Summary Six familial cases of partial absence of the sacrum and the coccyx are described. Four had sacral ventral meningocele. There was a sex‐linked dominant inheritance. The diagnosis of the meningocele was established by myelography. The symptoms were constipation and incontinence of urine. Three patients also had recurrent infections of the urinary tract, and three had congenital anal stenosis.
Augmentation of the Achilles mechanism utilizing the flexor hallucis longus (FHL) tendon transfer to the calcaneus is a well-described procedure. Traditional methods for this procedure require suturing the tendon onto itself after passing it through an osseous tunnel. Tendon fixation techniques that reduce dissection and thus operative time while allowing adequate fixation would be advantageous in reducing patient morbidity from the aforementioned extended operative times. The authors suggest a new technique for transfer of the FHL to the calcaneus as a treatment of chronic Achilles tendon insufficiency. The objective of this fresh cadaver study is to compare the tendon fixation pullout strength of a traditional tendon transfer technique versus bioabsorbable interference screw fixation and, subsequently, propose a less invasive but stronger and more efficient technique for FHL transfer and fixation. Clinical implications suggest more reliable fixation that may allow faster rehabilitation after the procedure. Ten cadaver foot and ankle matched pairs were used after undergoing bone densitometry. A specimen from each cadaver pair had the flexor hallucis longus tendon sutured to itself with #1 Ticron suture (Ethicon) after being pulled through an osseous tunnel. These 10 specimens were assigned to group A. In the contralateral ankle specimen, the flexor hallucis longus tendon was placed into a 6.5-mm osseous drill hole and fixed with a 7 3 25-mm bioabsorbable interference screw. These comprised group B. Mechanical testing of pullout strength was then performed; pullout strength and mode of failure were recorded during this testing. Tendon fixation in group A averaged 127.6 N, and group B 170.28 N. By paired 2-tailed Student t test, the differences between each matched pair were statistically significant (P = 0.04529). In group A, failure occurred most often at the bone tunnel (6 of 10) and tendon midsubstance (4 out of 10). Failures at the tendon midsubstance were not included in the data analysis. All Group B failures occurred at the tendon/screw interface. According to the results of our study, the bioabsorbable interference screw fixation technique was found to resist significantly higher pullout forces than the traditional approach to flexor hallucis longus transfer. The authors feel that the interference screw technique is technically easier while having the capacity to resist higher loads; subsequent to clinical testing, it could prove a superior method of flexor hallucis longus transfer for chronic Achilles tendon rupture or tendinopathy.
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