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Sabaghzadeh A, Biglari F, Sadighi M, Jafari Kafiabadi M, Ebrahimpour A. "Biological Fixation" of Flexor Digitorum Longus: A New Modification of Tendon Transfer for Treatment of Posterior Tibialis Tendon Dysfunction. Foot Ankle Spec 2024; 17:18S-21S. [PMID: 37929752 DOI: 10.1177/19386400231208525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Numerous surgical procedures for the treatment of posterior tibialis tendon (PTT) dysfunction have been developed, including tendon transfers, osteotomies, and arthrodesis. Among these methods, foot and ankle surgeons most frequently use flexor digitorum longus (FDL) tendon transfer in conjunction with medial translational osteotomy of the calcaneus. Formerly, some less invasive techniques have been described to reduce surgical-related complications after FDL tendon transfer. Herein, we introduced a new modification of short-stump FDL tendon fixation to the navicular bone and reported the functional outcomes of the current technique in a patient with PTT dysfunction. In the current technique, the FDL tendon was fixed to the navicular bone via a trans-osseous tunnel using a split PTT stump. This method does not require any kind of fixation devices, such as an interference screw or anchor suture.Level of Evidence: V.
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Affiliation(s)
- Amir Sabaghzadeh
- Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farsad Biglari
- Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sadighi
- Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Jafari Kafiabadi
- Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adel Ebrahimpour
- Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Elkaim M, Ankri M, Giunta JC. Endoscopic assisted flexor digitorum longus transfer in flexible flatfoot. Foot Ankle Surg 2024; 30:99-102. [PMID: 37891099 DOI: 10.1016/j.fas.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Posterior tibial tendon insufficiency is the commonest cause of adult flexible flatfoot. Transfer of the flexor digitorum longus (FDL) has been described a therapeutic arsenal in flexible flat feet and posterior tibial tendon disorders. It is often combined with bony procedure (open or percutaneous calcaneal osteotomy). METHODS We describe a technique and the steps endoscopic approach of FDL transfer. RESULTS The procedure is able to be performed safely and reproducible under perfect viewing CONCLUSION: In the future with a clinical study investigating, we purpose the results of such surgery in a cohort of patients with flexible flatfoot. Level IV Therapeutic study: case serie. No funding was received for this research project.
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Affiliation(s)
- Marc Elkaim
- Clinique Drouot Sport et Arthrose, 75009 Paris, France.
| | - Marine Ankri
- Hôpital Lariboisière AP-HP, 75010 Paris, France.
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Stevoska S, Pisecky L, Stadler C, Gahleitner M, Klasan A, Klotz MC. Tendon transfer in foot drop: a systematic review. Arch Orthop Trauma Surg 2023; 143:773-784. [PMID: 34524486 PMCID: PMC9925604 DOI: 10.1007/s00402-021-04162-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Foot drop is a disorder that impairs walking and leads to tripping and falling. Tendon transfer (e.g., tibialis posterior tendon) is a typical secondary procedure in foot drop treatment. The purpose of this systematic review was to identify the most common tendon transfer techniques for treating foot drop and to analyze the reported functional outcomes. Furthermore, it was of interest if the type of surgical technique affects the functional outcome. METHODS A PubMed and MEDLINE literature search was performed according to PRISMA guidelines. The search terms used were ("tendon transfer" OR "tendon transposition") AND ("foot drop" OR "peroneal neuropathies"). Any study published before January 2020 was considered for inclusion. No case reports or reviews were included. Common outcome measures (Stanmore score, AOFAS, FAAM, AFO use, patient satisfaction and active ankle dorsiflexion) were evaluated. The quality of the included studies was assessed using the Coleman Methodology Score. RESULTS Of the 125 reviewed publications, 37 met the inclusion criteria. 42 cohorts were analyzed. The frequently reported tendon transfer technique was the tibialis posterior tendon transfer through the interosseus membrane. The most used fixation technique was tendon on tendon fixation; however in recent years, a tendon to bone fixation has gained popularity. There was an increase in Stanmore scores and AOFAS postoperatively and a decrease of AFO use postoperatively observed. CONCLUSIONS Due to various outcome measures and lack of preoperative assessment in the included studies, a meta-analysis of the pooled results was not possible. Nevertheless, the findings of this study show that tendon transfer increases mobility and self-independency leading to patient satisfaction. The choice of the surgical technique does not affect the outcome. A prospective collection of patient data and standardized outcome measures will be important to further analyze the efficacy of tendon transfer techniques.
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Affiliation(s)
- Stella Stevoska
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria.
| | - Lorenz Pisecky
- grid.9970.70000 0001 1941 5140Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040 Linz, Austria
| | - Christian Stadler
- grid.9970.70000 0001 1941 5140Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040 Linz, Austria
| | - Manuel Gahleitner
- grid.9970.70000 0001 1941 5140Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040 Linz, Austria
| | - Antonio Klasan
- grid.9970.70000 0001 1941 5140Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040 Linz, Austria
| | - Matthias C. Klotz
- Marienkrankenhaus Soest, Orthopedics and Trauma Surgery, Widumgasse 5, 59494 Soest, Germany
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Abou Diwan R, Badr S, Boulil Y, Demondion X, Maynou C, Cotten A. Presurgical Perspective and Postsurgical Evaluation of Non-Achilles Tendons of the Ankle and Retinaculum. Semin Musculoskelet Radiol 2022; 26:670-683. [PMID: 36791736 DOI: 10.1055/s-0042-1760121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The vast majority of non-Achilles ankle tendinopathies are related to overuse. This article discusses the clinical aspect, imaging appearance, and management of tendinopathies of the lateral, medial, and the anterior compartments with a focus on presurgical perspective and postsurgical evaluation.
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Obey MR, Johnson JE, Backus JD. Managing Complications of Foot and Ankle Surgery: Reconstruction of the Progressive Collapsing Foot Deformity. Foot Ankle Clin 2022; 27:303-325. [PMID: 35680290 DOI: 10.1016/j.fcl.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Our understanding of the cause and principles of treatment of progressive collapsing foot deformity (PCFD) has significantly evolved in recent decades. The goals of treatment remain improvement in symptoms, correction of deformity, maintenance of joint motion, and return of function. Although notable advancements in understanding the deformity have been made, complications still occur and typically result from (1) poor decision making, (2) technical errors, and (3) patient-related conditions. In this article, we discuss common surgical modalities used in the treatment of PCFD and further highlight the common complications that occur and the techniques that can be used to prevent them.
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Affiliation(s)
- Mitchel R Obey
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave CB8233 St. Loiuis, MO 63110, USA
| | - Jeffrey E Johnson
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave CB8233 St. Loiuis, MO 63110, USA
| | - Jonathon D Backus
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave CB8233 St. Loiuis, MO 63110, USA.
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Benca E, Willegger M, Wenzel F, Hirtler L, Zandieh S, Windhager R, Schuh R. Biomechanical evaluation of two methods of fixation of a flexor hallucis longus tendon graft. Bone Joint J 2018; 100-B:1175-1181. [DOI: 10.1302/0301-620x.100b9.bjj-2018-0100.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aims The traditional transosseus flexor hallucis longus (FHL) tendon transfer for patients with Achilles tendinopathy requires two incisions to harvest a long tendon graft. The use of a bio-tenodesis screw enables a short graft to be used and is less invasive, but lacks supporting evidence about its biomechanical behaviour. We aimed, in this study, to compare the strength of the traditional transosseus tendon-to-tendon fixation with tendon-to-bone fixation using a tenodesis screw, in cyclical loading and ultimate load testing. Materials and Methods Tendon grafts were undertaken in 24 paired lower-leg specimens and randomly assigned in two groups using fixation with a transosseus suture (suture group) or a tenodesis screw (screw group). The biomechanical behaviour was evaluated using cyclical and ultimate loading tests. The Student’s t-test was performed to assess statistically significant differences in bone mineral density (BMD), displacement, the slope of the load-displacement curves, and load to failure. Results The screw group showed less displacement (loosening) during cyclical loading, which was significant during 300, 500, 600, 700, 800, 900, and 1000 cycles (p < 0.05: other cycles: 0.079 < p < 0.402). Compared with the suture group, the screw group had higher mean ultimate load values (133.6 N, sd 73.5 vs 110.1 N, sd 46.2; p = 0.416). Conclusion Fixation of the FHL tendon with a tenodesis screw enables a less invasive procedure to be undertaken and shows similar biomechanical behaviour and primary strength compared with fixation using a transosseus suture. Cite this article: Bone Joint J 2018;100-B:1175–81.
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Affiliation(s)
- E. Benca
- Department of Orthopedics and Trauma Surgery,
Medical University of Vienna, Vienna, Austria
| | - M. Willegger
- Department of Orthopedics and Trauma Surgery,
Medical University of Vienna, Vienna, Austria
| | - F. Wenzel
- Department of Trauma Surgery, Trauma Center
Meidling – AUVA, Vienna, Austria
| | - L. Hirtler
- Division of Anatomy, Center for Anatomy
and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - S. Zandieh
- Department of Radiology, Hanusch Hospital, Vienna, Austria
| | - R. Windhager
- Department of Orthopedics and Trauma Surgery,
Medical University of Vienna, Vienna, Austria
| | - R. Schuh
- Department of Orthopedics and Trauma Surgery,
Medical University of Vienna, Vienna, Austria
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