Mechanical considerations in the design of surgical reconstructive procedures

Tendon transfers are used to restore arm and hand function after injury to the peripheral nerves or after spinal cord injury. Traditional guidelines to choose the length at which the transferred muscle should be attached have a poor scientific foundation. We postulate that passive tension only becomes significant at relatively long lengths and that passive tension as the major factor in intra-operative decision making may result in overstretch of the muscle-tendon unit (MTU) and accompanying low-active force generation. It appears unwise to rely on unknown factors, such as slippage or stress relaxation, to correct an overstretched transfer. Instead, we suggest the use of intra-operative sarcomere length measurements to predict and set the optimal MTU length during reconstructive upper limb surgery.