tension to determine the length at which a muscle should be attached during tendon transfer. The principles used to choose the length at which the transferred muscle should be attached still are relatively vague and have not been examined thoroughly. Misunderstanding of the sarcomere length-passive tension relationship can result in severe overstretch of the muscle and poor function. Upper extremity muscles have operating ranges that vary between synergists and antagonists, and recent architectural and biochemical data suggest that upper extremity muscles are designed to provide optimal control of joint position and stability. It is hypothesized that a significant functional improvement will be realized when muscles are reattached during tendon transfer procedures at the appropriate length and tension.

[1]  R. Lieber,et al.  Architecture of selected wrist flexor and extensor muscles. , 1990, The Journal of hand surgery.

[2]  P. Brand.  Tendon transfers for median and ulnar nerve paralysis. , 1970, The Orthopedic clinics of North America.

[3]  J. Fridén,et al.  Human wrist motors: biomechanical design and application to tendon transfers. , 1996, Journal of biomechanics.

[4]  R. Lieber,et al.  Architecture of selected muscles of the arm and forearm: anatomy and implications for tendon transfer. , 1992, The Journal of hand surgery.

[5]  J. Fridén,et al.  Evidence for muscle attachment at relatively long lengths in tendon transfer surgery. , 1998, The Journal of hand surgery.

[6]  P. Brand,et al.  Relative tension and potential excursion of muscles in the forearm and hand. , 1981, The Journal of hand surgery.

[7]  J. Fridén,et al.  Quantitative evaluation of the posterior deltoid to triceps tendon transfer based on muscle architectural properties. , 2001, The Journal of hand surgery.

[8]  J. Fridén,et al.  Biomechanical Analysis of the Brachioradialis as a Donor in Tendon Transfer , 2001, Clinical orthopaedics and related research.

[9]  Protection of the deltoid to triceps tendon transfer repair sites. , 2000, The Journal of hand surgery.

[10]  Goldner Jl.  Tendon transfers for irreparable peripheral nerve injuries of the upper extremity. , 1974 .

[11]  A. Freehafer.  Tendon transfers in patients with cervical spinal cord injury. , 1991, The Journal of hand surgery.

[12]  J. Fridén,et al.  In vivo measurement of human wrist extensor muscle sarcomere length changes. , 1994, Journal of neurophysiology.

[13]  R. Brand,et al.  Muscle fiber architecture in the human lower limb. , 1990, Journal of biomechanics.

[14]  Brand Pw.  Tendon transfers for median and ulnar nerve paralysis. , 1970 .

[15]  J. Goldner.  Tendon transfers for irreparable peripheral nerve injuries of the upper extremity. , 1974, The Orthopedic clinics of North America.

[16]  F E Zajac,et al.  How musculotendon architecture and joint geometry affect the capacity of muscles to move and exert force on objects: a review with application to arm and forearm tendon transfer design. , 1992, The Journal of hand surgery.

[17]  J. Fridén,et al.  Functional and clinical significance of skeletal muscle architecture , 2000, Muscle & nerve.

[18]  R L Lieber,et al.  Intraoperative sarcomere length measurements reveal differential design of human wrist extensor muscles. , 1997, The Journal of experimental biology.

[19]  J. Fridén,et al.  Effect of muscle tension during tendon transfer on sarcomerogenesis in a rabbit model. , 2000, The Journal of hand surgery.

[20]  V. Hentz,et al.  Upper limb reconstruction in quadriplegia functional assessment and proposed treatment modifications , 1983 .

[21]  K. M. Chan,et al.  Surgical reconstruction of the upper limb in traumatic tetraplegia. A review of 41 patients. , 1983, The Journal of bone and joint surgery. British volume.

[22]  G. Goldspink,et al.  Changes in sarcomere length and physiological properties in immobilized muscle. , 1978, Journal of anatomy.