Tendon transfer surgery is a specialized orthopedic procedure designed to restore movement and function lost due to various conditions. This involves relocating a working tendon to take over the role of a damaged or non-functional one. The goal is to improve stability and motor function, enhancing a patient’s ability to perform daily activities.
What is Tendon Transfer?
Tendon transfer is a surgical technique that involves moving a healthy tendon from its original attachment point to a new one to replace the function of a compromised muscle or tendon. The primary goals of this procedure include restoring motor function, improving joint stability, and correcting deformities that may arise from muscle imbalances or paralysis.
Tendon transfers are commonly performed to address conditions where muscle function has been lost due to nerve injuries, such as radial nerve palsy, ulnar nerve palsy, or median nerve palsy. These nerve injuries can prevent signals from reaching muscles, leading to paralysis and loss of movement. The procedure is also indicated for muscle imbalances caused by neurological disorders like cerebral palsy, stroke, or spinal muscular atrophy. Additionally, traumatic injuries, such as irreparable tendon ruptures or lacerations, and certain congenital conditions where specific muscle functions are absent, can necessitate a tendon transfer.
The Surgical Process
The surgical process begins with careful pre-operative planning, which involves a detailed assessment of the patient’s condition and the selection of a suitable donor tendon. The surgeon evaluates muscle strength, range of motion, and may use imaging studies like X-rays or MRI, alongside electromyography (EMG) to determine the electrical activity of muscles. This evaluation helps identify a healthy, expendable tendon that can effectively take on the lost function without causing a new deficit.
During the surgery, general or regional anesthesia is administered. The surgeon makes precise incisions to access both the donor tendon and the recipient site. The donor tendon’s insertion point is detached, while its muscle belly, nerve supply, and blood supply remain intact. The tendon is then re-routed to its new location, often through existing soft tissue planes or tunnels drilled in bone, ensuring a straight line of pull to maximize efficiency.
Once re-routed, the tendon is securely attached to its new bone or tendon site using sutures, or sometimes with screws or anchors. Precise tensioning of the transferred tendon is paramount to ensure optimal function and to prevent it from being too loose or too tight. After the transfer, the incisions are closed, and dressings are applied to protect the surgical site.
Recovery and Rehabilitation
Following tendon transfer surgery, immediate post-operative care focuses on protecting the newly transferred tendon and managing pain. The affected limb is immobilized in a splint or cast for several weeks, often one to two months, to allow the tendon to heal securely in its new position. This initial immobilization prevents strain on the surgical site and facilitates the integration of the transferred tendon.
Pain management is implemented during this early healing phase. Once the initial immobilization is complete, a structured physical therapy program begins. Rehabilitation is phased, starting with gentle passive range of motion exercises to maintain joint flexibility.
Gradually, controlled active exercises retrain the transferred muscle to perform its new function. Patients learn to consciously activate the donor muscle to achieve the desired movement. Strengthening exercises follow, progressively increasing in intensity to build the power and endurance of the transferred unit. Adherence to the prescribed rehabilitation protocol is important for successful recovery and regaining optimal function.
What to Expect Long-Term
Long-term outcomes following tendon transfer surgery can lead to significant functional improvement, though recovery is individualized. While the procedure aims to restore lost movement and improve stability, the function of the transferred tendon may not be identical to the original. It takes considerable time to achieve maximum recovery, often extending from six months to a year, with continued gains sometimes observed beyond that period.
Patients are encouraged to continue home exercise programs after formal physical therapy to maintain strength and range of motion. The brain must adapt to using a different muscle for a new action, a process that improves with consistent practice. While the transferred muscle may gain strength, the original function of the donor muscle is lost. Realistic expectations are important; the goal is to enhance overall function and independence, even if a complete return to pre-injury capabilities is not always possible.