Definition
The word tenotomy comes from the Greek (“tenon” = tendon and “tome” = cut) and means cutting of the tendon. If a cut occurs exactly at the transition between the tendon and the corresponding muscle, it is called a tenomyotomy (“myo” = muscle). In a fractional tenotomy, however, the muscular part is not touched.
Instead, two transverse incisions are made only in the area of the tendon, which should be about 2 cm apart. In addition, a distinction can be made between an open and a closed tenotomy. Open describes the procedure in which the tendon is first surgically exposed before the tenotomy, as the incision, can be performed.
A closed tenotomy, on the other hand, does not require two work steps: the tendon is cut directly through the skin by means of a stab incision. However, this is only possible if the tendon is superficially located. Otherwise, the open tenotomy must be performed. Finally, the “z-shaped tenotomy” must be defined. In this procedure, the tendon is cut through in a z-shaped manner as the name suggests, i.e. not just crosswise as in the other procedures, and then sutured together again after the tendon has been lengthened.
Indications for a tenotomy
There are several indications for the performance of a tenotomy from different fields of medicine. The first example is a foot deformity from paediatrics, i.e. pediatrics. The so-called “clubfoot” presents itself as a combined malposition of the forefoot and hindfoot, which must be treated as soon as possible.
Still on the first day of life, treatment is carried out by a specific procedure named after Ponseti. This includes tenotomy as one of 3 treatment steps to correct the foot deformity. The Achilles tendon is severed under local anesthesia, which leads to a prompt improvement of the foot deformity.
Another indication is also a foot deformity, namely the pointed foot. In this case, a tenotomy of the Achilles tendon is also performed. Tenotomy is also a common procedure for some problems of the long biceps tendon in order to alleviate the symptoms.
In addition to the indications already specifically explained, it can be said in general terms that a tenotomy is always necessary when increased muscle tone results in joint malpositions or complaints in the joint. The increased muscle tension can be reduced by cutting the associated tendon, thus reducing or even eliminating the symptoms. A tenotomy is therefore always indicated when a tendon extension is desired for any reason. In addition, a tenotomy is often performed when the tendon itself causes discomfort or is injured.
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