A tendon transfer is a surgical process in which the insertion of a tendon is moved, but the origin remains in the same location. A tendon transfer involves the redistribution of muscle power, not recreation. Tendons are transferred at the distal attachment from lesser to more important functions so that the overall function is improved. Tendon transfers provide a substitute that can be permanent or temporary when muscle function is lost either due to nerve injuries or injuries
to the muscle/tendon unit. Tendon transfers are also performed to correct the imbalanced muscle tone due to spasticity
resulting from injuries to the central nervous system.
A tendon is a solid cord at either end of a muscle that is attached to the bone. Tendons, along with their muscles, make it easy to move the joints. A tendon transfer surgery is a surgical technique in which a functioning tendon is moved from its normal, anatomic location, to another area to replace a non-working muscle and tendon. A tendon transfer involves the only redistribution of muscle power, not recreation. Tendon transfers offer a temporary or permanent substitute when muscle function is lost due to either nerve injuries or injuries to the muscle/tendon unit. Tendon transfer surgery can also be carried out to correct an imbalanced muscle tone attributable to spasticity as a result of injuries to the central nervous system.
How is a tendon transfer surgery done?
Every muscle has a starting point (known as origin), which tapers down from its muscle belly to a tendon. The tendon then attaches to a bone (this attachment is known as insertion) in a particular area; when the muscle moves (this movement is known as contraction), it causes a specific motion (the motion is known as action).
In the course of a tendon transfer surgery, the origin of the muscle, the nerve, and the blood supply to the muscle is left in place and untouched. The tendon insertion to the bone is disconnected and sewn to a different location, which could be a different bone or a different tendon. After completing the new insertion, the muscle produces a different action when it fires. The fire, however, depends on where the new insertion has been made.
The procedure of tendon transfer surgery starts with making one or more incisions in the surgery location. Once the tendon of the extra muscle is found, it is moved and sewn to the tendon of a working muscle. At times, more than one tendon transfer is carried out at a time. Upon completion, the incisions are closed with stitches.
A tendon transfer surgery may be carried out with the patient awake, mildly sedated, or completely asleep. The anesthesia given depends on the injury, and it is a decision made between the patient and the surgeon.
The outcome of a tendon transfer surgery
In a proper situation, tendon transfer surgery can be extremely beneficial. It significantly improves pain, and muscle strength, and function by about 70 to 80%. However, a 100% recovery of strength and normal function cannot be guaranteed.
What is the recovery time for a tendon transfer surgery?
Usually, the bind stays on the patient’s leg for about 10-14 days. During this period the bind and sutures are removed. The patient is then cast.
For six weeks after surgery, patients are not allowed to be weight-bearing to let the transferred tendon heal to its new attachment. The duration for complete healing depends on what is seen during surgery. After six weeks, patients are allowed to start bearing more weight on the location of the surgery. 12 weeks after a tendon transfer surgery, patients are put out of the cast or boot.
To help regain the strength of the transferred muscle, physical therapy may be required. Due to the transfer, the transferred muscle is weaker, than it was, in its previous functional position.
You may need a tendon transfer to restore function after loss of muscle or tendon function from . Muscle injury (trauma, rheumatoid arthritis) Neuromuscular disorder (cerebral palsy, stroke, traumatic brain injuries, and spinal muscle atrophy).
Why may a tendon transfer surgery be required?
A tendon transfer surgery may be as a result of the following;
- Nerve injury (either cut, overstretched or torn).
- Muscle injury (either due to traumatized, cut broken or rheumatoid arthritis).
- Neuromuscular disorder (cerebral palsy, stroke, traumatic brain injuries, and spinal muscle atrophy).
- Birth defect (for instance, some infants are born without certain muscle functions).
What is the alternative to a tendon transfer surgery?
There may be a couple of alternatives. These may include:
- A repair or transfer of nerves.
- A repair of muscle or tendon.
- Strapping or fusion of joints.
What are the risks involved in a tendon transfer surgery?
These are rare. They include;
- Infection or injury to neighbouring nerves, tendons or blood vessels.
- Weakness of the transferred muscle.
- Rupture of the transfer.
- The need for another surgery.
What movements will I be able to do?
Depending on the location of the tendon transfer surgery, movements that may be restored are:
- Elbow straightening (or elbow extension).
- Wrist extension.
- Finger flexion; ability to grip or hold an object
- Thumb flexion.
What’s the success rate?
The success of a tendon transfer surgery depends on;
- The strength of surrounding muscles.
- The strength of donor muscles.
- The flexibility of the joints.
- The overall health of the patient and participation in exercises/therapy.
Are there any factors to be considered before a tendon transfer surgery?
There are plentiful requirements to be considered before determining whether a tendon transfer surgery would be suitable for an individual. Such as:
- 2. Presence or absence of arthritis.
- 3. The strength of the opposing muscle forces.
- 4. The quality of the bone to hold the fixation.
- 5. Patient compliance and endurance of the extensive and lengthy period of rehabilitation.
Will my foot move normally after a tendon transfer surgery?
This depends on the tendon transfer had. Some tendon transfers simply act as a leash for the foot and to hold it in proper alignment. In this case, not much movement is provided to the ankle and foot. Some tendon transfers transport functional muscles from a side of the foot to the other, and as a result the foot will have a normal movement after the surgical procedures.
What symptoms will be displayed after tendon transfer in the ankle?
- Pain, owing to the surgery.
- Temporary numbness or pinches if a nerve was disrupted during surgery.
- Rigidity of the muscles around the area.
- A scar at the location the incision has been made.