Protection of the deltoid to triceps tendon transfer repair sites

The posterior deltoid muscle was used to replace lost elbow extension in 11 patients with C5 or C6 level tetraplegia. During surgery stainless steel sutures were inserted into the donor muscle, graft, and tendon insertion sites. Over the succeeding time periods (1 month to 2 years) the distances between the various markers were measured. Significant tendon elongation of 23.1 +/- 4.8 mm (mean +/- SEM; n = 6) was observed in patients receiving traditional postoperative care. To reduce the tendon elongation observed, a specially designed armrest was developed and applied the first postoperative day. The armrest was designed to maintain the elbow in 20 degrees flexion and to prevent shoulder adduction. The addition of this armrest to the traditional postoperative protocol resulted in a dramatic decrease of tendon elongation to only 8.4 +/- 3.0 mm (n = 5). Elongation occurred within the first 6 postoperative weeks in the armrest group; in the nonprotected group, elongation continued for several additional months. The majority of the elongation in both groups occurred in the proximal portion of the tendon-graft-tendon unit. Although this study did not explicitly measure strength, we conclude that preventing excessive muscle length change is required to protect repair sites in posterior deltoid to triceps transfer. (J Hand Surg 2000; 25A:144-149.