Tendon Lengthening refers to the act of surgically cutting part, or all, of a tendon to create a longer, more functional tendon. A tendon is made up of specialized collagen fibers that are very strong and it attaches muscle to bone. In cerebral palsy and other neuromuscular disorders, because the nerve signals to the muscles are disorganized, the muscles and their tendons may become tighter. Over time the muscle becomes shorter than is normal and this can result in pain and deformity. When muscle stretching exercises and medicines are not successful in alleviating this tightness surgical intervention can be considered. Nerve surgeries can be used to relax the muscle and tendon lengthening can be done to overcome muscle shortening. Common tendons that are lengthened include the Achilles (done to allow the child wear a brace and walk with a flat foot), the hamstring (done to allow the child to extend their knee), or the hip flexors ( done so the child can extend their hip). Tendon lengthening must be combined with stretching and bracing to be effective but in the right situations can significantly improve function and minimize deformity.
Tendon Transfer refers to the transfer of a tendon from one part of the body to another to change the movement pattern that results when the muscle it is connected to contracts and relaxes. Sometimes, the tight muscles in cerebral palsy and other conditions result in the patient being unable to move a joint such as the knee, elbow or wrist from one position to another. Together with tendon lengthening, tendon transfer can be used to re-route a tendon so that it becomes helpful rather than harmful with respect to a desired movement.
The orthopedic surgeons at Function work with its other providers to coordinate tendon surgeries with other treatments thereby obtaining the optimal functional outcome. They remain involved after the surgeries to monitor ongoing maintenance programs that discourage the reemergence of muscle shortening as a functional problem.
Tendon Lengthening and Tendon Transfer