Cadaveric Limb Analysis of Tendon Length Discrepancy of Posterior Tibial Tendon Transfer through the Interosseous Membrane

Posterior Tibial Tendon Transfer with Combined Tendon-Tendon and Tendon-Bone Fixation using the Circum-Tibial Route and Superficial Retinacular Passage in the Foot Drop

“…As the circumferential tract is longer, the torque for dorsiflexion will be greater. Data from cadaveric studies have shown that tendon length is insufficient for transmembrane transfer [7]. Another important consideration is the retinacular junction.…”

“…Tendon transfers, such as the tibialis posterior tendon, are the most important adjunctive procedures in the treatment of foot drop [3,4]. It is important to apply the increasingly popular tendon transfer techniques and to understand the functional consequences of the type of surgical technique [5][6][7]. In particular, tendon transfer has been shown to improve patient satisfaction by increasing mobility and walking independence.…”

Posterior Tibial Tendon Transfer for the Correction of Drop Foot

“…Mayer, in 1937, then credited Putti with the modification of the procedure that transferred the PT tendon through the interosseous membrane. 6,11 Watkins later popularized the transmembranous approach in 1954. 11,12 The transmembranous approach is recommended over the circumtibial approach because of less gliding resistance, and routing the tendon underneath the extensor retinaculum is performed to prevent bowstringing of the tendon.…”

“…6,11 Watkins later popularized the transmembranous approach in 1954. 11,12 The transmembranous approach is recommended over the circumtibial approach because of less gliding resistance, and routing the tendon underneath the extensor retinaculum is performed to prevent bowstringing of the tendon. 13 Several modifications to the procedure have been described, including three incisions versus four, splitting the PT tendon into two tails, split anastomosis with the tibialis anterior or peroneus brevis tendon, double tendon transfer with the flexor digitorum longus tendon, and the Bridle tritendon anastomosis with the tibialis anterior and peroneus longus tendons.…”

“…13,14,16 The muscle to be transferred must be graded as 4 or greater because it will decrease one grade after transfer. 11,16 Transfers of muscles within the same phase of gait are preferred and have a better prognosis than those with out-of-phase transfers. In addition, fixed osseous deformities must be corrected before the tendon transfer.…”