Tenotomy is a common orthopedic procedure involving the surgical modification of a tendon. This technique is specifically designed to address issues of excessive tension or contracture within a tendon that restricts normal movement and function. The goal is to either lengthen a tendon that has become too short or tight, or to release it entirely to restore a balanced range of motion to a joint. Tenotomy is often considered after non-surgical methods like physical therapy and bracing have failed to resolve the underlying mechanical problem. It is a precise intervention used across various medical specialties to improve mobility and reduce pain caused by restrictive soft tissues.
Defining the Procedure and Mechanism
Tenotomy corrects a structural imbalance within the musculoskeletal system. The fundamental mechanism involves cutting or dividing the tendon fibers to achieve a controlled lengthening or release. This physical alteration reduces the restrictive pull that a taut muscle or scarred tissue places on a joint.
By releasing this mechanical tension, the procedure allows the associated joint to move into a more natural, functional position. In cases of chronic tendon pain, percutaneous tenotomy can also stimulate the body’s natural healing response. Creating small, controlled injuries helps introduce fresh blood and inflammatory cells. This prompts tissue repair and regeneration by transforming a chronic, non-healing injury into an acute one.
Common Applications of Tenotomy
Tenotomy is utilized for conditions ranging from congenital deformities to chronic, acquired tendon injuries. A recognized application is the treatment of congenital clubfoot, where an Achilles tenotomy is performed as part of the Ponseti method. This corrects the residual equinus, or downward-pointing, contracture of the foot.
The technique is also used to address muscle spasticity associated with neurological disorders, such as cerebral palsy. This may involve releasing tight tendons in the adductor muscles of the hip or the hamstrings, improving gait and overall mobility. For adults, tenotomy treats chronic tendon conditions like Achilles tendon contracture, which limits ankle movement.
Percutaneous tenotomy is frequently employed for chronic overuse injuries that have not responded to conservative care. These include tennis elbow, golfer’s elbow, and patellar tendon injuries (jumper’s knee). In these instances, the goal is often to break up damaged tissue within the tendon to promote healing.
Surgical Methods and Process
Tenotomy is performed using distinct technical approaches, primarily categorized as open or percutaneous. Open tenotomy involves a larger surgical incision to directly expose the tendon. This is typically reserved for more severe or complex contractures requiring visual precision. This approach allows the surgeon to cut the tendon completely or partially along its length to achieve the desired lengthening.
The percutaneous approach is minimally invasive, using a needle or small blade inserted through the skin. This method is often guided by ultrasound imaging, which provides the surgeon with real-time visualization of the tendon structure. Percutaneous tenotomy is quicker and typically performed under local anesthesia in an outpatient setting. During this procedure, the instrument is used to create multiple small perforations or to divide the tendon fibers without a large open incision.
Anesthesia varies by procedure. Percutaneous tenotomy often uses local anesthesia, sometimes with conscious sedation. Open procedures, or those involving more extensive corrections, usually require general anesthesia. Regardless of the technique, the procedure focuses on mechanically altering the tendon to immediately relieve tension and place the limb in a corrected position.
Recovery and Post-Operative Care
Post-operative care depends on the type of tenotomy and the tendon location. The affected limb is often immobilized in a cast, brace, or splint to maintain the joint’s newly corrected position, allowing the lengthened tendon time to heal.
Pain management typically involves NSAIDs or prescription medication, along with elevating the limb to control swelling. Patients undergoing percutaneous procedures are often advised to avoid anti-inflammatory drugs, as healing relies on a controlled inflammatory response. Returning to light activities takes a few days to a week, but intense exercise may take several months.
Physical therapy is necessary for long-term success. Rehabilitation focuses on restoring functional range of motion and preventing stiffness. As the tendon heals, therapy progresses to strengthening exercises to rebuild muscular support. Temporary swelling and stiffness are expected outcomes managed through therapy.