Anatomy of Second Muscular Layer of the Foot: Considerations for Tendon Selection in Transfer for Achilles and Posterior Tibial Tendon Reconstruction

1994 ◽  
Vol 15 (8) ◽  
pp. 420-423 ◽  
Author(s):  
Keith L. Wapner ◽  
Paul J. Hecht ◽  
John R. Shea ◽  
Thomas J. Allardyce
Keyword(s):  
Achilles Tendon ◽  
Relative Strength ◽  
Flexor Hallucis Longus ◽  
Posterior Tibial Tendon ◽  
En Bloc ◽  
Muscular Layer ◽  
Tendon Reconstruction ◽  
Posterior Tibial ◽  
Flexor Digitorum ◽  
Achilles Tendon Reconstruction

Controversy exists regarding tendon choice to substitute for a ruptured posterior tibial tendon. A similar debate about late Achilles tendon reconstruction also persists. To establish priorities and aid the surgeon's decision-making process, we studied 85 en bloc dissections of the second muscular layer of the sole. Muscular and tendinous interconnections were evaluated. Location and minimal donor deficit following harvest of the flexor digitorum longus make it the transfer of choice for posterior tibial tendon reconstruction. We suggest that relative strength, anatomic location, and available length of tendon make the flexor hallucis longus the superior choice for late Achilles tendon reconstruction.

Risk of Neurovascular Injuries in Flexor Hallucis Longus Tendon Transfers: An Anatomic Cadaver Study

2007 ◽  
Vol 28 (8) ◽  
pp. 910-915 ◽  
Author(s):  
Tom Mulier ◽  
Elise Rummens ◽  
Greta Dereymaeker
Keyword(s):  
Tibial Nerve ◽  
Cadaver Study ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Nerve ◽  
Nerve Lesions ◽  
Posterior Tibial ◽  
Incision Technique ◽  
Flexor Digitorum

Background: Flexor hallucis longus (FHL) tendon transfer is a frequently used treatment for both posterior tibial tendon insufficiency and chronic Achilles tendinopathy. We observed difficulties in harvesting the FHL tendon that may arise from cross-attachments with the flexor digitorum longus (FDL) tendon near the knot of Henry. The posterior tibial nerve is located nearby the decussation of these tendons. This study examined whether the difficult harvesting may be the cause of nerve injury. Methods: A cadaver study was performed on 24 foot specimens. In all feet, we used a double-incision technique. The FHL tendon was transected in the distal medial midfoot incision and retracted through the posteromedial hindfoot incision. After harvesting the FHL tendon, we exposed the posterior tibial nerve and its lateral and medial plantar branches to identify if any lesion had occurred. Results: The retraction failed at the first attempt in all specimens because of the presence of cross-attachments between the FHL and FDL tendons. A more extensive dissection of the FHL and FDL tendons was therefore required. We found lesions in 33% of all foot specimens, including two complete ruptures of the medial plantar nerve. Conclusions: Harvesting of the FHL tendon when transection is made distal to the knot of Henry may cause injuries to the medial and lateral plantar nerves. Experience in this procedure may reduce the risk of nerve injuries but even then nerve lesions remain possible. The clinical significance of these nerve lesions is not described in literature and remains to be determined.

Accessory Flexor Hallucis Longus Tendon Discovered During Achilles Tendon Reconstruction

2021 ◽  
Vol 11 (1) ◽  
pp. e19.00447-e19.00447
Author(s):  
Joe Kiblen ◽  
Clay Christensen ◽  
Nicholas A. Abidi
Keyword(s):  
Achilles Tendon ◽  
Flexor Hallucis Longus ◽  
Longus Tendon ◽  
Tendon Reconstruction ◽  
Achilles Tendon Reconstruction

Failed Achilles Tendon Reconstruction

2016 ◽  
Vol 9 (3) ◽  
pp. 241-244
Author(s):  
Patrick Bull ◽  
J. Mike Miller ◽  
Alan Ng ◽  
Stephen A. Brigido ◽  
Stephen A. Brigido ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Reconstruction ◽  
Achilles Tendon Reconstruction

scholarly journals Minimally invasive reconstruction technique for chronic Achilles tendon tears allows rapid return to walking and leads to good functional recovery

2019 ◽  
Vol 28 (1) ◽  
pp. 305-311 ◽  
Author(s):  
Paweł Bąkowski ◽  
Kinga Ciemniewska-Gorzela ◽  
Krzysztof Talaśka ◽  
Jan Górecki ◽  
Dominik Wojtkowiak ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Minimally Invasive ◽  
Achilles Tendon ◽  
Invasive Technique ◽  
Reconstruction Technique ◽  
Injured Limb ◽  
Tendon Reconstruction ◽  
Isokinetic Test ◽  
Tendon Tears ◽  
Achilles Tendon Reconstruction

Abstract Purpose Chronic Achilles tendon tears, including chronic ruptures with end gap over 6 cm making end-to-end suturing impossible, can be treated with autologous hamstring graft reconstruction. The primary goal of this study was to present the biomechanical and long-term clinical results of recently developed minimally invasive Achilles tendon reconstruction technique. Methods Minimally invasive Achilles tendon reconstruction was applied to 8 foot and ankle cadaveric specimens as well as 18 patients with chronic Achilles tendon tears. Repaired cadavers were subjected to the biomechanical testing using a cyclic loading protocol. Patients with reconstructed Achilles tendon were subjected to the clinical, functional and isokinetic tests at 12 months after the treatment. Results All of tested Achilles cadaveric specimens survived 2 loading blocks (250 cycles of 10–100 N load followed by additional 250 cycles of 10–200 N load). With three specimens, it was possible to perform the third cyclic loading block with 20-300 N load and two specimens survived the fourth block with 20–400 N load. Therefore, a mean number of 838 cycles (±178) within the range of 509–1000 was recorded. Two specimens which survived all 1000 cycles were pulled to failure at 25 mm/s rate. The results obtained in the load to failure testing were as follows: 398 N and 608 N of maximum load. The results of functional heel rise endurance test and single leg hop for distance test indicated a decrease in the endurance and strength of the injured limb. However, the results of the weight-bearing lunge tests indicated no tendency for elongation of the Achilles tendon. A comparative analysis of the isokinetic test results for the non-injured and injured limb was revealed no statistically significant differences for every isokinetic test (n. s.), with significant difference for isometric strength parameters (p = 0.0006). Conclusions The results of the biomechanical tests as well as 1-year extensive functional, clinical and isokinetic results of the minimally invasive technique for chronic Achilles tendon tears are encouraging. Patients returned to their normal physical activity, including sport pre-injury level in most cases. Level of evidence III

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