A CLINICAL EVALUATOIN OF TENDON TRANSPLANTATIONS FOR POLIOMYELITIS AFFECTING THE LOWER EXTRENMITIES

¹ Division of Orthopaedic Surgery, College of Medicine, University of Vermont; Crippled Children's Division, State Department of Health, Burlington, Vermont

Any reported investigation would be remiss not to reiterate the general principles of tendon transplantation which have been carefully formulated by earlier observers. This study confirms many of these principles, and they are here recounted:

1. Proper selection of cases: It seems wise to wait at least twelve months, preferably from eighteen to twenty-fourr months, after the onset of poliomyelitis before tendon transplantation is considered. The passage of time will delineate the muscle strength of the individual muscle groups. Unless the deforming pull is a pernicious force, causing a rapidly progressive deformity, it seems inadvisable to transplant any tendon in a patient younger than five years of age. The proper selection of the tendons to be transferred, in regard to their strength, size, and anatomical position, is mandatory.

2. Correction of fixed deformities: Any existing deformity must be corrected, preferably prior to, or at least. concomitant with, the tendon transplantation, either by manipunlation, ligamentous procedure, or bone operation.

3. Adherence to standard operative plans and techniques: The operative plan should be simple. Complicated tendon transference and multiplicity of tendon transplantation should be avoided. The delicate handling of the tendon during the operative procedure with preservation of the peritenon and with transplantation to the new insertion through a tendon sheath seems highly desirable. The straight-line pull of the transferred tendon should be firmly anchored to bone, reinforced by the overlying periosteum, and with just the "right amount" of tension to hold securely the part in the corrected position.

4. Attention to postoperative fixation and care: This should be sufficiently long to allow firm fixation of the transplanted tendon to occur; at least three, and usually six weeks are necessary.

5. Attention to convalescent protection and care: Continued protection of the transplanted tendon by a suitable orthopaedic appliance worn during the day with a protective splint or a retention cast at night seems desirable for a six months' period. Protective shoe corrections for an additional six months will prove advantageous. Functional exercises for the transplanted tendon should be encouraged as soon as firm fixation has taken place and should be checked clinically at regurlar periods. The results of this clinical study seem to indicate that, with the exception of the group with tendon transplantations about the knee, in which objective improvement was slight, tendon transference, as performed in the region of the ankle and foot, particularly when combined with tarsal arthrodesis, is a feasible and successful orthopaedic procedure. It should be emphasized that the success of the procedure depends upon the proper selection of cases and the rigid adherence to the other criteria for tendon transplantation.

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