eli5: How can tendon/ligament release surgery be a thing?


I get the concept of wanting to loosen a structure holding a joint together, but isn’t slicing through these tissues bad? How is your joint not flopping around and loose afterwards? Do the structures heal? Do they heal looser? Won’t they permanently be weaker from then on?

In: 1

The tendons that are released are often rerouted through a small incision in the bone that itself heals and cements the tendon in place. The tendon still recieves adequate blood flow and nerve impulses, it’s just attached at a point that will allow it to function normally. If done right the patient will have very little to no loss of functionality, though there will be a loss of strength and the patient shouldn’t strain that muscle more than they absolutely have to. However these surgeries are done for people whom have been significantly disabled by this tendon injury. So going back to normal function is a huge improvement.

There are lots of different types of releases like this. Tendons are held to shape by supporting sheaths and other supporting structures, and sometimes a little lengthwise opening of the sheath is enough.

A “tendon release” would rarely be just cutting through a tendon or lament straight across (although that exists)

Sometimes a tendon release is really a fascia release, slicing that sheath open lengthwise, or in a slight spiral. Also, tendon originates in muscle where muscle fascia transitions into the tendon, and sometimes slicing diagonally through the origin of the tendon allows the cut portion to “slip”a little, lengthening, then heal longer, and remodel the tendon, although with some scarring of the muscle.

Finally, SOMETIMES when the patient can be immobilized well for recovery, the actual tendon itself can be cut almost lengthwise partway, to like, less than half its thickness. This cut again in a long spiral only part way around, allowing the tendon to stretch. After this, it is very weak, and must be allowed to heal before any stress or use on the tendon it borne.

It’s a terrible analogy, but imagine the tendon is a steel tube. Now imagine spiral-cutting that tube into a Slinky, elongating the Slinky a little bit, and holding it until somehow new metal fills in the little spaces between coils. You end up with a slightly longer steel tube. It’s kind of like that, but far less of a spiral.

Source: I assist with imaging in some surgeries where this is done. My daughter has cerebral palsy and has had a couple. I I also ask a lot of questions.