Combined Suspensory and Aperture Fixation of Posterior Tibialis Tendon Anterior Transfer for Dropfoot

Category: Other; Trauma Introduction/Purpose: Anterior transfer of the tibialis posterior tendon (TPT) can restore ankle dorsiflexion in patients with foot drop. A limitation of this procedure is the need for postoperative ankle immobilisation. We present the results of a novel dual method of TPT docking which infers immediate stability, allowing early weightbearing. Methods: 8 patients underwent 9 tendon transfers,age range of 28-52 years. 3 patients had dropfoot from common peroneal nerve injury, 6 cases were part of a complex cavovarus or spastic equinovarus correction. The TPT is passed to the dorsum of the foot through the interosseous membrane. The docking site is prepared with a bicortical pilot hole followed by unicortical overreaming. The TPT is whipstitched and an Arthrex biceps button is threaded to the sutures. The button is passed bicortical and flipped using a tension slide technique give stable suspensory fixation. Additional stability is conferred by overpassing an Arthrex biotenodesis screw giving aperture fixation. Patients are immobilised in a boot and allowed to weightbear immediately. Results: Follow up was 6 months. There was difficulty in docking of suspensory fixation in two of the early cases. These patients had aperture fixation and were immobilised non weightbearing in a cast for 6 weeks. With technical modifications, all subsequent patients had dual fixation. At 6 months there were no radiological or clinical failures of fixation. Patients without other underlying issues were able to mobilise splint free at 6 months. All patients were satisfied with their procedure. Conclusion: Aperture fixation with an interference screw has become the gold standard for TPT transfer, however, patients still need a prolonged period of immobilisation. Combined suspensory and aperture fixation is technically straightforward and seems to give more initial stability allowing early weightbearing. Further prospective studies and biomechanical studies are needed to validate this technique.

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Isokinetic cross-training effect in foot drop following common peroneal nerve injury

Isokinetics and Exercise Science ◽

10.3233/ies-140559 ◽

2015 ◽

Vol 23 (1) ◽

pp. 17-20 ◽

Cited By ~ 4

Author(s):

Andrea Manca ◽

Francesco Pisanu ◽

Enzo Ortu ◽

Edoardo De Natale ◽

Francesca Ginatempo ◽

...

Keyword(s):

Nerve Injury ◽

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Training Effect ◽

Cross Training ◽

Peroneal Nerve Injury

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The anatomic location and importance of the tibialis posterior fascicular bundle at the sciatic nerve bifurcation: report of 3 cases

Journal of Neurosurgery ◽

10.3171/2018.8.jns181190 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1869-1875 ◽

Cited By ~ 1

Author(s):

Thomas J. Wilson ◽

Andres A. Maldonado ◽

Kimberly K. Amrami ◽

Katrina N. Glazebrook ◽

Michael R. Moynagh ◽

...

Keyword(s):

Sciatic Nerve ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Preoperative Imaging ◽

Tibialis Posterior ◽

Severe Injuries ◽

Nerve Action ◽

Internal Neurolysis

The authors present the cases of 3 patients with severe injuries affecting the peroneal nerve combined with loss of tibialis posterior function (inversion) despite preservation of other tibial nerve function. Loss of tibialis posterior function is problematic, since transfer of the tibialis posterior tendon is arguably the best reconstructive option for foot drop, when available. Analysis of preoperative imaging studies correlated with operative findings and showed that the injuries, while predominantly to the common peroneal nerve, also affected the lateral portion of the tibial nerve/division near the sciatic nerve bifurcation. Sunderland’s fascicular topographic maps demonstrate the localization of the fascicular bundle subserving the tibialis posterior to the area that corresponds to the injury. This has clinical significance in predicting injury patterns and potentially for treatment of these injuries. The lateral fibers of the tibial division/nerve may be vulnerable with long stretch injuries. Due to the importance of tibialis posterior function, it may be important to perform internal neurolysis of the tibial division/nerve in order to facilitate nerve action potential testing of these fascicles, ultimately performing split nerve graft repair when nerve action potentials are absent in this important portion of the tibial nerve.

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Strength of Interference Screw Fixation to Cuboid vs Pulvertaft Weave to Peroneus Brevis for Tibialis Posterior Tendon Transfer for Foot Drop

Foot & Ankle International ◽

10.1177/1071100718762442 ◽

2018 ◽

Vol 39 (7) ◽

pp. 858-864 ◽

Cited By ~ 3

Author(s):

Daniel Marsland ◽

Joanna M. Stephen ◽

Toby Calder ◽

Andrew A. Amis ◽

James D. F. Calder

Keyword(s):

Tendon Transfer ◽

Screw Fixation ◽

Insertion Site ◽

Interference Screw ◽

Foot Drop ◽

Tibialis Posterior ◽

Materials Testing ◽

Reliable Technique ◽

Load To Failure ◽

Interference Screw Fixation

Background: Tibialis posterior (TP) tendon transfer is an effective treatment for foot drop. Currently, standard practice is to immobilize the ankle in a cast for 6 weeks nonweightbearing, risking postoperative stiffness. To assess whether early active dorsiflexion and protected weightbearing could be safe, the current study assessed tendon displacement under cyclic loading and load to failure, comparing the Pulvertaft weave (PW) to interference screw fixation (ISF) in a cadaveric foot model. Methods: Twenty-four cadaveric ankles had TP tendon transfer performed, 12 with the PW technique and 12 with ISF to the cuboid. The TP tendon was cycled 1000 times at 50 to 150 N and then loaded to failure in a materials testing machine. Tendon displacement at the insertion site was recorded every 100 cycles. An independent t test and 2-way analysis of variance were performed to compare techniques, with a significance level of P < .05. Results: Mean tendon displacement was similar in the PW group (2.9 ± 2.5 mm [mean ± SD]) compared with the ISF group (2.4 ± 1.1 mm), P = .35. One specimen in the ISF group failed early by tendon pullout. None of the PW group failed early, although displacement of 8.9 mm was observed in 1 specimen. Mean load to failure was 419.1 ± 82.6 N in the PW group in comparison to 499.4 ± 109.6 N in the ISF group, P = .06. Conclusion: For TP tendon transfer, ISF and PW techniques were comparable, with no differences in tendon displacement after cyclical loading or load to failure. Greater variability was observed in the PW group, suggesting it may be a less reliable technique. Clinical Relevance: The results indicate that early active dorsiflexion and protected weightbearing may be safe for clinical evaluation, with potential benefits for the patient compared with cast immobilization.

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Tibialis Posterior Tendon Transfer in Post Injection Common Peroneal Nerve Palsy in a Paediatric Patient–A Case Report

Indian Journal of Physical Medicine and Rehabilitation ◽

10.5005/ijopmr-26-1-17 ◽

2015 ◽

Vol 26 (1) ◽

pp. 17-19

Author(s):

Pebam Sudesh ◽

Deepak Kumar

Keyword(s):

Peroneal Nerve ◽

Tendon Transfer ◽

Nerve Palsy ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Tibialis Posterior ◽

Peroneal Nerve Palsy ◽

Post Injection ◽

Common Peroneal Nerve Palsy ◽

Tibialis Posterior Tendon Transfer

Abstract Post injection foot drop is due to common peroneal nerve damage at site of injection (gluteal region) in which dorsiflexor of foot EHL, EDL and tibialis anterior are weakend or paralysed. It can be managed by reconstructive surgery; tibialis posterior tendon transfer to EHL, EDL and 2nd metatarsal. Here objective is rehabilitation of post injection common peroneal nerve palsy foot drop in a paeditaric patient. Our method and outcome measure as first rehabilitation programme for foot drop paediatric patient (common peroneal nerve palsy) thereafter reconstructive surgery of tibialis posterior transfer to EHL, EDL and 2nd metatarsal. Last we re-educate them to tibialis posterior contraction for dorsiflexion of foot. Our result was patient was able to walk similar as normal, able to elevate her toes and foot. Patient was happy and confident with her functional foot. But patient was advised to avoid heavy work, sprinting, and active aggressive game (like foot ball). Our conclusion is patient gets benefited by this procedure.

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Tendon Transfers in Foot Drop

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1688105 ◽

2019 ◽

Vol 52 (01) ◽

pp. 100-108 ◽

Cited By ~ 2

Author(s):

Sridhar Krishnamurthy ◽

Mohamed Ibrahim

Keyword(s):

Peroneal Nerve ◽

Nerve Repair ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Treatment Modalities ◽

Definitive Treatment ◽

Tibialis Posterior ◽

Tendon Transfers ◽

Secondary Procedures ◽

Uncertain Outcomes

AbstractThe common peroneal nerve is the most commonly injured nerve in the lower extremity. Peroneal nerve pathology results in loss of dorsiflexion at the tibiotalar joint, loss of eversion at the subtalar joint, and loss of extension of toes resulting in foot drop. The varied etiology of the problem is discussed. The various treatment modalities like conservative management, steroid therapy, nerve decompression, nerve repair, or reconstruction are described, but due to uncertain outcomes after primary nerve procedures, secondary procedures like tendon transfers often end up as definitive treatment. The rationale and technique of tibialis posterior transfer is discussed in detail.

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Case Series: Management of Foot Drop

Journal of Advances in Medical and Pharmaceutical Sciences ◽

10.9734/jamps/2019/v21i430143 ◽

2019 ◽

pp. 1-6

Author(s):

Isaac Olusayo Amole ◽

Stephen Adesope Adesina ◽

Adewumi Ojeniyi Durodola ◽

Samuel Uwale Eyesan

Keyword(s):

Case Series ◽

Common Peroneal Nerve ◽

Surgical Correction ◽

Foot Drop ◽

Tibialis Posterior ◽

Corrective Surgery ◽

Hansen's Disease ◽

Hansen’S Disease ◽

Tendo Achillis ◽

Tibialis Posterior Transfer

Aim: To highlight the functional outcome of surgical management of foot drop in patients with Hansen disease. Case Presentation: We present three cases of foot drop following Hansen’s disease that were managed surgically by Tibialis posterior transfer. The patients had preoperative physiotherapy for ten days and postoperative physiotherapy for four weeks. Their post-operative periods were uneventful and the corrections were satisfactory. Discussion: Involvement of common peroneal nerve in Hansen’s disease usually results in paralysis of the anterior tibial and/or peroneal muscles. Hansen’s disease patients with foot-drop walk with a ‘high-stepping gait’, lifting the leg high as if climbing steps even while walking on level ground. When the paralysis has been present for more than six months to one year without recovery, the best option of treatment at this stage is corrective surgery and the main aim of the corrective surgery is to restore active dorsiflexion of the foot so that the gait becomes normal. This is achieved by re-routing the tendon of Tibialis posterior muscle, brings that tendon to lie in front of the ankle and is anchored distally. If the tendo-achillis tendon is found to be tight, it should be lengthened as the first step of the Tibialis posterior transfer operation. Conclusion: Surgical correction of foot drop usually leads to restoration of active dorsiflexion of the foot thereby preventing development of secondary deformities and ulceration. Our patients were able to dorsiflex their feet after the surgical correction.

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Drop Foot Secondary to a Peroneal Intraneural Ganglion Connected to the Superior Tibiofibular Joint: A Case Report

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1716602 ◽

2020 ◽

Author(s):

Kenan Kıbıcı ◽

Berrin Erok ◽

Akın Onat

Keyword(s):

Peroneal Nerve ◽

Imaging Modality ◽

Axonal Neuropathy ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Intraneural Ganglion ◽

Articular Branch ◽

Ankle Eversion ◽

Adjacent Structures ◽

Tibiofibular Joint

AbstractPeroneal neuropathy is the most frequent mononeuropathy of the lower extremity. Intraneural ganglion cysts (INGCs) are among rare causes of peroneal nerve palsy. According to the articular (synovial) theory, the articular branch plays the key role in the pathogenesis. Patients present with pain around the fibular head and neck, motor weakness resulting in foot drop and paresthesia in the anterolateral calf and foot. Ultrasonography (US) and MRI are both useful in the diagnosis, but MRI is the best imaging modality in the demonstration of the articular connection and the relation of the cyst with adjacent structures, even without special neurography sequences. We present a 32-year-old male patient referred to our neurosurgery clinic with suspicion of lumbar radiculopathy. He presented with right foot drop which began 3 weeks prior. On examination, there was 90% loss in the ankle dorsiflexion and finger extension. Ankle eversion was also weakened. There was no low back or posterolateral thigh pain to suggest L5 radiculopathy and sciatic neuropathy. Following negative lumbar spine MRI, peripheral neuropathy was concerned. Electrodiagnostic evaluations findings were consistent with acute/subacute common peroneal nerve (CPN) axonal neuropathy. Subsequent MRI of knee showed a homogeneous, thin-walled tubular cystic lesion, extending along the course of the CPN and its articular branch. Full recovery of the neuropathy was achieved with early diagnosis and decompression via microsurgical epineurotomy. The diagnosis of INGC was confirmed by histopathologic examination. INGCs, although rare, should also be considered in the differential diagnosis of peripheral mononeuropathies.

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