Fixation Techniques for Split Anterior Tibialis Transfer in Spastic Equinovarus Feet

Abstract

Equinovarus of the foot is the most common lower extremity deformity following traumatic brain injury. We evaluated outcomes of the split anterior tibialis tendon transfer (SPLATT) for correction of equinovarus in 47 patients with hemiplegic traumatic brain injury and specifically studied differences in outcomes with two tendon fixation techniques. Seventeen patients constituting Group I underwent fixation with one technique and 30 constituting Group II had another technique. Patients in both groups had appropriate procedures based on dynamic electromyography and gait analyses. Both groups were demographically comparable. All 47 feet were corrected to plantigrade position. Thirty-six of 47 patients became brace-free at final followup. There was a notable decrease in the use of ambulatory aids and ambulatory status improved in both groups. There were three fixation-related complications in Group I and none in Group II. Surgical correction of the spastic equinovarus with SPLATT, in the appropriate patient, with or without associated tendon procedures helps to achieve and maintain correction, improves the ambulatory status of the patient, and eliminates the need for bracing in as much as 77% of patients.

The split anterior tibialis tendon transfer procedure for spastic equinovarus foot in children with cerebral palsy: results and factors associated with a failed outcome

“…Accordingly, the authors recommend that the transferred site needs to be protected during this interval. The tendon pull-through technique used in this report did not have any risk of developing a tunnel roof fracture [26], even though a lateral-medial tunnel is recommended because of a lower pull-out rate [21]. The rate of failed outcome in our series is comparable to previous reports [1,16].…”

“…Re-routing the AT tendon under the rectinaculum prevented an unsightly bowstringing [1] and might create fewer soft scar tissues around the transferred route [20]. It has been shown that re-routing the lateral half of the AT tendon onto the long axis of the fourth metatarsal was the most effective way [5,21] of correcting the deformity and is confirmed by the authors' clinical experiences. However, others have reported successful results by anchoring the AT tendon to the lateral cuneiform to coincide with the third metatarsal [22,23].…”

People Preferentially Increase Hip Joint Power Generation to Walk Faster Following Traumatic Brain Injury

“…Similarly, the cause of reduced ankle power generation at push-off in TBI may not be solely attributable to muscle weakness, particularly in a population susceptible to spastic equinovarus. [11][12][13][14][15] Nineteen of the participants with TBI elected not to attempt faster gait trials. Although data were collected for their self-selected gait trials, we do not know the impact of increasing speed on their gait performance.…”

Gait Analysis in Orthopedic Foot and Ankle Surgery—Topical Review, Part 1

“…30,81 EMG has been used to assess the outcome of tendon transfer surgeries. 52,64 It has been also been used as a tool to assess fixation strategies in tendon transfers, 29 to assist in preoperative planning of tendon transfer surgeries, 25,57,62 and to predict the success of planned transfers. 75 Recent attempts to measure age, gait parameter, and dominant-side related differences have added to the baseline data required to study the effects of altered or diseased states in different populations.…”