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63 Cards in this Set
- Front
- Back
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biggest problems with tendon transfer
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adhesions
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biggest cause of adhesions
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suturing
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tendon transfer
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detachment of the tendon from its insertion and then relocated to a new insertion
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tendon transplantation
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rerouting the course of the a tendon without detachment
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tendon suspension
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tendon acts to support a structure
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primary component of tendon
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water
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only cell type in tendon
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fibroblasts
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collagen in tendon is replaced how often
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every 6 months
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make up of tendons
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30% collagen
2% elastin 68% water |
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what covers endotendineum
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epitenon
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straight tendons are covered by what
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paratenon
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what runs in paratenon
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nerves and blood vessels
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tendons that are angled are covered in what
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tendon sheath
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peritenon includes what
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para, meso, epi and endotenon
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3 sources of blood supply in tendon
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from muscle belly
bone and periosteum paratenon |
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this is paramount in tendon surgery
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preservation of blood supply
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deep fibers enter bone at what angle
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90
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what are the phases of tendon healing
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inflammatory phase
reparative phase 5 days remodeling phase 15-28 days |
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when should early mobilization begin
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3-4 wks
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most active structure in tendon repair
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epitenon
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muscles produce greatest force at what length
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120% of resting length
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when are muscles at 0 tension
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at 60% of resting length
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what can you do to decrease adhesion
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create a channel through subcutaneous tissue
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where is incision made with tendon surgery
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directly over tendon you are harvesting
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where do you make the incision for the place you are moving the tendon to
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a few mm away from where you moving it to
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too much tension leads to what
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muscle degeneration
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too little tension leads to what
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muscle shortening and eventual loss of power
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how do you put proper tension on a tendon
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put foot at 90 degrees and then move the tendon
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where should tendon be fixed
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as close to insertion as possible
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what can tendon be fixed to
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tendon
periosteum bone |
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what is one time you don't take epitenon with you
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side to side to allow for scarring
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tendon transfers alone are not sufficient for what
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flatfoot surgery
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adductor hallucis transfer
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tendon resected and passed medially under capsule and sutured into medial aspect of capsule
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indications for adductor transfer
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HAV to help realign sesamoid apparatus
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abductor transfer
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tendon resected and transferred under 1st met head and fixated to the lateral aspect of the base of the proximal phalanx
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indications for abductor transfer
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hallux varus
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EHL transfer
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EHL transected and routed under DTIL and fixated to lateral aspect of base of proximal phalanx
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what needs to happen with EHL transfer
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IPJ fusion
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indications for EHL transfer
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when there is a sagittal componenet to the varus deformity
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Jones suspension
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EHL excised
transverse hole drilled in 1st met head tendon routed through hole and sutured onto itself |
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what other procedure needs to be done with jones suspension
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IPJ fusion
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indications for jones suspension
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flexible cavus
flexible plantarflexed 1st met removal of both sesamoids lesser metatarsalgia |
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hibbs tendosuspension
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EDL tendon slips are detached bundled and placed through midfoot
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indications for hibbs
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retrograde buckling at MPJs
metatarsal equinus lessermetatarsalgia lesions 2-4 |
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what is done with slips going to toes in a hibbs
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sutured to EDB
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TATT
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tibialis anterior tendon transfer
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how many incisions are needed for a TATT
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3
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TATT
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tendon rlsd from insertion rerouted out proximal insertion then brought down to new insertion usually 3rd cuneiform
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what are indications for TATT
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recurrent club foot
flexible forefoot equinus dropfoot trans met amp charcot marie tooth deformity |
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STATT
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spilt tibialis anterior tendon transfer
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how many incisions are made with a STATT
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3
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STATT
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tendon is split through proximal insertion then lateral slip is passed through the peroneus tertisu sheath tendon is fixated to tertius or into cuboid
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if you fixate lateral half of TA to peroneus tertius what do you not want to do
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take the epitenon with it
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what are indications for STATT
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spastic rearfoot varus
spastic equinovarus fixed equinovarus forefoot equinus flexible cavovarus excessive supination in giat dorsiflexory weakness |
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COBB procedure
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STATT but rerouting is to the PT tendon
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indications for COBB
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PT dysfunction
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FDL transfer
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tendon transected as far distally as possible then hole is drilled through the navicular tendon is rerouted through navicular inferior to superior and sutured to itself
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indications for FDL transfer
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help support medial arch in PT dysfunction
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tibialis posterior transfer
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tendon resected PT is pulled through window PT is brought downto insertion usually the 3rd cuneiform
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what needs to be considered with PT transfer
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phase change from a stance phase muscle to a swing phase muscle
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when should passive ROM begin after tendon transfer
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3 weeks
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what procedure should always be done with trans met
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TAL
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what tendon is indicated for use in the presence of chronic achilles ruptures
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FHL
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