Tendon Transfer Surgery Research Articles

Functional Outcome of Tibialis Posterior Tendon Transfer to Tibialis Anterior & Peroneus Longus among Foot Drop Patients- a Prospective Study

Introduction: Foot drop is described as the loss of active ankle dorsiflexion due to neurologic, systemic, or traumatic causes. The purpose of this study was to assess the functional outcome of tibialis posterior tendon transfer to tibialis anterior and peroneus longus in patients with foot drop. Aim of the study: The aim of this study was to evaluate the functional outcome of tibialis posterior tendon transfer to tibialis anterior and peroneus longus in patients with foot drop. Methods: This study was a randomized clinical trial that evaluate the results of tibialis posterior tendon transfer surgeries for patients with foot drop. The patients met certain inclusion and exclusion criteria, and gave written consent before the surgeries. The patients were followed up for six months after the surgery, and evaluated using the Stanmore assessment questionnaire and other measures. Result: The study enrolled 30 patients (26 males and 4 females) with mean age being 35.40 years. We evaluate tibialis posterior tendon transfer to tibialis anterior and peroneus longus for foot drop in the patients. After 24 weeks, all patient improved in foot dorsiflexion, eversion, function, posture, and satisfaction. 26 (86.70%) patients did not need orthosis and 28 (93.30%) had balanced foot posture with no deformity. Conclusion: The results showed all patient had significant improvement after the surgery. Therefore, this study concluded that tibialis posterior tendon transfer can be used effectively and safely for the management of foot drop.

Expected outcome for reconstructive hand surgery after spinal cord injuries related to level of injury and sex.

This retrospective, multicentre study maps grip strength and grasp ability after tendon transfer surgery in patients with tetraplegia. Data were analysed in the whole group and in subgroups stratified into the International Classification for Surgery of the Hand in Tetraplegia (ICSHT) and sex. In total, 200 arms (143 patients) had tendon transfer surgery to restore grip and pinch function, 74% were men, 42% were ICSHT group ≤3 and 58% ICSHT were group ≥4. The one-year outcome across all participants for grip strength was 5.2 kg, pinch strength 2.1 kg and a score of 108 for the Grasp and Release test. Men had significantly higher grip and pinch strength compared to women, while there was no significant difference with respect to grasp ability. ICSHT group ≥4 had significantly higher grip strength and grasp ability compared to ICSHT group ≤3, whereas no significant difference in pinch strength between ICSHT groups was seen.Level of evidence: III.

Effect of Muscle Strength on Functionality after Shoulder Tendon Transfer in Brachial Plexus Birth Injury: Is There a Relationship between Them?

Secondary problems in BPBI occur due to decreased muscle strength in the upper extremities. Comprehensive assessment methods are necessary to understand structural problems and to plan appropriate interventions in children with BPBI. We investigated the relationship between distal muscle strength, range of motion (ROM), and functionality by comparing distal muscle strength on the affected and unaffected sides in patients with BPBI who underwent shoulder tendon transfer. A total of 25 children with BPBI, 13 (52%) girls and 12 (48%) boys, aged 4-7 years (mean age: 5.98 ± 1.27 years), who had undergone shoulder tendon transfer surgery at least one year prior to the study were included. The muscle strength of the elbow, forearm, and wrist were assessed using the MicroFET®2 Digital Hand Dynamometer. The ROM of the elbow, forearm, and wrist were measured using the universal goniometer. The Pediatric Evaluation of Disability Inventory (PEDI) was used for functionality assessment. The strength of the elbow flexor-extensor, forearm pronator-supinator, and wrist extensor muscles on the affected side was greater than on the unaffected side in all children (p < 0.001). No correlation was found between muscle strength, ROM, and functionality in the affected extremity (p > 0.005). Although children with BPBI have good shoulder function after shoulder tendon transfer, structural problems in the distal joints may affect their functionality during daily life. Distal joint strengthening and ROM exercises, as well as bimanual functional activities, should be included in the rehabilitation programs of children with BPBI after shoulder tendon transfer.

Results of Tendon Transfers in Radial Nerve Palsies: A New Evaluation Protocol.

Radial nerve palsies present a challenging clinical scenario, often leading to substantial functional impairment. This study focuses on evaluating the outcomes of tendon transfer surgeries in patients with post-traumatic radial nerve injuries. The radial nerve, vital for upper limb movements, faces various etiologies, such as trauma, compression, or idiopathy. Patients with radial nerve palsy encounter difficulties in daily activities, emphasizing the need for effective management strategies. The research introduces a novel evaluation protocol, aiming to comprehensively assess tendon transfer outcomes. This protocol incorporates functional movements of wrist and finger joints, encompassing both objective and subjective parameters. The retrospective study includes eleven patients treated between 2010 and 2022, with a minimum follow-up of one year post-surgery. Tendon transfers demonstrated positive results. The evaluation protocol covers a wide range of parameters, including wrist and finger mobility, thumb function, grip strength, and patient satisfaction. The results indicate successful restoration of motor function, with an average grip strength of 70% compared to the healthy arm. The proposed evaluation protocol facilitates standardized and reproducible assessment, minimizing subjective errors in clinical evaluations. Despite the study's limitations, such as a relatively small sample size, the findings underscore the effectiveness of tendon transfers in treating radial nerve palsies. The introduced evaluation scheme provides a comprehensive and reproducible approach to assess outcomes, contributing to the global standardization of tendon transfer assessments in radial nerve injuries.

Accessing Rehabilitation after Upper Limb Reconstructive Surgery in Cervical Spinal Cord Injury: A Qualitative Study

Objectives: To investigate the barriers and facilitators to rehabilitation experienced by individuals with cervical SCI after upper limb (UL) reconstructive surgery. Methods: We conducted a prospective cohort study with a follow-up period of up to 24 months. Data collection occurred at two academic and two Veterans Affairs medical centers in the United States. Participants were purposively sampled and included 21 adults with cervical SCI (c-SCI) who had received nerve or tendon transfer surgeries and 15 caregivers. We administered semi-structured interviews about participants' experiences of accessing rehabilitation services after surgery. Results: Four themes emerged from the data: (1) participants encountered greater obstacles in accessing therapy as follow-up time increased; (2) practical challenges (e.g., insurance coverage, opportunity costs, transportation) limited rehabilitation access; (3) individuals with c-SCI and their caregivers desired more information about an overall rehabilitation plan; and (4) external support systems facilitated therapy access. Conclusion: Individuals with c-SCI experience multilevel barriers in accessing rehabilitation care after UL reconstructive surgeries in the United States. This work identifies areas of focus to mitigate these challenges, such as enhancing transparency about the overall rehabilitation process, training providers to work with this population, and developing, testing, and disseminating rehabilitation protocols following UL reconstruction among people with c-SCI.

Introducing the Principles of Tendon Transfer for Surgical Trainees to Improve Anatomical Knowledge

Introduction: Surgeons require procedural experience and a clear understanding of the anatomy and biomechanics of the muscles to successfully examine patients and accurately execute tendon transfer operations. Aims: The purpose of the study was to identify the principles of tendon transfer surgeries, develop a training package that focused on anatomical knowledge gaps and evaluate its effectiveness. Methods: A systematic literature review was performed to identify the principles of tendon transfers and areas of insufficient knowledge in these surgeries. 128 eligible studies were extracted through an online database search. Clinical case examples from these papers were used to develop a training package to educate trainees. The effectiveness of the training package was evaluated by a questionnaire which captured the familiarity of the trainees with the material taught. Results: The systematic review highlighted 8 main principles of successful tendon transfer procedures. The questionnaire outcome revealed 66% of attendees at the annual surgeons in training workshop recognised the need to have a firm understanding of anatomy. 70% of attendees reported a significant enhancement in their basic scientific understanding and an overwhelming 90% observed an improvement in their anatomical knowledge. 90% expressed confidence in the training provided and its prospects of improving their chances of success in their surgical examination and would therefore recommend the training to others. Conclusion: Case discussions are pivotal in improving trainee anatomical knowledge and surgical understanding. Therefore, directly refining patient assessment and achieving precise diagnosis. This coupled with applying the 8 principles will ultimately achieve more successful surgical outcomes in tendon transfer surgeries.

New dynamic suture material for tendon transfer surgeries in the upper extremity – a biomechanical comparative analysis

BackgroundEarly mobilization after tendon surgery is crucial to avoid commonly observed postoperative soft tissue adhesions. Recently, a new suture was introduced (DYNACORD; DC) with a salt-infused silicone core designed to minimize laxity and preserve consistent tissue approximation in order to avoid gap formation and allow early mobilization.AimsTo compare the biomechanical competence of DC against a conventional high strength suture (FiberWire; FW) in a human cadaveric tendon transfer model with an early rehabilitation protocol.MethodsSixteen tendon transfers (flexor digitorum superficialis (FDS) IV to flexor pollicis longus (FPL)) were performed in 8 pairs human cadaveric forearms using either DC or FW. Markings were set 0.8 cm proximally and 0.7 cm distally to the level of the interweaving zone of the transfer. All specimens underwent repetitive thumb flexion against resistance in 9 intermittent series of 300 cycles each, simulating an aggressive postoperative rehabilitation protocol. After each series, the distance of the proximal marker to the interweaving zone (proximal), the length of the interweaving zone (intermediate) and the distance of the distal marker to the interweaving zone (distal) were measured.ResultsPooled data over all nine series, normalized to the immediate postoperative status, demonstrated no significant differences between FW and DC (p ≥ 0.355) for the proximal and distal markers. However, at the intermediate zone, DC was associated with significant length shortening (p < 0.001) compared to FW without significant length changes (p = 0.351). Load to catastrophic failure demonstrated significant higher forces in FW (p = 0.011). Nevertheless, due to failure mainly proximal or distal of the transfer zone, these loads are not informative.ConclusionFrom a biomechanical perspective, DC preserved tissue approximation and might be considered as a valid alternative to conventional high-strength sutures in tendon transfer surgery. DC might allow for a shorter interweaving zone and a more aggressive early postoperative rehabilitation program, possibly avoiding commonly observed postoperative soft tissue adhesions and stiffness.

Upper Extremity Surgery in Cervical Spinal Cord Injury: A Prospective Comparative Mixed Methods Study.

Cervical spinal cord injury (SCI) is a devastating injury. Restoring upper extremity function is a top priority, which can be accomplished by tendon transfer (TT) and nerve transfer (NT) surgeries. The purpose of this prospective comparative study was to assess long-term changes in UE function between surgical (TT or NT) and non-surgical groups through a comprehensive mixed methods approach. This multicenter, cohort study compared data among three groups: those undergoing 1) no surgery 2) TT surgery, or 3) NT surgery. Quantitative data, the Spinal Cord Independence Measure (SCIM) and Short Form Health Survey (SF-36), was collected at baseline and long-term follow-up (6-24 months). Qualitative semi-structured interview data was also obtained from these participants and their identified caregivers at baseline, early follow-up (1 month), and long-term follow-up (6-24 months). Thirty-one participants had quantitative data across all timepoints: no surgery (n=14), TT (n=7), and NT (n=10). SCIM scores improved in TT and NT groups compared to the no surgery group (p<0.05). SF-36 scores did not differ among groups. Qualitative data analysis (n=168 interviews) corroborated SCIM findings: surgical participants and their caregivers reported improvement in transfers and ability to perform activities of daily living, including grooming and self-catheterization. Improved use of electronics and ability to operate a motor vehicle were also reported. Post-operative therapy was identified as a critical component of achieving gains. Both TT and NT surgery leads to quantitative and qualitative functional gains as compared to the no surgery group. This comparative information should be used to help surgeons discuss treatment options.

Examination of accessory extensor carpi radialis longus and brevis musculotendinous units for functional impact and tendon transfer suitability

IntroductionArchitectural characteristics of skeletal muscles are used to inform biomechanical analysis and candidacy for tendon transfer surgeries. Tendons of non-typical skeletal muscles may serve as optimal grafts, yet a thorough comparison of their parameters to those of typical musculature is not well represented in current literature. This study aims to analyze accessory extensor carpi radialis longus (aECRL) and accessory carpi radialis brevis (aECRB) muscles for their functional impact and suitability for use in tendon transfer surgeries. MethodsOut of 122 dissected forearms examined, one right aECRB and one left aECRL were discovered and photographed in situ. The accessory muscles, along with eleven other muscles associated with ECRL and ECRB tendon transfers from the same forearms, were analyzed for their sarcomere contraction states, structural properties, and maximal isometric force (Fmax) generating capacities. An architectural difference index was then calculated between each muscle to determine and discuss possible candidates for tendon transfer surgeries. ResultsThe Fmax of aECRL, ECRL, aECRB, and ECRB were determined to be 11.78 N, 57.24 N, 28.21 N, and 78.64 N, respectively. In this regard, aECRL and aECRB represented a 20.58% and 35.87% increase to ECRL and ECRB Fmax, respectively. The aECRL inserted with ECRB, and the aECRB inserted with ECRL. The aECRL and aECRB tendons, measuring 188.33 mm × 2.98 mm and 217.17 mm × 3.00 mm respectively, coursed independently with the ECRL and ECRB tendons to their shared insertions. The aECRL and aECRB muscles were each most structurally similar to the extensor pollicis longus and adductor pollicis muscles. ConclusionsBased on their morphology and structural characteristics, the aECRL and aECRB may be suitable grafts in adductorplasty or for extensor pollicis longus muscle/tendon repair. As the aECRL and aECRB tendons were relatively superficial and considerably long and wide, they may also be suitable for other musculotendon-based surgeries elsewhere in the body. This report may contribute new and beneficial insights for healthcare providers and medical educators when presented with cases where upper extremity musculotendinous reconstruction is warranted and/or non-typical musculoskeletal morphologies – particularly aECRL and aECRB – are present.

Comparing surgeries to restore upper extremity function in tetraplegia: Impact on function during the perioperative period

Context/Objective To assess short-term changes in health outcomes in people with cervical-level spinal cord injury (SCI) who underwent upper extremity (UE) reconstruction via either novel nerve transfer (NT) or traditional tendon transfer (TT) surgery with individuals who did not undergo UE surgical reconstruction. Design Prospective, comparative cohort pilot study. Participants 34 participants with cervical SCI met the following inclusion criteria: age 18 or older, greater than 6 months post-injury, and mid-cervical level SCI American Spinal Injury Association Impairment Scale (AIS) A, B or C. Setting Two tertiary academic hospitals and their affiliated veterans’ hospitals. Methods Health outcomes were assessed using two previously validated measures, the Spinal Cord Independence Measure (SCIM) and Short-Form Health Survey (SF-36). Demographic, surgical, and survey data were collected at the initial evaluation and one month postoperatively/post-baseline. Results 34 participants with cervical SCI were recruited across three cohorts: no surgery (n = 16), NT (n = 10), and TT (n = 8). The TT group had a decline in SCIM and SF-36 scores whereas the NT and no surgery groups experienced little change in independence or health status in the immediate perioperative period. Conclusions Surgeons and rehabilitation providers must recognize differences in the perioperative needs of people with cervical SCI who chose to have restorative UE surgery. Future work should focus on further investigation of health outcomes, change in function, and improving preoperative counseling and cross-disciplinary management.

A scoping review of tendon transfer surgeries and postsurgical physical therapy interventions in individuals with massive rotator cuff tears.

To identify tendon transfer surgeries and postsurgical physical therapy interventions in people with massive rotator cuff (RC) tears. The literature search was conducted in the MEDLINE, Science Direct, Scopus, Web of Science, and PEDro databases from inception to September 2022. Studies with patients diagnosed with massive RC tears undergoing tendon transfers that reported physical therapy interventions after surgery were included. Two reviewers pooled the data into ad hoc summary tables with the following information: authors, year, study characteristics (sample size, tendon transfer surgical used, approach type, preoperative risk, deficit addressed, additional surgical interventions), and physical therapy interventions (early stage, intermediate stage, and advanced stage). Forty-four articles (59.0% case series) were included, with a total sample of 1213 participants. The most frequently used surgery was the isolated tendon transfer of the latissimus dorsi (49.1%). Most of the studies reported three main stages of physical therapy interventions after tendon transfer surgery: early stage (lasting 5-6 weeks), intermediate stage (started at 7-12 weeks), and advanced stage (started at 12 weeks). Physical therapy interventions included passive, active-assisted, resisted therapeutic exercise, and hydrotherapy. The evidence regarding physical therapy interventions after RC tendon transfer surgery is limited to the number and duration of the stages and general characteristics without specifying the type and dose of the interventions. Future research with high methodological quality should integrate more detailed rehabilitation protocols to better guide therapeutic decisions after RC transfer surgery.

Tendon Transfers to Improve Grip and Pinch in Patients with Sporadic Inclusion Body Myositis.

Sporadic inclusion body myositis (sIBM) is a rare and slowly progressive skeletal muscle disease that can cause hand dysfunction, which is a major source of disability. Tendon transfers have been reliably used to improve function in other neuromuscular settings. Given that sIBM patients often present with flexion impairments and mostly functioning extensors, we investigated the potential opportunity for tendon transfer surgery to improve hand dysfunction in sIBM patients. We conducted a scoping review for studies of sIBM and tendon transfers, extracted descriptions of hand function and surgical technique, and recorded results in terms of hand function. We also conducted an institutional review board-approved survey with 470 participants to determine baseline patient-reported function and to determine participant perceptions and expectations for tendon transfer surgery to improve hand function in sIBM. We identified three published case reports on tendon transfers in sIBM patients with subjectively improved grip and pinch strength, but standardized measures of hand function or quality-of-life were not reported. Within the surveyed cohort, half of participants reported that they would consider surgery, yet only 8% had been referred to a hand surgeon. Fifty four percent of participants reported that they would consider surgery if there would be 1-2 years of benefit after surgery. All participants who would consider surgery also had significant upper extremity disability. Tendon transfer surgery has the potential to improve quality-of-life for sIBM patients, and there is significant patient interest in this approach. To objectively assess its efficacy, we propose conducting a surgical trial.

Robot-assisted orthopedic surgeries around shoulder joint: where we are?

This study aims to comprehensively review the current literatures about robot-assisted techniques for shoulder joint arthroplasty and also in experimental articles or case series about around shoulder soft tissue surgeries including arthroscopy, tendon transfer and brachial plexus surgeries. This article evaluates the existing literature and clinical studies to suggests future direction of robotic-assisted techniques in shoulder joint surgeries. Robotic surgery has emerged as an innovative and transformative technology in orthopedics, offering advancements in surgical precision and optimization particularly during total hip and knee arthroplasty. In shoulder joint, patients specific instrumentation with preoperative planning and intraoperative navigation system are being used. Robotic-assisted shoulder arthroplasty will be introduced. In soft tissue surgery, robot-assisted tendon transfer and around brachial plexus surgeries is being clinically tried. In additions, postoperative robot-assisted rehabilitation after may have potential advantages. With the overall development of several industries including robotic technology, robot-assisted pre-, intra- and post-operative techniques could be an essential part of the overall shoulder surgery. However, further research and larger-scale studies are needed to establish its long-term efficacy, and potential complications.

Measurement of the Three-Dimensional Muscle Endpoint Forces in the Extended Thumb and Its Application to Determining Muscle Combinations that Enable Lateral Pinch Force Production Throughout the Plane of Flexion-Extension.

Functional outcomes of tendon transfer surgeries, designed to restore lateral pinch grasp to persons following cervical spinal cord injury, have been mixed. That is, pinch force magnitudes have varied by 10-fold and have been reported to be as low as low as tenths of a pound. We believe a novel tendon transfer approach in which the donor muscle actuates a small group of paralyzed thumb muscles, instead of just the flexor pollicis longus (FPL) muscle (the current approach), will enable endpoint forces that are better directed and therefore a consistently stronger pinch force following surgery. We further believe that such surgeries can be better designed to account for grasp force production throughout the entire plane of flexion-extension if muscle endpoint forces in the extended thumb are known. Consequently, we measured muscle endpoint forces in the extended thumb in 6 cadaveric specimens after a force of 10 N was applied to each muscle. Further, we simulated a tendon transfer surgery in which the donor muscle applied equal force to each muscle in 246 small groups of muscles, calculated the direction of the resulting endpoint force throughout the flexion-extension plane, and determined if those groups of muscles produced a better directed force than FPL's. While we found that 3 individual muscles and 52 muscle groups could produce desirably directed endpoint forces in parts of the flexion-extension plane, no muscle or muscle group could produce well-directed endpoint forces throughout the flexion-extension plane. We concluded that a group of muscles could likely be found if the donor muscle provided different levels of force to each of the muscles in a muscle group. This would be possible through intentional geometric manipulation of the donor-to-recipient muscle attachment to allow for unequal splitting of donor muscle force.Clinical Relevance-This work aims to determine whether the same combination of thumb muscles can produce well-directed endpoint forces throughout the flexion-extension plane. If so, then this work informs surgeons which muscle groups could be involved in a tendon transfer to restore lateral pinch grasp ability throughout the plane of flexion-extension in person with cervical spinal cord injury.

Assessing an Online Patient Decision Aid about Upper Extremity Reconstructive Surgery for Cervical Spinal Cord Injury: Pilot Testing Knowledge, Decisional Conflict, and Acceptability.

People with cervical spinal cord injury prioritize gaining upper extremity function after injury, but few individuals receive information about treatment options.A newly created patient decision aid (PtDA) provides information about recovery after spinal cord injury and the role of traditional tendon and newer nerve transfer surgery to improve upper extremity upper extremity function.The PtDA improved knowledge and decreased decisional conflict in this pilot study.Future work should focus on studying dissemination and implementation of the ptDA into clinical practice.

The Incidence of Palmaris Longus Muscle and Its Association with the Biodemographic Data of Medical and Allied Health Science Students

Background: The Palmaris longus (PL) muscle is one of the most anatomically variable muscles in the human body. The presence or absence of the muscle tendon is relevant information to hand and plastic surgeons. The muscle tendon can be harvested for reconstructive surgeries, tendon transfer and tendon surgeries, facial paralysis, repair ptosis, arthritis of the thumb and to repair oncologic defects of the head and neck. Therefore, this study aimed at identifying the incidence of PL and its association with the study participant’s age, gender and geo-political region of origin. Methods: This cross-sectional study was performed on students that were taught ‘muscles of the forearm’ during the 2021/2022 academic session of the Edo state university, Uzairue, Nigeria. Bio-demographic data was retrieved using a self-structured hard-copy questionnaire. Schaeffer’s, Thompson’s and Pushpakumar’s testing methods were used to assess the absence/presence of PL. Data was entered into Microsoft Office Excel 2019 and exported to IBM SPSS version 23 for analysis. Fisher’s and Pearson chi-square tests were used to determine association. Probability values &lt; 0.05 were accepted as significant. Results: Of the 294 enrolled students taught the topic “muscle of the forearm” during the 2021/2022 academic session, 269 (91%) students willingly participated in this study. 155 were females (57.6%), and 114 were males (42.4%). Out of the 269 students assessed, 253 (94.1%) students had the PL tendon in both hands, nine (3.3%) students didn’t have the tendon in both hands, seven (2.6%) students didn’t have the tendon in either the left hand (2.2%) or the right hand (0.4%). While, gender was a significant predictor for left- and right-hand values of the absence or presence of PL muscle tendon (p &lt; 0.05), age and geo-political zone of origin was not (p &gt; 0.05). Conclusion: The Palmaris muscle varied in only 5.9% of our study population. It was found that the occurrence of PL is gender dependent but not dependent on age or the individual’s region of origin. The absence of the muscle was common in females and on the left hand.

Caregiving for People With Spinal Cord Injury Undergoing Upper Extremity Reconstructive Surgery: A Prospective Exploration of Lived Experiences, Perioperative Care, and Change Across Time.

Nerve transfer (NT) and tendon transfer (TT) surgeries can enhance upper extremity (UE) function and independence in individuals with cervical spinal cord injury (SCI). Caregivers are needed to make this surgery possible, yet caregivers experience their own set of challenges. This comparative study explored the perioperative and nonoperative experiences of caregivers of individuals with cervical SCI, focusing on daily life activities, burden, and mental health. Caregivers of individuals with cervical SCI were recruited and grouped by treatment plan for the person with SCI: (1) no surgery (NS), (2) TT surgery, and (3) NT surgery. Semistructured interviews were conducted at baseline/preoperative, early follow-up/postoperative, and late follow-up/postoperative. Caregivers were asked about their daily life, mental health, and challenges related to caregiving. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Quantitative, single-item standardized burden score (0-100) data were collected at each timepoint. Participants included 23 caregivers (18 family members, 4 friends, 1 hired professional). The surgeries often brought hope and motivation for caregivers. Caregivers reported increased burden immediately following surgery (less for the NT compared to TT subgroup) yet no long-term changes in the amount and type of care they provided. NS caregivers discussed social isolation, relationship dysfunction, and everyday challenges. Health care providers should consider the changing needs of SCI caregivers during perioperative rehabilitation. As part of the shared surgical decision-making approach, providers should educate caregivers about the postoperative process and the extent and potential variability of short- and long-term care needs.

A Novel Passive Implantable Differential Mechanism to Restore Individuated Finger Flexion during Grasping following Tendon Transfer Surgery: A Pilot Study

Tendon transfer surgery is often used to restore hand grasp function following high median-ulnar nerve palsy. This surgery typically reroutes and sutures the tendon of the extensor carpi radialis longus (ECRL) muscle to all four flexor digitorum profundus (FDP) tendons of the hand, coupling them together. This makes it difficult to grasp irregularly shaped objects. We propose inserting a novel implantable passive device between the FDP tendons to surgically construct a differential mechanism, enabling the fingers to individually adapt to the irregular contours during grasping. These passive implants with no moving parts are fabricated from biocompatible materials. We tested the implants’ ability to create differential flexion between the index and middle fingers when actuated by a single muscle in two human cadaver hands using a computerized closed-loop control paradigm. In these cadaveric models, the implants enabled significantly more differential flexion between the index and middle fingers for a wide range of donor tendon tensions. The implants also redistributed fingertip forces between fingers. When grasping uneven objects, the difference in contact forces between fingers reduced by nearly 23% compared to the current suture-based surgery. These results suggest that self-adaptive grasp is possible in tendon transfers that drive multiple distal flexor tendons.

The efficacy of split tibial tendon transfers on functional gait outcomes for children and youth with cerebral palsy and spastic equinovarus foot deformities

To systematically review the efficacy of split tendon transfer surgery on gait-related outcomes for children and adolescents with cerebral palsy (CP) and spastic equinovarus foot deformity. Five databases (CENTRAL, CINAHL, PubMed, Embase, Web of Science) were systematically screened for studies investigating split tibialis anterior or split tibialis posterior tendon transfer for spastic equinovarus foot deformity, with gait-related outcomes (published pre-September 2022). Study quality and evidence were assessed using the Methodological Index for Non-Randomized Studies, the Risk of Bias In Non-Randomized Studies of Interventions, and the Grading of Recommendations Assessment, Development and Evaluation. Overall, 17 studies (566 feet) were included: 13 studies used clinical grading criteria to report a postoperative 'success' of 87% (75% to 100%), 14 reported on orthotic use with 88% reduced postoperative use, and one study reported on ankle kinematics improvements. Ten studies reported post-surgical complications at a rate of 11/390 feet (2.8%), but 84 feet (14.8%) had recurrent varus (68 feet, 12%) or occurrence of valgus (16 feet, 2.8%). Only one study included a patient-reported outcome measure (pain). Split tendon transfers are an effective treatment for children and youth with CP and spastic equinovarus foot deformities. Clinical data presented can be used for future study designs; a more standardized functional and patient-focused approach to evaluating outcomes of surgical intervention of gait may be warranted.

Expectant Management, Tendon Transfer, or Nerve Transfer Surgery for Radial Nerve Injury: A Qualitative Study Exploring Patient Expectations, Goals, and Treatment Experiences.

After a radial nerve injury, patients must weigh a complicated set of advantages and disadvantages to observation or surgery. We conducted semistructured interviews to characterize the decision-making process that these patients undertake. We recruited participants who were treated with expectant management (nonoperatively), received only a tendon transfer, or received a nerve transfer. Participants completed a semistructured interview that was transcribed and coded to identify recurring themes, to describe the influence of qualitative findings on treatment decision-making. We interviewed 15 participants (5 expectant management, 5 tendon transfer only, and 5 nerve transfer). Participants' primary concerns were returning to work, hand appearance, regaining motion, resuming activities of daily living, and enjoying hobbies. Delayed diagnosis and/or insurance coverage led 3 participants to change treatment from nerve transfer to isolated tendon transfer. Interactions with providers early in diagnosis and treatment had strong effects on how members of the care team were perceived. The hand therapist was the primary person who shaped expectations, provided encouragement, and prompted referral to the treating surgeon. Participants valued debate among the care team members regarding treatment, provided that medical terminology was explained. This study highlights the importance of initial, collaborative care in setting expectations for patients with radial nerve injuries. Many participants named returning to work and hand appearance as primary concerns. Hand therapists were the primary source of support and information during recovery. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.