The Journal of Bone and Joint Surgery (American). 2006;88:2009-2016.
doi:10.2106/JBJS.E.00973
© 2006 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activities for this article:
 CME 3: July, August, September 2006 (publication date October 5, 2006; expi...
Hand Test 6: Fall 2006 (publication date November 15, 2006; expiration date...
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Murray, W. M.
Right arrow Articles by Lieber, R. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Murray, W. M.
Right arrow Articles by Lieber, R. L.
Related Collections
Right arrow Hand/Wrist
Right arrow Rehabilitation
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Variability in Surgical Technique for Brachioradialis Tendon Transfer

Evidence and Implications

Wendy M. Murray, PhD1, Vincent R. Hentz, MD2, Jan Fridén, MD, PhD3 and Richard L. Lieber, PhD4

1 The Bone and Joint Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (153), Palo Alto, CA 94304. E-mail address: murray{at}rrdmail.stanford.edu
2 Robert A. Chase Hand and Upper Limb Center, Department of Surgery, Stanford University and Veterans Administration Medical Center, 770 Welch Road, #400, Stanford, CA 94304-5775
3 Department of Hand Surgery, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden
4 Departments of Orthopaedics and Bioengineering, University of California and Veterans Administration Medical Centers, 9500 Gilman Drive, La Jolla, CA 92093-9151

Investigation performed at VA Palo Alto Health Care System, Palo Alto, California, and Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Rehabilitation Research and Development Service of the Department of Veterans Affairs (Palo Alto B2785R and San Diego A2626R) and the National Institutes of Health (RO1 HD046774 and RO1 HD048501). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Transfer of the tendon of the brachioradialis muscle to the tendon of the flexor pollicis longus restores lateral pinch function after cervical spinal cord injury. However, the outcomes of the procedure are unpredictable, and the reasons for this are not understood. The purpose of this study was to document the degree of variability observed in the performance of this tendon transfer.

Methods: The surgical technique used for the brachioradialis tendon transfer was assessed in two ways. First, the surgical attachment length of the brachioradialis was quantified, after transfer to the flexor pollicis longus, with use of intraoperative laser diffraction to measure muscle sarcomere length in eleven individuals (twelve limbs) with tetraplegia. Second, ten surgeons who regularly performed this procedure were surveyed regarding their tensioning preferences. Using a biomechanical model of the upper extremity, we investigated theoretically the effect of different surgical approaches on the active muscle-force-generating capacity of the transferred brachioradialis in functionally relevant elbow, wrist, and hand postures.

Results: The average sarcomere length (and standard deviation) of the transferred brachioradialis was 3.5 ± 0.3 µm. That length was significantly correlated to the in situ sarcomere length (r2 = 0.53, p < 0.05). Surgical tensioning preferences varied considerably; however, six of the ten surgeons positioned the patient's elbow between full extension (0° of elbow flexion) and 50° of flexion when selecting the attachment length, and six of the ten stated that their goal was to tension the transfer slightly tighter than its resting tension. The computer simulations suggested that a "tighter" brachioradialis transfer would produce its peak active force in an elbow position that is more flexed than the elbow position in which a "looser" transfer would produce its peak active force.

Conclusions: This study provides evidence that experienced surgeons perform this tendon transfer differently from one another. Biomechanical simulations suggested that these differences could result in substantial variability in the active force that the transferred brachioradialis can produce in functionally relevant postures.

Clinical Relevance: The surgical attachment length and the position of the patient's limb at the time of tendon transfer are both controllable and measurable parameters. Understanding the relationship between surgical technique and postoperative muscle function may provide surgeons with more control of clinical outcomes.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?