Tenodesis Dnb ortho question

TENODESIS

• tendon fixation or suturing of tendon end to bone
• done to
• correct deformity
• reconstructive procedure for paralytic disorders of extremities
• stabilize joints

Deformity correction

• Hallux varus correction
  • extensor hallucis brevis tenodesis
  • distal part of tendon transected – passed deep to transverse metatarsal ligaments from distal to proximal – through hole drilled in I MT – corrects the deformity
• Correction of old mallet finger
  • palmaris longus tenodesis
  • reconstructs the oblique retinacular ligament to correct the swan neck deformity
• Swan neck deformity in CP
  • infrequent in CP
  • caused by intrinsic spasticity – quite disabling
  • secondary ligamentous and capsular relaxation at PIP cause this joints to hyperextension
  • Curtis sublimus tenodesis (FDS) of PIP improves function
• Calcaneovalgus deformity
  • tenodesis of achilles tendon to fibula
• Talipes calcaneus
  • rapidly progressive – paralytic deformity – gastrosoleus is paralyzed – other extrinsic foot muscles esp dorsiflexors of ankle remain functional
  • consider tendon transfer if muscles of adequate power available
  • if not consider tenodesis of achilles tendon to fibula (Westin)

Paralytic disorders

• Intrinsic paralysis of hand
  • Fowlers tenodesis
  • tendon graft is substituted for finger intrinsics
  • when wrist flexed – fixed length phenomenon exerted by tendon graft result in extension of IP joints
• Restore key pinch in quadriplegic
  • only if there is no muscle available for tendon transfer
  • Moberg key grip procedure
    • FPL tendon tenodesed to distal ulna
    • on wrist extension – volar pulp of thumb contact the radial side of index finger
    • stabilization of thumb IP and MCP needed
    • A1 pulley release to increase the torque
  • Brand modification of Moberg procedure
    • A1 pulley left intact
    • FPL routed across palm – beneath the flexor tendons – through Guyon canal – tenodesed to distal radius
• Irreparable damage to FDP
  • done when tendon grafting is impossible
  • tenodesis keeps the joints partially flexed and stabilized
  • gets a functionally more useful position

Stabilization procedures

• Triple tenodesis of genu recurvatum
  • proximal advancement of posterior capsule of knee
  • semitendinosus and gracilis tendons used to create check rein in midline posteriorly
  • biceps and anterior half of iliotibial band used to create two diagonal straps posteriorly
• Extra articular procedure for ACL reconstruction
  • MacIntosh iliotibial band tenodesis
• Ankle joint weakness due to peroneal tendon weakness
  • Peroneus brevis tendon tenodesis by Myerson
• Stabilize unstable proximal ulnar segment after distal ulnar excision
  • tenodesis of ECU and transfer of PQ
  • or combined tenodesis of FCU and ECU

Other indications

• Distal peroneus longus tendinitis associated with Os peroneum
  • debridement of peroneus longus tendon
  • removal of os peroneum
  • tenodesis of peroneus longus to peroneus brevis
• Proximal rupture of biceps tendon
  • proximal end of tendon detached from glenoid
  • end of tendon rolled and sutured or knotted
  • knot is inserted in the cortex of humerus in floor of bicipital groove

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