Passive muscle-tendon amplitude may not reflect skeletal muscle functional excursion

Biomechanics of Tendon Transfers

The transfer of tendons in the upper extremity is a powerful technique to restore function to a partially paralyzed hand. The biomechanical principles of muscle tension and tendon excursion dictate motor function both in the native as well as transferred states. Appropriately tensioning transferred tendons to maximize the function of the associated muscle remains an area of focused research. Newer methods of tendon coaptation have proven similar in strength to the standard Pulvertaft weave, affording more options to the surgeon.

Dissection of a single rat muscle-tendon complex changes joint moments exerted by neighboring muscles: implications for invasive surgical interventions

The aim of this paper is to investigate mechanical functioning of a single skeletal muscle, active within a group of (previously) synergistic muscles. For this purpose, we assessed wrist angle-active moment characteristics exerted by a group of wrist flexion muscles in the rat for three conditions: (i) after resection of the upper arm skin; (ii) after subsequent distal tenotomy of flexor carpi ulnaris muscle (FCU); and (iii) after subsequent freeing of FCU distal tendon and muscle belly from surrounding tissues (MT dissection). Measurements were performed for a control group and for an experimental group after recovery (5 weeks) from tendon transfer of FCU to extensor carpi radialis (ECR) insertion. To assess if FCU tenotomy and MT dissection affects FCU contributions to wrist moments exclusively or also those of neighboring wrist flexion muscles, these data were compared to wrist angle-moment characteristics of selectively activated FCU. FCU tenotomy and MT dissection decreased wrist moments of the control group at all wrist angles tested, including also angles for which no or minimal wrist moments were measured when activating FCU exclusively. For the tendon transfer group, wrist flexion moment increased after FCU tenotomy, but to a greater extent than can be expected based on wrist extension moments exerted by selectively excited transferred FCU. We conclude that dissection of a single muscle in any surgical treatment does not only affect mechanical characteristics of the target muscle, but also those of other muscles within the same compartment. Our results demonstrate also that even after agonistic-to-antagonistic tendon transfer, mechanical interactions with previously synergistic muscles do remain present.

Update of the physiology and biomechanics of tendon transfer surgery

Tendon transfer surgery has evolved over the past decade. Unique muscle properties have been elucidated in terms of potential force generation, excursion, and metabolic properties. The choice of an appropriate donor muscle is becoming more of a science than an art. The measurement of sarcomere length has progressed from the laboratory into surgery. Methods of tendon coaptation have advanced to allow early mobilization. This article reviews recent advances in our understanding of tendon transfer surgery of the hand and upper extremity.

Intraoperative single-site sarcomere length measurement accurately reflects whole-muscle sarcomere length in the rabbit

PURPOSE

To compare single-site intraoperative sarcomere length values with sarcomere lengths measured from systematic sampling of the entire transferred muscle.

METHODS

The tendon of the rabbit second toe extensor muscle was transposed to the ankle extensor retinaculum under levels of stretch over the sarcomere length range of about 2.5 microm to about 4.0 microm. Intraoperative sarcomere length was measured at a single site with a laser diffraction device. Whole-muscle sarcomere length measurement was then determined by sampling across the muscle in the proximal, middle, and distal regions. Linear regression analysis and intraclass correlation coefficients were used to validate single intraoperative sarcomere lengths relative to whole-muscle sarcomere lengths.

RESULTS

Single intraoperative sarcomere lengths correlated strongly with average whole-muscle sarcomere length, although there was a systematic tendency to overestimate intraoperative sarcomere length. Intraoperative sarcomere length also matched well with all regions sampled, indicating that there was no tendency for intraoperative sarcomere length to better represent one region of the muscle compared with another.

CONCLUSIONS

These results show that intraoperative sarcomere lengths accurately represent the entire muscle. The relatively small sarcomere length variations validate the use of intraoperative sarcomere length measurement during tendon transfer in which the entire muscle is not available for measurement because of limited surgical exposure.