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tendon transfer Flashcards

1
Q

Tibialis posterior tendon transfer (TPTT) indication/contraindication

A
  1. Goals: eliminate dropfoot; eliminate flexor substitution (triceps surae weakness).
  2. Indications: anterior muscle weakness, dropfoot, nonspastic equinovarus, recurrent clubfoot, peroneal nerve palsy (CMT), and triceps surae weakness.
  3. Contraindications: spastic TP, pes valgus, rigid clubfoot.
  4. Technical considerations: approaches, interosseous window, phase conversion, often combined with arthrodesis.
  5. Aftercare: BK cast 3 weeks NWB, then additional 3 weeks WB, begin ROM at 4 weeks.
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2
Q

Type of collagen for tendinitis vs tendinosis

A

tendinitis: composed of type I collagen

Tendinosis: composed of type III collagen

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3
Q

swing phase muscle vs stance phase muscle

A

swing phase:
TA, EHL, EDL, Peroneus tertius, Peroneus longus, peroneus brevis

stance phase: gastrocnemius, soleus, FHL, FDL, Posterior tibialis

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4
Q

Peroneus brevis into talus tendon transfer (PBTT)

indication/contraindication

A
  1. Goals: suspend talar neck, eliminate flexible vertical talus.
  2. Indications: Type I vertical talus, severe pes valgo planus.
  3. Contraindications: rigid pes valgoplanus, immature talus or compromised talar neck circulation.
  4. Technical considerations: may be combined with closing adductory wedge osteotomy of talar neck, medial arch tendosuspension (McGlamry-Young), Evans lateral column lengthening.
  5. Aftercare: up to 8 weeks BK cast NWB
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5
Q

tibialis anterior tendon transfer

A

reduce supination and increase dorsiflexion

TA is transfered to the 3rd cuneiform through the EDL tendon sheath

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6
Q

Type I collagen

A

most abudnant found in skin, ligaments, tendon, bone, FIBROcartilage

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7
Q

split tibialis anterior tendon transfer

A

Procedure increases dorsiflexion to the foot and balances the force laterally

TA is split from its insertion up to just proximal to the superior extensor retinaculum.

lateral fibers are passed through the peroneus tertius sheath and sutured to the tendon or attached to cuboid

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8
Q

what attaches the epitenon to the paratenon

A

mesotenon: allows blood supply to be transferred from paratenon to the tendon
The point at which it attaches to the epitenon is called the hilus

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9
Q

type II collagen

A

hyaline cartilage (articular cartilage)

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10
Q

Phases for tendon healing

A

A. Lag (substrate) phase
Week one, the ends are joined by a fibroblastic splint, strength due to sutures, immobilization required. The repair site consists of serous material and granulation tissue (zone of degeneration) and is in its weakest state.
Week two, increasing fibroplasia and vascular, strength due to sutures, immobilization required.

B. Fibroproliferation (collagenation) phase
Week three, marked increased fibroplasia, moderate collagenation strength; can sustain gentle passive motion or isometric (in cast or brace) exercises.

C. Remodeling phase
Week four, collagen realignment and remodeling, moderate strength (not full), gradual progressive strengthening with passive and active exercises.

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11
Q

how long after CVA before pt can have tendon transfer?

A

6 months

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12
Q

Indication and contraindication for hibbs tenosuspension

A

Goals: decrease MTPJ buckling and increase ankle dorsiflexion.

Indications: anterior weakness (mild), flexible anterior cavus with extensor substitution, claw toes often with associated IPK.

Contraindications: posterior weakness, weak interossei, gross EDL weakness, structural rigidity, and osseous instability.

Aftercare: BK WB cast 4-6 weeks.

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13
Q

peroneus long tendon transfer

A

Technical considerations: easy phase conversion, caution sural and intermediate dorsal cutaneous nerves.

Peroneus longus is released at the level of the cuboid and transferred through the intermuscular septum down the EDL sheath and inserted into the lesser tarsus or base of 3rd met

PL may also be split- half anastomosed to the TA and inserion and other half to peroneus tertius

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14
Q

Jones tenosuspesion

A

Indications: cock-up hallux, weak tibialis anterior, and loss of sesamoid function, forefoot driven cavus–flexible plantarflexed 1st ray

EHL is transected rerouted medial to lateral through the the head of the 1st metatarsal and sewered back on itself

the distal stump of EHL attached to EHB

important for IPJ arthrodesis to prevent of overpowering of the EHL and hammering

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15
Q

Heyman procedure; indication

A

transfer of all long extensor tendons to their respective metatarsal head

indication for metatarsus adductus a

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16
Q

post op care for tendon healing/transfer

A

NWB for 4 weeks

gentle passive ROM an/or isometric exercises inside the cast may be started at 3 weeks to prevent adhesion

at 4 weeks, active mobilization should begin, but maximum contracture should be postponed for several more weeks

17
Q

what complication can develop if ankle is not kept in neutral position when the distal stump of the FDL is sutured to the FHL

A

Hammertoes: IMPORTANT. to have ankle in neutral because if FDL is pulled too tight or left too laxed, Hammertoes will develop. Physiologic tension must be maintained to keep rectus lesser toes

18
Q

what grade muscle strength is needed for transfer

A

Grade 4; lose a grade of muscle strength after transfer

19
Q

Girdle stone procedure

A

flexor digitorum longus transected at the level of the distal phalanx and split longitudinally to the base of the proximal phalanx, wrapped around the proximal phalanx and suture together

20
Q

achilles strength vs other tendon

A

4:1, so for weak transfer may need two tendons

21
Q

Which tendon structure is the most important structure in tendon repair process

A

epitenon

22
Q

Complication of Tibialis posterior tendon transfer for CP pt

A

can cause calcaneal gait -possibly due to transferring it too early

23
Q

what are the pros/cons to transferring tendon subcutaneously

A

transferring subQ will enhance power but will cause bowstringing and introduce unpredictable degree of torsion

24
Q

Type III collagen

A

skin, vessels, lymphatic, granulation tissue, tendinosis

25
Q

Hibbs Tenosuspension

A

This procedure release the buckling force at the MPJ and elevates forefoot

EDL tendon slips are dettached from insertion, combined together, and reattached to lateral cuneiform or base of 3rd met then the EDB tendons are transected and reattached to the stump of the corresponding EDL and the 4th and 5th longus slips are attached to the 4th EDB

26
Q

Peroneus longus tendon transfer (PLTT) indication/contraindication

A
  1. Goals: increase ankle dorsiflexion, eliminate PL cavus influence.
  2. Indications: anterior muscle weakness, dropfoot, and flexible cavus.
  3. Contraindications: posterior weakness, pes valgus.
27
Q

Youngs tenosuspension

A

reroute TA to navicular keyhole without detachment, for sagittal correction for pes planus

28
Q

Anchovy procedure

A

tendon interposition used in arthroplasties.

Tendon graft rolled up and inserted into damaged or resected joint. the capsule is closed to hold the interposition “anchovy” in place

K wire may be placed across the joint for 6 weeks to hold anchovy in place

29
Q

Indication/contraindication for Tibialis anterior tendon transfer (TATT)

A
  1. Goals: decrease forefoot supinatory twist, increase true ankle dorsiflexion
  2. Indications:
    recurrent clubfoot, flexible anterior cavus/forefoot equinus, dropfoot (CMT)
  3. Contraindications: excessively weak TA (<4), pes valgus, weak PL, severe anterior cavus with claw toes.
  4. Aftercare: BK WB cast 3-4 weeks.
30
Q

you always want to preserve gliding by transfer tendon with paratenon an can transfer within sheath–if not possible, what is the other alternative?

A

you can make gliding channel w/in subQ adipose tissue

31
Q

indication/contraindication for Split tibialis anterior tendon transfer (STATT)

A

Goals: increase true ankle dorsiflexion, decrease long extensor swing phase overload, and decrease adductocavovarus forefoot deformity.

Indications: flexible anterior cavus, extensor substitution, claw toes; spastic posterior ankle equinus, equinovarus (CP), anterior weakness dropfoot, flexible cavovarus, overpowering invertors.

32
Q

Indication for hibbs tenosuspension

A

Improves dorsiflexion when posterior tibialis is weak

Flexible forefoot Equinus with or without claw toes, anterior cavus

33
Q

The limbs of the V in the V-Y advancement should be made how many times the length of the tendon defect?

A

The rule of thumb for the inverted V fascia cut is that the arms of the V cut should be 1.5 times of the measured defect distally. This allows an arithmetical approach to planning the arms of the V-Y.

34
Q

Epitenon

A

the outer covering of a tendon within its sheath

***Soft tissue (3 decks)

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