Interosseous membrane window size for tibialis posterior tendon transfer-Geometrical and MRI analysis

Charcot-Marie-Tooth Disease: A Surgical Algorithm

In Charcot-Marie-Tooth (CMT) cavovarus surgery, a regimented approach is critical to create a plantigrade foot, restore hindfoot stability, and generate active ankle dorsiflexion. The preoperative motor examination is fundamental to the algorithm, as it is not only guides the initial surgical planning but is key in the decision making that occurs throughout the operation. Surgeons need to be comfortable with multiple techniques to achieve each surgical goal. There is no one operation that works for all patients with CMT. A plantigrade foot is the most important of the surgical goals as hindfoot stability and ankle dorsiflexion can be augmented with bracing.

Anterior Tibial Tendon Side-to-Side Tenorrhaphy after Posterior Tibial Tendon Transfer: A Technique to Improve Reliability in Drop Foot after Common Peroneal Nerve Injury

Common peroneal nerve injury is present in 40% of knee dislocations, and foot drop is the principal complication. Posterior tibial tendon transfer is a viable solution to replace the function of the anterior tibial tendon (ATT) in the mid-foot. Several techniques for posterior tibial tendon transfer exist today, with variable results reported. However, adding augmentation with side-to-side tenorrhaphy of ATT to the transferred posterior tibial tendon (PTT) enhances anterior tissue balance and load sharing stress between native ATT enthesis and PTT tenodesis, allowing early rehabilitation and improving functional outcomes. Side-to-side tenorrhaphy is performed after PTT tenodesis in the lateral cuneiform to improve reliability in foot drop. This technique allows shorter immobilization time (from 6 to 2 weeks), earlier rehabilitation, sooner weight-bearing, and decreased risk of arthrofibrosis, scar formation, and muscle atrophy.

Ultrasound Imaging Is Reliable for Tibialis Posterior Size Measurements

OBJECTIVES

The tibialis posterior (TP) is a vital muscle for controlling the medial longitudinal arch of the foot during weight-bearing activities. Dysfunction of this muscle is associated with a variety of pathologic conditions; thus, it is important to reliably assess its morphologic characteristics. Ultrasound (US) has been used to assess characteristics of TP tendons but not the muscle cross-sectional area (CSA). The purpose of this study was to establish a reliable US technique to measure the TP CSA and thickness.

METHODS

Twenty-three healthy volunteers participated. We evaluated the CSA and thickness at 4 measurement locations (anterior and posterior views at both 30% and 50% of the shank length).

RESULTS

The participants included 12 female and 11 male volunteers (mean age ± SD, 31.23 ± 14.93 years). Excellent reliability was seen for the CSA and thickness at all locations (intraclass correlation coefficients, 0.988-0.998). Limits of agreement (LoA) and standard errors of the measurement (SEMs) were slightly lower at the 30% locations (LoA at 30%, 4.6-9.2; LoA at 50%, 6.4-9.7; SEM at 30%, 0.03-0.05; SEM at 50%, 0.04-0.07). Strong correlations were seen between anterior and posterior measurements of the CSA (30%, r = 0.99; P < .0001; 50%, r = 0.94; P < .0001) and thickness (30%, r = 0.98; P < .0001; 50%, r = 0.95; P = .0001).

CONCLUSIONS

Based on these results, the TP can be measured accurately with US at any of the tested locations. Due to the ease of collection and the quality of the data, we recommend the anterior view at 30% of the shank length to measure the CSA. The ability to assess muscle size of the TP will aid in a variety of medical and research applications.

Diagnosis and treatment of ankle syndesmosis injuries with associated interosseous membrane injury: a current concept review

BACKGROUND

Tibiofibular syndesmosis injury leads to ankle pain and dysfunction when ankle injuries are not treated properly. Despite several studies having been performed, many questions about diagnosis and treatment remain unanswered, especially in ankle syndesmosis injury with interosseous membrane injury. Therefore, the purpose of this study was to help guide best practice recommendations.

METHODS

This review explores the mechanism of injury, clinical features, diagnosis methods, and the treatment strategy for ankle syndesmosis injury with interosseous membrane injury to highlight the current evidence in terms of the controversies surrounding the management of these injuries.

RESULTS

Radiological and CT examination are an important basis for diagnosing ankle syndesmosis injury. Physical examination combined with MRI to determine the damage to the interosseous membrane is significant in guiding the treatment of ankle syndesmosis injury with interosseous membrane injury. In the past, inserting syndesmosis screws was the gold standard for treating ankle syndesmosis injury. However, there were increasingly more controversies regarding loss of reduction and broken nails, so elastic fixation has become more popular in recent years.

CONCLUSIONS

Anatomical reduction and effective fixation are the main aspects to be considered in the treatment of ankle syndesmosis injury with interosseous membrane injury and are the key to reducing postsurgery complications.