Communications between the tendons of flexor hallucis longus and flexor digitorum longus: a cadaveric study

Vasudha, T. K.; Vani, Preeti; Sankaranarayanan, G.; Rajasekhar, S. S. S. N.; Kumar, V Dinesh

doi:10.1007/s00276-019-02311-x

Cited by 7 publications

(15 citation statements)

References 29 publications

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“…In this study, the mean foot lengths were 246 mm and 225 mm in male and female respectively. A significant difference between genders was found similar to the previous reports [3,22] MKH has been widely utilized as a surgical landmark for the FHL tendon graft harvesting especially in double incision technique [2] [2,28]. According to the results of this study, the location of MKH resided proximal to the first IP joint, inferior to NT and distal to MM which resembled findings of previous reports [2,28] (Table 6).…”

Section: Discussionsupporting

confidence: 90%

Surface localisation of master knot of Henry, in situ and ex vivo length of flexor hallucis longus tendon: pertinent data for tendon harvesting and transfer

et al. 2021

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Background: Length of flexor hallucis longus (FHL), localization of master knot of Henry (MKH) and relationship between MKH and neurovascular bundle are essential for the achievement of FHL tendon transfer. The purpose of this study is to define the localization of MKH in reference to bony landmarks of the foot, its relationship to plantar neurovascular bundle and to investigate in situ and ex vivo length of FHL tendon in single incision, double incision and minimally invasive techniques. Materials and methods: Foot length was examined in sixty-two feet of thirty-one soft cadavers (9 males, 22 females). Various parameters including the relationship between MKH and neurovascular bundle, the distances from MKH to medial malleolus (MM), navicular tuberosity (NT) and the first interphalangeal joint of great toe (IP) were measured. Surface localization of MKH in relation to a line joining the medial end of plantar flexion crease at the base of great toes (MC) to NT (MC-NT line) was determined. Lengths of FHL tendon graft from three surgical techniques were examined. In situ length was measured in the plantar surface of foot and ex vivo length was measured after tendon was cut from its insertion. Results: The mean length of foot was 230.98±15.35 mm with a statistically significant difference between genders in both sides (p<0.05). No distance was found between medial plantar neurovascular bundle (MPNVB) and MKH. Mean distance of 17.13±3.55 mm was found between lateral plantar neurovascular bundle (LPNVB) and MKH. MKH was located at a mean distance of 117.11±1.00 mm proximal to IP, 26.28±4.75 mm under NT and 59.58±7.51mm distal to MM with a statistically significant difference of MKH-IP distance between genders in both sides and MKH-NT in right side. MKH was located anterior to NT (66.1 %), at NT (27.4%) and posterior to NT (6.5%) on the MC-NT line. Surface localization of MKH was 94.75+8.43% of MC-NT line from MC with a perpendicular distance of 25.11±5.37mm below MC-NT line. The in situ and ex vivo tendon lengths from MTJ to ST, to MKH and to IP were 39.05±10.88 mm and 34.43±10.23 mm, 73.45±9.91 mm and 68.63±9.43 mm, 197.98±13.89 and 191.79±14.00 mm, respectively. A statistically significant difference between genders was found in MTJ-IP of in situ and ex vivo length of both sides (p < 0.05). The mean length of tendon between in situ and ex vivo was significantly different in all techniques (p < 0.05). A moderate positive correlation between foot length and tendon length was found in MTJ-IP of both in situ and ex vivo tendon length. Conclusions: A statistically significant difference between in situ and ex vivo tendon length was shown in all harvesting techniques. Surface location of MKH was approximately at 95%of MC-NT line from MC with a perpendicular distance of 25 mm from MC-NT line.

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Section: Discussionsupporting

confidence: 90%

Surface localisation of master knot of Henry, in situ and ex vivo length of flexor hallucis longus tendon: pertinent data for tendon harvesting and transfer

et al. 2021

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“…Anatomically, the FHL originates from the posterior surface of the fibula in the deep posterior compartment, passes through the medial retromalleolar region, and inserts into the hallux. An invariable intertendinous connection is observed between the FHL and flexor digitorum longus (FDL) at the master knot of Henry ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic checkrein deformity following isolated Lauge–Hansen pronation external rotation stage IV malleolar fracture—a case report and literature review

2023

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The checkrein deformity is characterized by flexion contracture of the interphalangeal joint and extension contracture of the metatarsophalangeal joint. It is a rare condition occurring after lower extremity trauma, especially a malleolar fracture. Little is known about the possible cause and therapeutic strategy. This unique case presents a 20-year-old male patient with a diagnosis of the checkrein deformity secondary to open reduction and internal fixation of a Lauge–Hansen pronation external rotation stage IV malleolar fracture. After performing a detailed physical examination, radiographic evaluation, and ultrasonography, open exploration was performed to remove the hardware and correct the deformity with sole tenolysis of the flexor hallucis longus (FHL). In the 4-month follow-up, no recurrence of the checkrein deformity was observed. This deformity was caused by FHL adhesion. Interosseous membrane injury and fibular fracture together with local hematomas increases the risk of FHL adhesion. Open exploration and tenolysis of the FHL are feasible options to correct the checkrein deformity.

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“…In a study of Thai people [ 7 ], it was suggested that the foot length was 230.9 ± 15.3 mm and the length of MKH-FHLi was 117.1 ± 10.0 mm. In a study of Indian people [ 9 ], it was suggested that the foot length was 189.5 ± 30.2 mm and the length of MKH-FHLi was 122.3 ± 10.0 mm. In a Chinese study [ 10 ], the length of MKH-FHLi was 10.89 ± 1.08 mm.…”

Section: Discussionmentioning

confidence: 99%

A Simple Method to Locate the Master Knot of Henry Using the Correlation between the Flexor Tendon Length Parameter and the Foot Length

Park

Lee

et al. 2022

IJERPH

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The precise location of the Master Knot of Henry (MKH) has important clinical significance, but its anatomical definition has not been agreed upon. The purpose of this study is to present a linear regression equation for predicting length variables based on foot length, by evaluating the correlation of length variables related to flexor hallucis longus (FHL) and flexor digitorum longus (FDL), with respect to the location of the MKH. A total of 95 limbs were dissected from 48 adult cadavers, and were fixed in formalin. Measurements were made for the length parameter, with reference to the landmark. The relevance between length variables was analyzed through simple correlation analysis and linear regression analysis. The foot length was 213.69 ± 17.53 mm, MKH-great toe distal phalanx was 140.16 ± 14.69 mm, MKH-FHL insertion was 124.55 ± 13.46 mm, MKH-little toe distal phalanx was 121.79 ± 13.41 mm, MKH-FDL little toe insertion was 109.07 ± 14.16 mm, and the FHL-FDL angle was 33.15 ± 5.39. The correlation coefficient between all the length variables for foot length showed a high positive correlation. We derived a regression equation that can predict the length of each variable. This regression formula is considered to be highly useful because it can estimate the positional relationship of the MKH relatively simply.

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Communications between the tendons of flexor hallucis longus and flexor digitorum longus: a cadaveric study

Cited by 7 publications

References 29 publications

Surface localisation of master knot of Henry, in situ and ex vivo length of flexor hallucis longus tendon: pertinent data for tendon harvesting and transfer

Surface localisation of master knot of Henry, in situ and ex vivo length of flexor hallucis longus tendon: pertinent data for tendon harvesting and transfer

Posttraumatic checkrein deformity following isolated Lauge–Hansen pronation external rotation stage IV malleolar fracture—a case report and literature review

A Simple Method to Locate the Master Knot of Henry Using the Correlation between the Flexor Tendon Length Parameter and the Foot Length

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