Name of the Procedure:

Tenotomy, open, hamstring, knee to hip; multiple tendons, bilateral

Summary

Tenotomy is a surgical procedure involving the cutting of tendons to relieve tension, improve mobility, or correct deformities. This particular procedure targets multiple hamstring tendons from the knee to the hip in both legs.

Purpose

The procedure addresses issues related to tendon tightness, muscle contractures, or deformities affecting the hamstring muscles. The primary goal is to improve range of motion, reduce pain, and enhance overall function in the legs.

Indications

• Chronic tendon tightness or contractures that impair mobility
• Conditions such as cerebral palsy, muscular dystrophy, or spasticity disorders
• Patients who have not responded well to conservative treatments like physical therapy or medications

Preparation

• Patients may be instructed to fast for several hours before surgery.
• Adjustments to medication regimens, especially blood thinners, may be necessary.
• Preoperative assessments might include physical examinations, blood tests, and imaging studies like MRI or ultrasound.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made over the targeted tendons from the knee to the hip.
3. The surgeon identifies and carefully releases (cuts) multiple hamstring tendons.
4. Any necessary adjustments to surrounding tissues are made to ensure proper alignment and function.

5. The incision is closed with sutures, and a sterile dressing is applied.

   Tools include surgical scalpels, forceps, clamps, and sutures. General anesthesia ensures the patient is unconscious and pain-free during the procedure.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and number of tendons involved.

Setting

Tenotomy is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon or specialized surgical team
• Nurses and surgical technologists
• Anesthesiologist

Risks and Complications

• Common risks: infection, bleeding, and adverse reactions to anesthesia
• Rare risks: nerve damage, incomplete release of the tendon, and scarring
• Management may involve antibiotics for infections and physical therapy for functional recovery.

Benefits

• Improved flexibility and range of motion
• Reduced muscle tightness and associated pain
• Enhanced ability to perform daily activities These benefits may be realized gradually over weeks to months with appropriate rehabilitation.

Recovery

• Initial post-operative care involves pain management, wound care, and physical therapy.
• Patients may need to use crutches or a walker initially.
• Recovery time can vary but usually spans several weeks to a few months.
• Follow-up appointments will monitor progress and address any complications.

Alternatives

• Non-surgical options include physical therapy, medications, and orthotic devices.
• Botulinum toxin injections may offer temporary relief from muscle spasticity.
• Surgical lengthening procedures or tendon transfers as alternative surgical options.

Patient Experience

• During the procedure: The patient will be under general anesthesia and unaware of the surgery.
• After the procedure: Patients may experience discomfort or pain at the incision site, manageable with prescribed pain relievers. Physical therapy is crucial for achieving optimal outcomes and regaining mobility.

Pain management and comfort measures, like proper positioning and use of ice packs, play an important role in the initial stages of recovery.