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

Abstract

Twelve patients with drop-foot secondary to sciatic or common peroneal nerve palsy treated with transfer of the tibialis posterior tendon were followed-up for a mean of 90 (24-300) months. In 10 patients the results were 'excellent' or 'good'. In 11 patients grade 4 or 5 power of dorsiflexion was achieved, although the torque, as measured with a Cybex II dynamometer, and generated by the transferred tendon, was only about 30% of the normal side. Seven patients were able to dorsiflex their foot to the neutral position and beyond. The results appeared to be better in men under 30 years of age with common peroneal palsies. A painful flatfoot acquired in adulthood does not appear to be a significant long-term complication despite the loss of a functioning tibialis posterior tendon.Résumé 12 patients avec pied tombant secondaire à une paralysie sciatique et traités par transfert du tendon tibial postérieur ont été suivis en moyenne 90 mois (24-300). Chez 10 patients les résultats étaient 'Excellent' ou 'Bon'. Chez 11 patients une force de dorsiflexion de grade 4 ou 5 a été atteinte, bien que le couple produit par le tendon transféré, mesuré avec un dynamomètre et le Cybex II n'était que de 30% de la valeur du côté normal. 7 patients étaient capables de relever leur pied en position neutre et au-delà. Les résultats ont paru meilleurs chez les hommes de moins de 30 ans avec paralysie du sciatique poplité externe. Un pied-plat acquis douloureux ne paraît pas être une complication à long terme en dépit de la perte de l'action normal du tendon tibial posterieur.

Posterior Tibial Tendon Transfer Improves Function for Foot Drop After Knee Dislocation

“…Other studies have instead focused on functional outcome or patient satisfaction as measured in other ways [7,32], with 10 of 12 patients satisfied in one report [32] and 15 good and two improved in another [7]. Certainly the mean AOFAS score of 91 in this study would appear to hold up well against the results of others [7,32]. The aim of the tendon transfer is to reduce or prevent pes equinus and improve gait so that the patient can discard the ankle-foot orthosis.…”

“…However, this is an uncommon complication of an uncommon injury, and no other patient series on the topic have comparable numbers [7,10,18,27,32]. One limitation in interpreting the results is that there is no consensus in outcome scores for this group.…”

“…Posterior tibial tendon transfer as treatment for foot drop has been reported with good to fair functional results [1,7,10,18,32], but the previous studies have included patients with a variety of causes for their foot drop. All of the patients included in our study had a knee dislocation as the specific injury causing the nerve damage.…”

“…Also, the retrospective nature of the study is a limitation. However, it will be difficult to do a prospective study on this patient population, and all other studies are retrospective [7,10,18,32]. Another limitation is that the technique of posterior tibial tendon transfer is complex, and the number of these procedures performed is low; one needs to consider surgeon experience in deciding to what degree the results here (which were obtained in a high-volume trauma setting) are generalizable to other settings.…”

“…Some authors recommend repeated EMG and nerve conduction velocity testing to evaluate the status of the common peroneal nerve [9], and some recommend surgical intervention if no recovery of motor function is noted 3 months after the initial injury [5,9]. Previous studies describe the results after posterior tibial tendon transfer for foot drop as fair to good [1,7,10,18,32], but the studies include patients with a wide range of reasons for foot drop. No previous studies, to our knowledge, have exclusively focused on patients with knee dislocation as the specific reason for the foot drop, and this may be important because patients with a more proximal lesion to the nerve (such as occurs with knee dislocations) may have some impairment to other muscle groups of the calf that can influence functional results when these lesions are treated surgically, and the severity of trauma associated with knee dislocations might itself influence the likelihood of motor recovery.…”