Tendon Transfer

What is tendon transfer?

Tendon transfer is a procedure in which a functioning muscle-tendon unit is redirected to improve a lost function in another area, with the result that function in one part of the body is lost to improve another. Tendon transfers are used to improve mobility of limb segments, stability of joints, or balance between muscle groups in patients who have suffered injuries or neuro-muscular disorders.

Indications and contraindications of tendon transfer

Tendon transfers are commonly employed in nerve or muscle injuries, paralysis, congenital deficiencies and degenerative diseases, including:

Nerve or muscle injuries: where muscle or tendon function cannot be restored by other means.

Paralysis: where paralysis is incomplete, preserved muscle function may be redirected to improve mobility.

Congenital deficiency: where abnormal or absent muscle function has caused muscle imbalance.

Degenerative disease: where a condition like muscular dystrophy has caused progressive loss of muscle strength or muscle imbalance.

Contraindications for tendon transfer include:

  • Active infection.
  • Poor general health, including uncontrolled heart disease or severe lung disease.
  • Non-cooperation with clinical instruction.
  • Severe muscle dysfunction, weakness or atrophy. 

Benefits and complications of tendon transfer

Benefits

  • Tendon transfers can significantly improve joint function and stability, particularly in cases where a native muscle has been weak or paralysed.
  • Enhanced joint mobility and active range of motion.
  • Increased joint stability.
  • Reduced pain and discomfort through improved alignment and joint stability.
  • Deformity correction.


Known complications

  • Post-operative infection
  • Wound dehiscence.
  • Nerve injury, proximal to the harvest area.
  • Stiffness and limited range of motion.
  • Scarring.

The surgery

Preparation prior to surgery

  • You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.  Functional deficiencies will be assessed; additional nueromuscular testing may be completed. Potential donor muscles are selected.
  • Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
  • Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility. 

 

On the day of the surgery

  • You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
  • The surgical site will be prepared.
  • You will be administered general or regional anaesthesia.
  • An incision will be made over the hip joint, which can vary in length depending on the complexity of the case.
  • The bone of the femoral head and the hip socket will be prepared.
  • Prosthetic components are implanted into the target areas.
  • The wound will be sutured and dressed.

 

After your surgery

  • Wound care: your incisions will be closed with sutures and covered by a waterproof dressing. You may clean the wound gently with warm water and soap, being careful to dry it thoroughly. 
  • Pain and swelling: You may experience mild to moderate pain. You will be prescribed painkillers to manage these symptoms. Inflammation can be controlled by icing (15 minutes per hour maximum).
  • Mobilising: You may remain immobile for up to 6 weeks. Weightbearing will be increased gradually thereafter, under supervision. Crutches may be used initially and non-impact exercises with a physiotherapist, designed to improve strength, flexibility and range of motion, may commence later. 
  • Aftercare: after 6 weeks, you will be asked to complete further checks to assess healing, and at three, six and twelve months after your surgery for the same reason. 
  • Physiotherapy: a tailored program will help you to build strength, flexibility and mobility around your newly transferred tendon. 

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000