Fig. 123
Shortening a tendon.
It was a great service, in which perhaps Gluck figured most conspicuously, to show that when tendon ends could not be neatly coapted an animal material could be interposed in such a way as to serve as a trellis along which cells could group, or around which they might organize, and thus gradually and finally become a part of the complete tendinous cord. Silk and catgut have best served this purpose, and new tendons have gradually formed around these artificial substitutes, to the length of 10 Cm. In every fresh case where there has been such loss of original structure as to justify a measure of this kind, or in certain old cases where tendons have long since sloughed away, it may be possible to resort to these expedients.
It has been possible to transplant fresh tendons from the smaller animals and to see them serve the same purpose in a satisfactory manner.
Among these methods of tendoplasty is tendon grafting, by which a part or all of the tendon of an active muscle is inserted into the terminal portion of a paralyzed muscle and thus made to assume to a greater or less extent the purpose and function of the latter; in other words it assists in ingeniously diverting the activity and direction of a given muscle to a purpose different from its original intent. By this diversion a more equal or equable distribution of muscle force is afforded the parts into which the affected muscles are inserted. For its successful performance only those muscles which are still active can be utilized. Among the simplest of cases where this expedient can be used are those produced by traumatic and peripheral paralyses, or traumatic loss of a given tendon or a set of tendons. It is rarely to be practised as an emergency measure, but as an expedient to be availed of later. It finds its greatest usefulness in cases of long standing. It is equally applicable where muscles and tendons have been divided by injury, or paralyzed by injury to their nerve supply, as well as where deformities are produced by chronic neurotic disturbance, by scars, by excessive callus, etc. It proves equally serviceable in paralyses of spinal origin, particularly those due to anterior poliomyelitis.
Tendon grafting will serve both as a substitute in cases of lost function and as a provision against future deformity. In cases of the ordinary paralyses of children, tendoplasty should be deferred for several months after the occurrence of the paralysis. In the case of growing children it is desirable not to wait too long, as other objectionable features may present themselves. In the congenital and hereditary paralyses and in conditions like athetosis or the dystrophies of syringomyelia, meningocele, etc., also in such conditions as habitual dislocations of the patella, much can be accomplished by a carefully planned tendoplasty. It will be easily seen then how wide a field of usefulness lies before one who familiarizes himself with the recent technique of tendon surgery.
Fig. 124