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Asynchronous Muscle and Tendon Adaptation After Surgical Tensioning Procedures

Takahashi, Mitsuhiko MD, PhD; Ward, Samuel R. PT, PhD; Marchuk, Linda L. BS; Frank, Cyril B. MD; Lieber, Richard L. PhD

Journal of Bone & Joint Surgery - American Volume: March 2010 - Volume 92 - Issue 3 - p 664–674
doi: 10.2106/JBJS.I.00694
Scientific Articles
Supplementary Content

Background: Donor muscles are often highly stretched in tendon transfer surgery. Despite literature reports that showed adaptation of the serial sarcomere number to moderate stretch, little is known regarding adaptation to stretch outside of the physiological range (commonly seen in clinical tendon transfer). This study was performed to evaluate muscle-tendon-unit adaptation to tendon transfer surgery in an animal model.

Methods: Thirty-seven male New Zealand White rabbits were used for muscle analysis, and twenty-five of those rabbits were also used for biological analysis of the tendons after the experiment. The extensor digitorum muscle of the second toe was transferred at a specific sarcomere length of 3.7 μm, chosen to be near the end of the descending limb of the rabbit sarcomere length-tension curve. Animals were killed at five time points, at which complete muscle architectural analysis as well as measurements of tendon dimension, tendon water content, and tendon cytokine transcript levels were performed.

Results: As expected, a rapid increase in the serial sarcomere number (mean and standard error of the mean, 4658 ± 154 in the transferred muscle compared with 3609 ± 80 in the control muscle) was found one week after the surgery. From this time point until eight weeks, this increased serial sarcomere number paradoxically decreased, while the sarcomere length remained constant. Eventually, at eight weeks, it reached the same value (3749 ± 83) as that in the control muscle (3767 ± 61). Tendon adaptation was delayed relative to muscle adaptation, but it was no less dramatic. Tendon length increased by 1.43 ± 0.74 mm over the eight-week time period, corresponding to a strain of 15.55% ± 4.08%.

Conclusions: To our knowledge, this is the first report of biphasic adaptation of the serial sarcomere number followed by tendon adaptation, and it indicates that muscle adapts more quickly than tendon does. Taken together, these results illustrate a complex and unique interaction between muscles and tendons that occurs during adaptation to stretching during tendon transfer.

Clinical Relevance: Understanding the time course of muscle-tendon-unit adaptation can provide surgeons with information to guide postoperative care following tendon transfers as well as guidelines for tensioning muscles during tendon transfer.

1Departments of Orthopaedic Surgery (M.T. and R.L.L.), Radiology (S.R.W.), and Bioengineering (R.L.L.), University of California and Veterans Affairs Medical Center, San Diego, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail address for R.L. Lieber: rlieber@ucsd.edu

2McCaig Center for Joint Injury and Arthritis Research, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB T2N 4N1, Canada

Copyright 2010 by The Journal of Bone and Joint Surgery, Incorporated
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