Split Posterior Tibial Tendon Transfer Through the Interosseus Membrane in Spastic Equinovarus Deformity

Abstract

The split posterior tibial tendon transfer procedure was first reported by Green for correction of equinovarus hindfoot deformity in patients with cerebral palsy. A modification of the split posterior tibial tendon transfer combined with an Achilles tendon lengthening is described in 17 children (21 procedures) with a minimum follow-up of 3 years. This modified technique is indicated in young children with a continuously spastic posterior tibial tendon to correct a dynamic equinovarus. It restores active dorsiflexion when the anterior tibial and extensor muscles are weak. The anterior half of the split tibialis posterior is transferred through the interosseus membrane to the dorsum of the foot. Excellent or good results and two poor results were noted after a mean follow-up of 29 months. In the patients with an excellent or good result, marked improvement of their equinovarus foot deformity in stance and swing phase of gait was seen. In two patients, the procedure failed because of technical errors.

New Tendon Transfer for Correction of Drop-foot in Common Peroneal Nerve Palsy

“…The objectives of tendon transfer for treatment of posttraumatic paralysis are (1) to improve functional deficit by restoring or reinforcing lost functions; (2) to neutralize deforming forces; and (3) to gain stability eliminating the need for bracing during gait [17,28]. These objectives can be achieved by static and dynamic surgical procedures.…”

“…Vigasio, I. Marcoccio (&), A. Patelli, V. Mattiuzzo, G. Prestini Istituto Clinico Città di Brescia-Gruppo San Donato, 2°Unità Operativa di Chirurgia della Mano e Microchirurgia Ortopedica, Via Gualla 15, 25123 Brescia, Italy e-mail: info@ignaziomarcoccio.it As reported by Watkins et al, Codivilla in 1899 and Putti in 1914 [26] are considered the pioneers of the anterior transposition of the posterior tibialis tendon (PTT) to the dorsum of the foot through the interosseous membrane. This technique has been widely used [6,13,17,22], becoming the most accepted reconstructive method to correct dropfoot [6]. This technique, however, has several disadvantages relating to insufficient length of the PTT after harvest preventing easy tendon-to-bone (TtB) insertion on the dorsal aspect of the foot often requiring the ankle to be maximally dorsiflexed or altering the plan of location or the method of tendon insertion [6,8,12,22,24,26,29].…”

“…Tendon-to-tendon (TtT) suturing has been described [3,8,17,22,24] as an alternative to the TtB procedure eliminating the need for screws, staples, or pullout wires tied over a button [12,26]. Direct TtT suture, however fails to achieve balanced dorsiflexion because the foot needs to be pulled medially (using anterior tibialis tendon [ATT] and/or extensor hallucis longus tendon [EHL]) and laterally (using the peroneus longus or tertius) using recipient tendons as reins [3,8,17,18,21,22,26,27,29].…”

“…Direct TtT suture, however fails to achieve balanced dorsiflexion because the foot needs to be pulled medially (using anterior tibialis tendon [ATT] and/or extensor hallucis longus tendon [EHL]) and laterally (using the peroneus longus or tertius) using recipient tendons as reins [3,8,17,18,21,22,26,27,29]. Unfortunately, these methods are surgically demanding and the complexity of reconstruction dissipates the pull strength of the PTT reducing dorsiflexion power.…”

Reply to Letter to the Editor: New Tendon Transfer for Correction of Drop-foot in Common Peroneal Nerve Palsy

“…Numerous papers [2][3][4][5][6]9] play on the ''reins'' concept in order to obtain a balanced foot dorsiflexion. Several bone attachments have also been tested (first, second, third cuneiform, cuboid, and the base of the fifth metacarpal bone).…”