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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