General principles of tendon transfers: The ten commandments

Area of Science:

• Orthopedics
• Hand Surgery
• Rehabilitation Medicine

Background:

• Tendon transfers are a surgical technique that modifies a muscle's function by changing its point of force application.
• While less common due to advances in nerve repair, understanding tendon transfers remains crucial for hand surgeons.
• These procedures are applicable in various scenarios, including nerve trunk palsy, brachial plexus injuries, and upper limb tetraplegia.

Purpose of the Study:

• To highlight the principle and utility of tendon transfers in functional restoration.
• To emphasize the importance of adhering to established guidelines for optimal outcomes.
• To discuss the role of tendon transfers in conjunction with other palliative procedures.

Main Methods:

• The study is based on the principle of altering distal insertions of muscles to change their functional outcome.
• It references a proposed set of guidelines, the "Ten Commandments," for the application of tendon transfers.
• The discussion considers the availability of donor muscles and the combination with other surgical interventions like arthrodesis and tenodesis.

Main Results:

• Tendon transfers, when performed according to proposed guidelines, can yield good and useful functional recovery.
• The success of the transfer is dependent on the number of available muscles for the procedure.
• These transfers are active treatments controlled by voluntary command.

Conclusions:

• Tendon transfers are valuable palliative treatments for restoring function in cases of nerve palsy and paralysis.
• They effectively re-allocate existing limb forces but do not generate new muscle power.
• Familiarity with tendon transfer principles and guidelines is essential for hand surgeons to achieve successful functional recovery.