Effects of Tensioning Errors in Split Transfers of Tibialis Anterior and Posterior Tendons

Piazza, Stephen J.; Adamson, Robert L; Moran, Mark; Sanders, James O.; Sharkey, Neil A.

doi:10.2106/00004623-200305000-00013

Cited by 36 publications

(35 citation statements)

References 19 publications

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“…When a split anterior tibial tendon transfer was tested, all specimens had an eversion moment arm. In contrast to previously reported biomechanical studies [14,18], we found the split anterior tibial tendon transfer resulted in forefoot pronation and hindfoot valgus comparable to that provided by a whole transfer. Hui et al [12] performed split transfers of the anterior tibial tendon in cadaver specimens routed to different insertion sites.…”

Section: Discussioncontrasting

confidence: 99%

“…In this study, hindfoot motion was defined as varus and valgus motion between the tibia and the calcaneus from a fixed coronal plane along the tibia. The split transfer was found to produce hindfoot motion, a finding that generally was consistent with previous biomechanical studies [14,18,19]. Specifically, previous studies measured the moment arm of the tibialis anterior muscle in anatomic specimens [14], before and after split transfer of the anterior tibial tendon [18,19].…”

Section: Discussionsupporting

confidence: 84%

“…Moment arms were measured with the talocrural joint fixed in either the neutral position or in plantar flexion by securing the tibia to the talus. It was found that, in intact specimens, shortening the tibialis anterior muscle created an inversion moment arm at the subtalar joint [14,18,19]. When a split anterior tibial tendon transfer was tested, all specimens had an eversion moment arm.…”

Section: Discussionmentioning

confidence: 99%

“…The split anterior tibial tendon transfer was designed to convert the deforming force of a spastic tibialis anterior muscle to a pure dorsiflexor and minimize the risk of overcorrection. The split tendon, having insertions on the medial and lateral sides of the foot, is intended to provide balance so that it neither inverts nor everts the foot [18,19]. This transfer also has been used to treat residual dynamic forefoot supination after clubfoot treatment [1,16,24].…”

Section: Introductionmentioning

confidence: 99%

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How Do Different Anterior Tibial Tendon Transfer Techniques Influence Forefoot and Hindfoot Motion?

Knutsen

Avoian

Sangiorgio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Idiopathic clubfoot correction is commonly performed using the Ponseti method and is widely reported to provide reliable results. However, a relapsed deformity may occur and often is treated in children older than 2.5 years with repeat casting, followed by an anterior tibial tendon transfer. Several techniques have been described, including a whole tendon transfer using a two-incision technique or a three-incision technique, and a split transfer, but little is known regarding the biomechanical effects of these transfers on forefoot and hindfoot motion. Questions/purpose We used a cadaveric foot model to test the effects of three tibialis anterior tendon transfer techniques on forefoot positioning and production of hindfoot valgus. MethodsTen fresh-frozen cadaveric lower legs were used. We applied 150 N tension to the anterior tibial tendon, causing the ankle to dorsiflex. Three-dimensional motions of the first metatarsal, calcaneus, and talus relative to the tibia were measured in intact specimens, and then repeated after each of the three surgical techniques. Results Under maximum dorsiflexion, the intact specimens showed 6°(95% CI, 2.2°-9.4°) forefoot supination and less than 3°(95% CI, 0.4°-5.3°) hindfoot valgus motion. All three transfers provided increased forefoot pronation and hindfoot valgus motion compared with intact specimens: the three-incision whole transfer provided 38°( 95% CI, 33°-43°; p \ 0.01) forefoot pronation and 10°( 95% CI, 8.5°-12°; p \ 0.01) hindfoot valgus; the split transfer, 28°(95% CI, 24°-32°; p \ 0.01) pronation, 9°( 95% CI, 7.5°-11°; p \ 0.01) valgus; and the two-incision transfer, 25°(95% CI, 20°-31°; p \ 0.01) pronation, 6°( 95% CI, 4.2°-7.8°; p \ 0.01) valgus.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

How Do Different Anterior Tibial Tendon Transfer Techniques Influence Forefoot and Hindfoot Motion?

Knutsen

Avoian

Sangiorgio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…This deformity is attributed to the imbalance of the ankle invertor, including the anterior tibialis (AT), posterior tibialis (PT) and evertor muscles [2,3]. A combination of a split AT (SPLATT) or PT transfer of the tendon and lengthening of the ankle plantar flexor muscles have been proposed to position the plantigrade foot [1,[4][5][6][7][8]. Biomechanically, SPLATT is an appealing procedure [7].…”

Section: Introductionmentioning

confidence: 99%