, Volume 10, Issue 1, pp 116–122 | Cite as

Implanted passive engineering mechanism improves hand function after tendon transfer surgery: a cadaver-based study

  • Katherine L. Mardula
  • Ravi BalasubramanianEmail author
  • Christopher H. Allan



The purpose of this study was to investigate if a new tendon transfer surgical procedure that uses an implanted passive engineering mechanism for attaching multiple tendons to a single donor muscle in place of directly suturing the tendons to the muscle improves hand function in physical interaction tasks such as grasping.


The tendon transfer surgery for high median ulnar palsy was used as an exemplar, where all four flexor digitorum profundus (FDP) tendons are directly sutured to the extensor carpi radialis longus (ECRL) muscle to restore flexion. The new procedure used a passive hierarchical artificial pulley system to connect the muscle to the tendons. Both the suture-based and pulley-based procedures were conducted on N = 6 cadaver hands. The fingers’ ability to close around four objects when the ECRL tendon was pulled was tested. Post-surgery hand function was evaluated based on the actuation force required to create a grasp and the slip between the fingers and the object after the grasp was created.


When compared with the suture-based procedure, the pulley-based procedure (i) reduced the actuation force required to close all four fingers around the object by 45 % and (ii) improved the fingers’ individual adaptation to the object’s shape during the grasping process and reduced slip by 52 % after object contact (2.99° ± 0.28° versus 6.22° ± 0.66°).


The cadaver study showed that the implanted engineering mechanism for attaching multiple tendons to one muscle significantly improved hand function in grasping tasks when compared with the current procedure.


Tendon transfer surgery High median ulnar palsy Implant Engineering mechanism 



A special thanks to the Institute for Simulation and Interprofessional Studies at UW Medicine for their support during the cadaver experiments, Sarani Chatterjee for aiding in the data processing, and Dr. Cliff Pereira for the statistical guidance. Drs. Joseph McGuire, Brian Bay, and Buddy Ratner also provided advice for the project.

Conflict of Interest

Katherine L. Mardula states that she has no conflict of interest in conducting this research.

Christopher H. Allan states that he received a grant from the army and money from Oregon State University for conducting this research (please see complete COI statement).

Ravi Balasubramanian states that he has no conflict of interest in conducting this research.

Statement of Human and Animal Rights

This article does not contain any studies with human or animal subjects.

Statement of Informed Consent

This is to state that no human subjects were used in the conduct of the experiment described in the paper titled “Implanted Passive Engineering Mechanism Improves Hand Function After Tendon-Transfer Surgery: A Cadaver-Based Study.”


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Copyright information

© American Association for Hand Surgery 2014

Authors and Affiliations

  • Katherine L. Mardula
    • 1
  • Ravi Balasubramanian
    • 1
    Email author
  • Christopher H. Allan
    • 2
  1. 1.School of Mechanical, Industrial and Manufacturing EngineeringOregon State UniversityCorvallisUSA
  2. 2.School of MedicineUniversity of WashingtonSeattleUSA

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