Flexor digitorum longus tendon transfer to the navicular: tendon-to-tendon repair is stronger compared with interference screw fixation

Abstract

Minimal tendon displacement of less than 2 mm occurred during cyclic testing in both groups. The two premature failures and significantly reduced load to failure observed in the ISF group, however, indicate that the traditional TT technique is more robust. Regarding clinical relevance, this study suggests that early active range of motion and protected weight bearing may be safe following FDL tendon transfer for stage 2 tibialis posterior tendon dysfunction.

“Biological Fixation” of Flexor Digitorum Longus: A New Modification of Tendon Transfer for Treatment of Posterior Tibialis Tendon Dysfunction

“…6 Fixation of the transferred tendon by the “tendon to tendon repair” technique requires a longer tendon. 5,9 It could also lead to more extensive dissection and consequently increase the associated surgical morbidities. 10 Previously, many surgeons have tried to find less invasive techniques to reduce surgically related complications, such as iatrogenic injury to the medial planter nerve and/or the venous plexus located deep to the abductor hallucis muscle belly, near the flexor knot of Henry.…”

“…6 Fixation of the FDL tendon to the navicular bone includes various techniques, such as tendon-to-tendon (TT) repair and interference screw fixation (ISF). [7][8][9] Tendon-to-tendon repair technique requires a long harvest tendon, consequently, needs a more extensive surgical approach that could lead to additional surgical scar, more surgical site complications, and more soft tissue damage, such as nerve injury. 5 Short harvest tendon usually needs fixation devices, such as anchor sutures or interference screws.…”

Tendon transfer in foot drop: a systematic review

“…Their use minimizes the risk of wound complications or skin ulcerations in comparison to staples or button fixation on the plantar surface. Additionally, compared to tendon fixation or fixation through bone tunnels, the use of a shorter tendon graft is sufficient and less surgical dissection is required [26][27][28][29][30]. The outcomes of the Marsland et al [27] study find that the strengths of both, interference screw (bone) fixation and Pulvertaft weave (tendon) fixation of the posterior tibial tendon were comparable.…”

Presurgical Perspective and Postsurgical Evaluation of Non-Achilles Tendons of the Ankle and Retinaculum

“…84 However, the preferred technique is to pass the FDL tendon through a bone tunnel in the navicular tuberosity where the FDL is transferred from plantar to dorsal and anchored or sutured back onto itself (tendon-to-tendon repair). 85,86 Complications of FDL tendon transfer are detected on postoperative imaging, 63 such as avulsion of the transferred tendon with clinical acute recurrence of the pes planus deformity. 60 FDL tendon or residual PTT tendinosis can also occur, resulting in pain and swelling, and it may be due to a reaction to the suture material.…”

“…84 However, the preferred technique is to pass the FDL tendon through a bone tunnel in the navicular tuberosity where the FDL is transferred from plantar to dorsal and anchored or sutured back onto itself (tendon-to-tendon repair). 85 86…”