WHAT YOU SHOULD KNOW
After tendon rupture of laceration a critical function is lost. After surgery to restore that function has failed the patient usually has added significant stiffness to the simpler problem of a lost function. Heavily scarred or unstable wounds and associated nerve or skeletal injuries may complicate the situation further.
MEDICAL HISTORY
Patients may complain of pain, weakness, stiffness, and loss of function. All the details of the original injury and subsequent treatments must be reviewed. The patient should bring the typewritten reports of any previous surgeries that have been performed.
EXAMINATION
Each of the relevant tendon functions is carefully tested along with individual joint ranges of motion, both active and passive. Careful note is taken of the elasticity and quality of all nearby wounds and relevant nerve functions.
ADDITIONAL TESTS
Plain x-rays will demonstrate any joint damage that might make achieving good function more difficult.
TREATMENT OPTIONS
| TENDON TRANSFER | TENDON GRAFTING | |
| CONSISTS OF | Moving a working tendon from its original assignment to one needed to make up for one of the lost movement functions | One or two stage replacement of a segment of tendon with a new piece of tendon taken from elsewhere in the body |
| FEATURES | Only tendons that can afford to give up their original function are used | Silicone rods are placed in the tendon pathway in stage one then replaced with actual tendon in stage two |
| ADVANTAGES | Transferred tendons have blood supply and a single connection point that must heal | The brain is using the original muscle to tendon unit it is programmed to understand |
| DISADVANTAGES | Substitution with a tendon transfer can never really recreate the original lost function and the brain must learn to use the new connection | Lack of blood supply to the spliced tendon segment causes significant adhesions and limited final motion, 2 connection points that must heal |
RECOVERY
Outpatient rehabilitation exercises are begun early to maintain motion in the joints. Stress is kept off the tendon connections until healing has occurred. Early healing takes place in the first 4-6 weeks with full healing only after several months. The second phase of rehabilitation includes exercises to pull the tendons along their pathway to limit sticking or adherence that will cause a restriction of final motion. For tendon transfer or one stage grafting the whole process takes just over 3 months. For two stage tendon grafting the process takes over 6 months.
