1. Tendon Transfer (Mahan)

Question 1

define:

tendon transfer

Answer 1

the detachment of a tendon of a functioning muscle at its insertion and RELOCATION to a new insertion

Question 2

define:

tendon transposition

Answer 2

REROUTING of the course of a muscle WITHOUT detachment

to assist other functions

Question 3

define:

tendon suspension

Answer 3

tendon procedures designed to SUPPORT a structure

e.g. young’s suspension

Question 4

what provides the majority of tendon circulation?

Answer 4

majority comes from paratenon or mesotenon

Question 5

along STRAIGHT COURSE, tendon is surrounded by:

Answer 5

paratenon;

e.g. tendo achilles follows a straight course;

paratenon looks like a spider web; when incised, becomes very hypervascular

Question 6

along ANGLED COURSE, tendon is surrounded by:

Answer 6

surrounded by tendon SHEATH;

e.g. peroneal tendons, TP, FDL, FHL

Question 7

how is strength affected by muscle transfer?

Answer 7

transferred muscles lose ONE GRADE of strength

Question 8

when selecting muscle for transfer, what should you consider?

Answer 8

• adequate strength
• functionally similar (same gait phase, or suitable for phase conversion)
• long term function

Question 9

grading system for MMT:

high level

Answer 9

• 5: normal
• 4: good
• 3: fair
• 2: poor
• 1: trace
• 0: zero

Question 10

which muscle become weak over time with

Charcot Marie tooth?

Answer 10

• TA/extensors/peroneals become weak over time in CMT –> won’t maintain strength long term

Question 11

what is a good muscle to transfer for CMT?

Answer 11

**TP is not affected by CMT –> will maintain strength long term, better muscle to transfer

Question 12

describe surgical technique for tendon transfer

Answer 12

1. transfer in a straight line (will be more effective in pulling),
   
   • longer lever arm increases muscular force,
   • must consider effect of muscle on particular axis of motion you are trying to affect
2. transfer along an anatomical course,
3. preserve gliding function,
4. appropriate tension,
5. fix tendon insertion to bone

Question 13

types of fixation in tendon transfer attachments

Answer 13

• Tendon to tendon attachment
• Tendon to periosteum
• Tendon to bone (most effective as an anchoring device)

Question 14

with tendon to bone-type tendon attachment,

describe possible fixations

Answer 14

• bone anchors
• trephine hole (hole in bone)
• screw and polyacetyl washer
• suture with external button

Question 15

how to find 3rd cuneiform during surgery

Answer 15

follow 3rd MT backward, take a C-arm picture

Question 16

how do you recognize extensor substitution hammertoes?

Answer 16

extensor tendons pulling toes up during swing phase

Question 17

what procedure is jones suspension usually combined with?

Answer 17

Usually combined with hallux IPJ fusion

Question 18

why attach (EDL) to the 3rd cuneiform in Hibbs suspension?

Answer 18

3rd cuneiform it is the central point of the foot

Question 19

key difference between jones suspension and hibbs suspension

Answer 19

Jones = EHL transfer

Hibbs = EDL transfer

Question 20

how often is peroneus tertius muscle present?

Answer 20

90% of the time

Question 21

in the STATT procedure,

if we have split tendon and attached it half medially/half laterally, what have we accomplished?

Answer 21

more effective in ankle dorsiflexion as it is more perpendicular to ankle joint axis

Question 22

important considerations with tibialis posterior tendon transfer

Answer 22

• Option – transfer superficially over medial malleolus (easier but not perpendicular to axis of motion so not as mechanically effective)
• Transfer of TP may require talo-navicular fusion to prevent collapse
  
  • If you have a functioning PB, you will likely get abduction of foot around midtarsal joint and collapse once you transfer TP
• Avoid entrapment of tendon in interosseous membrane by making large incision

Question 23

post-op management for tendon transfer procedures

Answer 23

• Immobilization at right angle and in neutral position for 4-6 weeks until attachment secure
• Movement – after 3 weeks, motion helps to prevent adhesion

Question 24

post-op mgmt: FUNCTION

Answer 24

isometric exercises for strength

Question 25

post-op mgmt: for ESTABLISHING PHASE

Answer 25

pre-op training and post-op rehab