Protection of the deltoid to triceps tendon transfer repair sites

The posterior deltoid muscle was used to replace lost elbow extension in 11 patients with C5 or C6 level tetraplegia. During surgery stainless steel s utures were inserted into the donor muscle, graft, and tendon insertion sit es. Over the succeeding time periods (1 month to 2 years) the distances bet ween the various markers were measured. Significant tendon elongation of 23 .1 +/- 4.8 mm (mean +/- SEM; n = 6) was observed in patients receiving trad itional postoperative care. To reduce the tendon elongation observed, a spe cially designed armrest was developed and applied the first postoperative d ay. The armrest was designed to maintain the elbow in 20 degrees flexion an d to prevent shoulder adduction. The addition of this armrest to the tradit ional postoperative protocol resulted in a dramatic decrease of tendon elon gation to only 8.4 +/- 3.0 mm (n = 5). Elongation occurred within the first 6 postoperative weeks in the armrest group; in the nonprotected group, elo ngation continued for several additional months. The majority of the elonga tion in both groups occurred in the proximal portion of the tendon-graft-te ndon unit. Although this study did not explicitly measure strength, we conc lude that preventing excessive muscle length change is required to protect repair sites in posterior deltoid to triceps transfer. Copyright (C) 2000 b y the American Society for Surgery of the Hand.