Tenodesis Dnb ortho question - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE - Orthodnb.com

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE - Orthodnb.com

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Friday 12 May 2017

Tenodesis Dnb ortho question


  • 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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