myodesis

Myodesis is a surgical technique used in the management of amputated limbs to improve control of myoelectric prostheses by anchoring residual muscle tissue to bone. By securing the muscle to the skeleton, myodesis aims to produce stable, well-localized electromyographic signals that can be more reliably interpreted by a prosthetic device. The method is typically discussed in contrast with myoplasty, where muscle is repositioned or buried into soft tissue without direct bone fixation; myodesis tends to offer more mechanically stable signal generation but can involve more complex surgery and different risk profiles.

Technique and rationale: The procedure usually involves exposing the residual limb, preparing a site on the bone, creating one or more bone tunnels or channels, and fixing the muscle or its tendon to the bone with nonabsorbable sutures, bone anchors, or other fixation devices. The muscle is then positioned to maximize distinct, user-intent related signals. Variations exist depending on the level of amputation and surgeon preference. The goal is to create durable muscle–bone contact that remains functional during rehabilitation and prosthetic use.

Indications and outcomes: Myodesis is most commonly considered in upper-limb amputations where multiple independent myoelectric control sites are desired. Reported benefits include improved signal amplitude, reduced crosstalk between sites, and potentially enhanced prosthesis control. Limitations include surgical complexity, potential bone pain, infection, hardware-related complications, and the need for careful patient selection and rehabilitation. Evidence largely consists of small case series and comparative studies with variable results.

History: The approach emerged in the context of advances in myoelectric prosthetics during the late 20th century and has since been described by several surgical groups as an option to augment prosthetic control.