J Hand Surg Eur Vol, 2019 · DOI: 10.1177/1753193419827814 · Published: May 1, 2019
Reconstructive upper extremity surgeries in tetraplegia are technically challenging because of the many complicated real-time decisions that need to be made, e.g. extent of release of donor muscle-tendon complex, routing of donor muscles, tissue preparation and optimization, tensioning of muscle-tendon units, balancing joints and suturing tendon-to-tendon attachments. Nerve transfer surgeries can add functionality but also make the reconstruction planning more complex. In this overview, we present some of the fundamental muscle-tendon-joint mechanics studies that allow for single-stage surgical reconstruction of hand function as well as early postoperative activity-based training in patients with cervical spinal cord injuries.
The 'Alphabet operation' demonstrates how multiple clinical ideas collected over the years have been tested and developed in the biomechanics laboratory before implemented in surgical practice.
Implementing early and rigorous active training of restored functions together with careful and guided mobilization of the tenodeses, adhesions can be avoided and recruitment of transferred muscles can be initiated early.
The current trend is to direct the treatment towards restoring abilities more than just functions. Of course, the available surgical treatments depend of level of lesions, i.e. the lower level of cervical spinal cord injury, the more available motors for nerve and tendon transfer.