Name of the Procedure:

Tenotomy, open, hamstring, knee to hip; single tendon Common name(s): Hamstring tenotomy, Hamstring tendon release

Summary

In layman's terms, an open hamstring tenotomy involves surgically cutting a single hamstring tendon to relieve tension and improve flexibility. This is performed through an open surgical technique.

Purpose

This procedure addresses conditions that cause tight or contracted hamstring muscles, often seen in patients with cerebral palsy, spasticity, or post-stroke muscle contractures. The goal is to improve mobility, reduce pain, and prevent deformities.

Indications

• Chronic hamstring tightness or contracture
• Difficulty with mobility or extending the leg
• Pain or discomfort due to hamstring tension
• Spasticity resulting from neurological conditions
• Failure of non-surgical treatments like physical therapy or bracing

Preparation

• Fasting for at least 6-8 hours prior to surgery
• Adjustments or temporary discontinuation of certain medications (e.g., blood thinners)
• Preoperative assessments including imaging studies (e.g., MRI, X-rays) and blood tests

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A small incision is made over the targeted hamstring tendon.
3. Exposure: The surgeon carefully exposes the tendon by separating the surrounding tissues.
4. Tenotomy: The identified tendon is cut to release tension.
5. Closure: The incision is closed with sutures, and sterile dressings are applied.

Tools used may include scalpels, retractors, and surgical scissors.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is typically performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurse
• Anesthesiologist
• Operating room technician

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Nerve damage
• Adverse reactions to anesthesia
• Scarring
• Temporary or persistent pain

Benefits

• Improved range of motion
• Decreased muscle tightness and spasticity
• Reduced pain and discomfort
• Enhanced ability to perform daily activities Benefits are usually observed shortly after recovery but can improve progressively over time.

Recovery

• Patients may require crutches or other assistive devices initially.
• Physical therapy is often necessary to maximize mobility gains.
• Specific instructions regarding wound care, activity restrictions, and medications to manage pain.
• Recovery time varies but typically spans several weeks to a few months.

Alternatives

• Physical therapy and stretching exercises
• Botulinum toxin (Botox) injections
• Orthotic devices and bracing
• Less invasive interventions such as percutaneous tenotomy Alternatives may offer temporary relief with varying degrees of efficacy compared to open tenotomy.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Postoperative pain and swelling are manageable with medications. Patients may experience some discomfort and need reassurance during the early recovery phase. Physical therapy will be an integral part of the post-procedure rehabilitative process.