Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot

Wagner, Emilio; Wagner, Pablo; Zanolli, Diego; Radkievich, Rubén; Redenz, Gunther; Guzmán, Rodrigo

doi:10.1177/1071100718760845

Cited by 17 publications

(18 citation statements)

References 15 publications

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“… 13 The STS-T proposes a stronger reconstruction model that permits sharing pull force strength and soft-tissue balance, which allows an earlier joint motion and better muscle performance. 14 , 15 Some studies propose the use of a long-time lower-leg splint (or combined with a cast) up to 6-8 weeks after tendon transfer. 16 , 17 This delay in the rehabilitation process increases muscle weakness and arthrofibrosis risk because of prolonged immobilization.…”

Section: Discussionmentioning

confidence: 99%

Anterior Tibial Tendon Side-to-Side Tenorrhaphy after Posterior Tibial Tendon Transfer: A Technique to Improve Reliability in Drop Foot after Common Peroneal Nerve Injury

Rodríguez-Argueta

Suárez-Ahedo

Jiménez-Aroche

et al. 2021

Arthroscopy Techniques

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Common peroneal nerve injury is present in 40% of knee dislocations, and foot drop is the principal complication. Posterior tibial tendon transfer is a viable solution to replace the function of the anterior tibial tendon (ATT) in the mid-foot. Several techniques for posterior tibial tendon transfer exist today, with variable results reported. However, adding augmentation with side-to-side tenorrhaphy of ATT to the transferred posterior tibial tendon (PTT) enhances anterior tissue balance and load sharing stress between native ATT enthesis and PTT tenodesis, allowing early rehabilitation and improving functional outcomes. Side-to-side tenorrhaphy is performed after PTT tenodesis in the lateral cuneiform to improve reliability in foot drop. This technique allows shorter immobilization time (from 6 to 2 weeks), earlier rehabilitation, sooner weight-bearing, and decreased risk of arthrofibrosis, scar formation, and muscle atrophy.

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Section: Discussionmentioning

confidence: 99%

Anterior Tibial Tendon Side-to-Side Tenorrhaphy after Posterior Tibial Tendon Transfer: A Technique to Improve Reliability in Drop Foot after Common Peroneal Nerve Injury

Rodríguez-Argueta

Suárez-Ahedo

Jiménez-Aroche

et al. 2021

Arthroscopy Techniques

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“…An a priori power analysis was calculated (G*Power 3.0.10) using previously reported means and standard deviations from a study on transmembranous PTT transfer. 18 An effect size of 1.2 was determined and used to estimate that a minimum of 7 specimens would be required for 80% power with alpha set at 0.05. We performed statistical analysis using PRISM software (version 7.04; Graphpad Software Inc, San Diego, CA).…”

Section: Methodsmentioning

confidence: 99%

Extensor Tendon Transfers for Treatment of Foot Drop in Charcot-Marie-Tooth Disease: A Biomechanical Evaluation

et al. 2020

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Background: In Charcot-Marie-Tooth (CMT) disease, selective weakness of the tibialis anterior muscle often leads to recruitment of the long toe extensors as secondary dorsiflexors, with subsequent clawing of the toes. Extensor hallucis longus (EHL) and extensor digitorum longus (EDL) tendon transfers offer the ability to augment ankle dorsiflexion and minimize claw toe deformity. The preferred site for tendon transfer remains unknown. Our goal was to quantify ankle dorsiflexion in the “intact” native tendon state, compared with tendon transfers to the metatarsal necks or the cuneiforms. We hypothesized that EHL and EDL transfers would improve ankle dorsiflexion as compared with the intact state and would produce similar motion when anchored at the metatarsal necks or cuneiforms. Methods: Eight fresh-frozen cadaveric specimens transected at the midtibia were mounted into a specialized jig with the ankle held in 20 degrees of plantarflexion. The EHL and EDL tendons were isolated and connected to linear actuators with suture. Diodes secured on the first metatarsal, fifth metatarsal, and tibia provided optical data for tibiopedal position in 3 dimensions. After preloading, the tendons were tested at 25%, 50%, 75%, and 100% of maximal physiologic force for the EHL and EDL muscles, individually and combined. Results: Transfers to metatarsal and cuneiform locations significantly improved ankle dorsiflexion compared with the intact state. No difference was observed between these transfer sites. Following transfer, only 25% of maximal force by combined EHL and EDL was required to achieve a neutral foot position. Conclusion: Transfer of the long toe extensors, into either the metatarsals or cuneiforms, significantly increased dorsiflexion of the ankle. Clinical Relevance: The transferred extensors can serve a primary role in treating foot drop in CMT disease, irrespective of the presence of clawed toes. This biomechanical study supports tendon transfers into the cuneiforms, which involves less time, fewer steps, and easier tendon balancing without compromising dorsiflexion power.

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“…There are no clinical data to favor one technique; however, placing the posterior tibial tendon beneath the retinaculum will avoid bowstringing of the tendon, and a cadaveric biomechanical study has indicated this will not adversely affect the function. 37…”

Section: Musculotendinous Perspectivementioning

confidence: 99%

Current Concepts Review: Common Peroneal Nerve Palsy After Knee Dislocations

Inclan

Matava

et al. 2021

Foot Ankle Int.

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Dislocation of the native knee represents a challenging injury, further complicated by the high rate of concurrent injury to the common peroneal nerve (CPN). Initial management of this injury requires a thorough neurovascular examination, given the prevalence of popliteal artery injury and limb-threatening ischemia. Further management of a knee dislocation with associated CPN palsy requires coordinated care involving the sports surgeon for ligamentous knee reconstruction and the peripheral nerve surgeon for staged or concurrent peroneal nerve decompression and/or reconstruction. Finally, the foot and ankle surgeon is often required to manage a foot drop with a distal tendon transfer to restore foot dorsiflexion. For instance, the Bridle Procedure—a modification of the anterior transfer of the posterior tibialis muscle, under the extensor retinaculum, with tri-tendon anastomosis to the anterior tibial and peroneus longus tendons at the anterior ankle—can successfully return patients to brace-free ambulation and athletic function following CPN palsy. Cross-discipline coordination and collaboration is essential to ensure appropriate timing of operative interventions and ensure maintenance of passive dorsiflexion prior to tendon transfer.

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Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot

Cited by 17 publications

References 15 publications

Anterior Tibial Tendon Side-to-Side Tenorrhaphy after Posterior Tibial Tendon Transfer: A Technique to Improve Reliability in Drop Foot after Common Peroneal Nerve Injury

Anterior Tibial Tendon Side-to-Side Tenorrhaphy after Posterior Tibial Tendon Transfer: A Technique to Improve Reliability in Drop Foot after Common Peroneal Nerve Injury

Extensor Tendon Transfers for Treatment of Foot Drop in Charcot-Marie-Tooth Disease: A Biomechanical Evaluation

Current Concepts Review: Common Peroneal Nerve Palsy After Knee Dislocations

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