The Bridle Procedure

Transfer of the Posterior Tibial Tendon for Chronic Peroneal Nerve Palsy

“…The Bridle procedure is a newer technique that was partially introduced in 1968 76 . The first large case series, which was not published until 1991, demonstrated excellent and good results in 74% of 107 procedures performed in patients with cerebral palsy 77 . Wagenaar et al and Johnson et al reported excellent to good results in 69% of 12 patients and 100.0% of 19 patients, respectively, who underwent the Bridle procedure 78,79 .…”

“…This theoretical issue comes up occasionally when some peroneal function persists, as in cases of partial CPN injury, lumbar disc disease, atypical Charcot-Marie-Tooth disorder, anterior-only compartment syndrome, and neglected TA rupture. Despite being often discussed, this complication has been reported only a handful of times in the literature 77,78,106,107 . McCall et al reported on the first outcomes from the Bridle procedure in 101 patients, 80 of whom had cerebral palsy, and found that 4 patients within the cerebral palsy group developed pes planovalgus deformity 77 .…”

“…Despite being often discussed, this complication has been reported only a handful of times in the literature 77,78,106,107 . McCall et al reported on the first outcomes from the Bridle procedure in 101 patients, 80 of whom had cerebral palsy, and found that 4 patients within the cerebral palsy group developed pes planovalgus deformity 77 . However, these patients had a neurologic condition that might well have contributed to the development of this deformity; hence, they do not represent the typical adult patient with CPN palsy.…”

“…There is a paucity of literature detailing the functional outcomes of the Bridle procedure. McCall et al 77 reported that 26% of 101 patients with cerebral palsy had postoperative active dorsiflexion of ≥5°. One of the largest reports, which involved 19 patients, demonstrated that all reported excellent to good outcomes without requiring an AFO for everyday activities 11 .…”

“…The Bridle procedure is a newer technique that was partially introduced in 1968 76 . The first large case series, which was not published until 1991, demonstrated excellent and good results in 74% of 107 procedures performed in patients with cerebral palsy 77 78,79 .…”