Bridle Transfer for Paresis of the Anterior and Lateral Compartment Musculature

Abstract

In the Riordan (bridle) transfer, the posterior tibialis muscle as motor is routed through the interosseous membrane and anastomosed into a "bridle" formed by the distal tibialis anterior and peroneus longus muscles. In theory, the bridle provides inversion/eversion balance even if the transfer effects only tenodesis. However, the procedure has been criticized because its insertion is not into bone. This review analyzes the use of bridle transfer in flaccid paresis involving musculature innervated by the peroneal nerve. Surgery was performed 1 to 3 years after injury for patients with traumatic etiology. Ten patients are reviewed at 61 months' mean follow-up. Eight patients had traumatic peroneal nerve loss. Two had neuromuscular etiology. Evaluation included review of records, telephone interviews, and physical examinations. Data on functional status included walking barefoot running, need for bracing, return to duty, and patient satisfaction. Physical examination recorded ankle position and motions, gait findings, and results of static electromyograms. All patients were able to walk barefoot, but 6 of 10 had a mild to moderate limp. Five patients returned to running initially; only two were able to keep running. Nine patients were brace-free initially (polio sequela required bracing initially), and four others returned to bracing. Of these, two experienced an acute "tearing" and dorsiflexion loss, one sustained a prolonged gradual loss of dorsiflexion, and one sustained a contralateral cerebrovascular accident. Only three of seven patients returned to active duty, and one is on jump status. All patients were satisfied with their initial result. Only two patients had no detectable swing phase problems (both returned to active duty). Five patients had peroneal nerve exploration with repair or neurolysis; two of them sustained complete transections. Postoperative electromyograms showed insignificant, if any, nerve return. The Riordan transfer works well for neuromuscular flaccid paresis and in patients with peroneal nerve injuries with low demands. It may stretch out over time to the point of acute failure in patients with high demands. Concurrent peroneal nerve exploration and repair did not seem to be beneficial in this small study.

Long-term results of tibialis posterior tendon transfer for drop-foot

“…De Marchi et al [4] concluded that there was no deterioration in function with time in patients who had the distal attachment to the cuneiform, while Prahinski et al [16] commented that function deteriorated in time due to the tendon stretching out. We are not able to comment on this phenomenon, except to report that one patient felt that dorsiflexion was weaker following her pregnancy, and another felt this following a recent fall.…”

“…The medial tail was inserted into the tendon of extensor hallucis longus and the lateral tail into the tendons of extensor digitorum longus and peroneus tertius. The Bridle procedure [14], a tritendon double-end-weave anastomosis between tibialis posterior, tibialis anterior and peroneus longus tendon was used by Prahinski et al [16] to treat 10 soldiers.…”

Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

“…Given that many patients have acquired a foot drop by a longitudinal traumatic stretch injury to the peroneal nerve, neurolysis and/or nerve grafting has not resulted in successful restoration of ankle dorsiflexion [17,22]. Posterior tibial tendon transfers and their variants, although a reasonable treatment option for foot drop, provides only weak ankle dorsiflexion [15] and is fraught with long-term complications [5]. Nerve transfers Fig.…”

“…Posterior tibial tendon transfers and their variants (Bridle procedure, Riordan transfer) are a commonly used treatment for foot drop [6]. Although this tendon transfer has had reasonable success in allowing patients to return to ambulation without assistive devices [6], the procedure provides weak dorsiflexion and may not completely restore normal gait [15]. This procedure is fraught with long-term complications, including hindfoot valgus deformity, arthritis, and flat foot deformity [5].…”

Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: An anatomical study

“…The most common such procedure has been the transfer of all or a portion of the tibialis posterior tendon, redirected to the dorsum of the foot. This provides weak ankle dorsiflexion and may not completely correct the gait problem (Prahinski et al, 1996); furthermore, long-term complications, including hind-foot valgus deformity, arthritis, and flatfoot deformity, have been reported (Johnson and Strom, 1989).…”