Tendon Transfer

What is Tendon Transfer?

A tendon is the strong cord found at both ends of a muscle that attaches it to a bone. Tendons work together with muscles to facilitate joint movement. Tendon transfer surgeries are performed to restore lost joint function. In these surgeries, the original connection is re-established.

Why is Tendon Transfer Performed?

Conditions that may necessitate tendon transfer include the following:

• Tendon ruptures caused by rheumatic diseases
• Fractures
• Traumatic injuries
• Untreated joint diseases
• Congenital deformities

How is Tendon Transfer Performed?

For a tendon transfer surgery to be successful, the following conditions must be met:

• The muscle attached to the tendon must be functional.
• The soft tissue to which the tendon will be transferred should be as normal as possible.
• The joints the tendon passes through must be both mobile and stable.

If these conditions are met, tendon transfer surgeries are recommended. The surgery begins with an incision made near the tendon's normal placement. The tendon is then repositioned around the surrounding bones and soft tissues of the relevant area.

Finally, it is attached to another bone to complete the surgery. If the operated tendon is sufficiently long, a hole can be drilled into the target bone to pass the tendon through and then suture it in place. If it is not long enough, after being passed through a tunnel in the bone, it can be secured with a plastic or metal screw.

For Which Conditions is Tendon Transfer Applied?

The medical conditions for which tendon transfer is applied include the following:

Nerve Injuries

If a nerve injury is irreparable, signals cannot be sent to activate certain muscles. Tendon transfer surgery can restore the functionality of these muscles.

Tendon Ruptures

Muscle injuries caused by tendon ruptures due to rheumatoid arthritis or fractures are treated with tendon transfer in cases of irreparable tendon and muscle tears.

Nervous System Disorders

It can be applied in conditions such as cerebral palsy, traumatic brain injuries, stroke, or spinal muscular atrophy.

Congenital Disabilities

This procedure is applied in cases of congenital disabilities, such as hypoplastic thumb or congenital brachial plexopathy, which occur when babies are born without certain muscle functions.

The Recovery Process of Tendon Transfer

After tendon transfer surgery, patients use a splint. Splint usage typically lasts between 10 - 14 days. Once the stitches are removed, the splint is replaced with a cast or a removable boot.

To ensure healing, patients must avoid bearing weight for 6 weeks. This period may vary depending on the type of surgery. After 12 weeks, the cast is removed.

Physical therapy is necessary to restore the functionality of the transferred muscle. It also helps alleviate movement restrictions in the muscle and joint.

Risks of Tendon Transfer

Potential complications that may occur after tendon transfer surgery include the following:

• Bleeding
• Infection
• Damage to nearby tissues
• Stiffness
• Weakness of the transferred muscle or rupture of the transfer, potentially requiring a second surgery

Types of Tendon Transfer Surgeries

There are several types of tendon transfer surgery procedures. The procedure to be performed is determined by the doctor based on the patient's needs. These methods include the following:

Extensor Indicis Proprius (EIP)

This involves transferring the tendon from the index finger to the thumb to enhance grip and pinch strength.

Flexor Digitorum Longus Transfer

This surgery is performed to improve ankle dorsiflexion, thereby enhancing the ability to lift the foot upward. It is a procedure applied to the ankle.

Brachioradialis-Flexor Pollicis Longus Transfer

This procedure is applied to patients with brachial plexus injury. Its purpose is to restore thumb and finger flexion.

Latissimus Dorsi Transfer

This procedure involves transferring the Latissimus Dorsi (LD) muscle to the shoulder joint.

Peroneus Longus Transfer

The purpose of this procedure is to enhance foot stability. Therefore, the Peroneus Longus tendon is transferred to the lateral ankle.