ABSTRACT

The transfer of musculotendinous units is an example of reconstruction, a term which signifies operations other than nerve repair that are designed to restore function. These include the release or correction of fixed deformities and, on occasion, arthrodesis. Musculotendinous units are transferred to restore balance across joints and also to restore lost active movements of joints. The term tendon transfer, although convenient, is misleading. Restoration of joint balance and of active movement is done by transfer of a musculotendinous unit (MTU), and the integrity of that MTU rests on its blood supply and upon connection and integration with central nervous system pathways. Successful transfers require a degree of plasticity within the central nervous system. When antagonistic muscles are transferred, such as the tibialis posterior for dorsiflexion of the ankle or hamstring muscles for extension of the knee, it is a common experience to see the patient able, immediately upon removal of the plaster splint, to induce the desired movement. Disruption of these central connections presents difficulties which are, at times, insuperable, so that transfers in cerebral palsy are

less predictable than those for peripheral nerve injuries.