- Tensioning the Graft:
- as a muscle is tensioned to mid stretch, most of the potential energy generated results from passive tension of elastic recoil;
- note that the tenodesis effect can effectively increase tendon excursion by 2-3 cm;
- Mayer's Rule:
- origin is brought as close as possible to the insertion and the tendon is then sutured w/ no tension;
- the greatest contraction force is exerted when a muscle is at resting length (on Blix curve);
- flexor to extensor transfer:
- it is permissible to error slightly on the side of over-tensioning;
- w/ slight overtensioning, the patient may have difficulty in achieving full flexion, however, there will be no difficulty in achieving full extension;
- in addition, many of these patients will regain full flexion w/ time;
- extensor to flexor transfer:
- take care not to over tension the graft;
- overtensioning will lead to flexion contracture of the digit;
Excursion of prime wrist tendons.
The technique and timing of tendon transfers.
Omer GE. Orthop Clin North Am. 1974;5:243.