Principles of Tendon Transfer

1. correction of contracture
2. adequate strength
3. adequate amplitude (3/5/7 rule at hand & wrist)
4. straight line of pull — artificial pulleys always attenuate
5. 1 tendon : 1 function  (exception is FDS insertion allows natural split to 2 insertions — but definitely a fiddle)
6. synergism
7. expendable donor
8. tissue equilibrium

N.B. timing of transfers.

3 key questions:

1. What function is missing?
2. What can be sacrificed?
3. What does the patient need?