36 Questions
What is a key principle to consider when selecting a tendon for transfer?
Phasic nature
Which grade of power loss is acceptable when transferring a muscle tendon unit?
Losing 1 or more grades of power is acceptable
What is the recommended course for the transferred tendon to follow after the surgery?
Straight line of pull
Which technique involves attaching tendons to bone directly?
Tendon-to-bone transfer
What is the problem associated with side-to-side lengthening or transfers?
Slippage
What device is NOT typically used to secure tendons to bone?
"Zero" Tension Mechanism
What is the primary purpose of a tendon transfer procedure?
To provide structural support to a weakened or paralyzed muscle
Which of the following is an example of a tendon transfer procedure?
All of the above
Which principle of tendon transfers is most important to consider when planning the procedure?
Ensuring adequate blood supply to the transferred tendon
In a tendon transposition procedure, what is the key difference compared to a standard tendon transfer?
The tendon is rerouted without detachment from its original insertion
What is the primary goal of a muscle-tendon transplantation procedure?
To detach a functioning muscle-tendon unit and relocate it to a new location
Which type of tendon transfer procedure involves the detachment of a tendon at its insertion and relocation to a new attachment site?
Tendon transfer
Which of the following is NOT a primary reason for performing a tendon transfer?
To improve cosmetic appearance of a limb
In a tendon transfer procedure, which of the following steps is typically performed first?
Detaching the tendon from its original insertion
Which of the following is a potential complication of a tendon transfer procedure?
All of the above
In a tendon transposition procedure, what is the primary goal?
To change the direction of pull of the tendon
Which of the following tendons is commonly used as a donor graft for tendon transfers in the hand?
Palmaris longus
In the context of tendon transfers, what does the term 'tendon detachment' refer to?
The separation of the tendon from its original insertion site
What is a key principle to consider when determining the ideal tendon for transfer?
Phasic nature of the tendon
In the context of tendon transfers, what is the recommended range of movement remaining within the joint where the transferred muscle will act?
Limited range of movement
Which grade of power loss is considered acceptable when transferring a muscle tendon unit?
Lose at least 1 grade of power with the transfer
What is the primary problem associated with side-to-side lengthening or transfers?
Slippage
Which technique involves attaching tendons to bone directly rather than to another tendon?
Tendon-to-bone transfer
What is the optimal course for the transferred tendon to follow after surgery according to the principles of tendon transfers?
Running as straight a course as possible
What is the primary function of a tendon sheath in the context of tendon anatomy?
Prevents bowstringing of tendons that curve
What distinguishes a tendon sheath from a paratenon in terms of function?
Lined with synovial cells and facilitates tendon gliding in curves
During which phase of tendon healing does the response to tendon injury involve overlapping stages?
Inflammatory phase
What characterizes the inflammatory phase of tendon healing?
Features three overlapping stages as a response to injury
Which type of tendons are associated with paratenon, nerve, and blood vessels according to the text?
Tendons with straight pull
What is the primary distinction between a tendon sheath and mesotenon in terms of structure?
Ability to prevent bowstringing
Which type of tendon repair involves debridement and tubulerization of the tendon ends?
Debridement/Tubulerization
What is the primary purpose of a tendon transfer procedure?
To detach a functioning muscle tendon and relocate it to a new insertion
Which of the following is an example of a tendon transposition procedure?
Rerouting the course of a normal muscle tendon without detachment
Which principle of tendon transfers is most important to consider when planning the procedure?
Selecting the appropriate donor tendon
What is the key difference between a tendon transfer and a tendon transposition procedure?
Tendon transfers relocate the tendon, transpositions only reroute the tendon
What is a key principle of tendon transfer procedures?
All of the above
Study Notes
Principles of Tendon Transfers
- Tendon to be transferred ideally should be phasic
- Adequate range of movement within the joint on which the transferred muscle will act should be remaining
- Muscle must have adequate power (at least M4 or M5) and the transfer is recommended even for a weak muscle if it's the deforming force
- After the transfer, the tendon should run in as straight a course as possible with zero tension
Types of Tendon Transfers
- Side-to-side/Tenodesis
- Tendon-to-bone
Securing Tendons to Bone
- Trephine
- Button
- Screw and Washer
- Suture Anchor
- Biotenodesis/Interference Screw
Tendon Healing
Phases of Tendon Healing
- Inflammatory
- Proliferative
- Remodeling (starts 1-2 months after injury, lasts more than a year, and tissue never completely regains pre-injury properties)
Phases of Tendon Repair
- Debridement with Tubulerization
- End-to-end Reconstruction
- Debridement/Tubulerization End-to-end Repair Reconstruction
- Krakow
Tendon Reconstruction Options
- Allograft Reconstruction
Tendon Transfers Purpose
- Detachment of a tendon of a functioning muscle at its insertion and then relocation to a new insertion or attachment
- Rerouting of the course of a normal muscle tendon without detachment to assist other functions
- Muscle-Tendon Transplantation
- Tendon Suspension (tenosuspension)
Tendon Anatomy
- Epitenon (synovial layer) surrounds the tendon
- Paratenon (areolar tissue) continuous with epitenon contains nerve and blood vessels
- Mesotenon is epitenon + paratenon
- Tendon Sheath: tubular structure prevents bowstringing, found in tendons that curve, lined with synovial cells, and allows tendon to glide like a piston in a cylinder
Tendon Histology
- 55-70% water
- Extracellular matrix (ECM) primarily of aligned Type I collagen fibers (65-80% dry weight)
- Elastin, Aggrecan, Decorin, Biglycan, and Fibromodulin
Test your knowledge on the principles of tendon transfers with this quiz. Questions cover topics such as phasic transfer, range of movement, and muscle power requirements.
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