Titolo and colleagues proposed a modified version of Vigasio tendon transfer [7, 8] in which surgeons reroute only half of the anterior tibialis tendon. The remaining half of the anterior tibialis tendon is used as a rein to “improve in dorsiflexion the correct balance of pronation/supination of the foot especially when the exit hole of the transosseous tunnel at the third cuneiform is not perfectly centered on the axis of the ankle,” according to Titolo and colleagues’ letter to the editor.
The basis for their proposal is not new. Numerous papers [2–6, 9] play on the “reins” concept in order to obtain a balanced foot dorsiflexion. Several bone attachments have also been tested (first, second, third cuneiform, cuboid, and the base of the fifth metacarpal bone). Goh and colleagues [1] demonstrated that the ideal tendon insertion to achieve a balanced foot dorsiflexion is on the third cuneiform.
Generally, a “reins” procedure, like the one proposed by Titolo, has not been widely adopted among surgeons because the approach is technically demanding. Additionally, the procedure does not respect the “straight line of pull principle” on tendon transfer [1]. According to this principle, if two or more tendons are sutured with an oblique angle of incidence, the donor tendon further dissipates the residual contraction power, risking the creation of a tenodesis effect rather than a voluntary, dynamic dorsiflexion of the ankle and digits.
The anterior tibialis tendon rerouting technique as described by Vigasio [7, 8] use an anterior tibialis tendon as a single rein. When correctly extracted from the third cuneiform, the tendon gives a working balanced foot dorsiflextion.
We understand that surgical techniques continually need updates and revisions, and we thank Titolo and coauthors for their proposal.
Footnotes
(Re: Vigasio A, Marcoccio I, Patelli A, Mattiuzzo V, Prestini G. New Tendon Transfer for Correction of Drop-foot in Common Peroneal Nerve Palsy. Clin Orthop Relat Res. 2008;466:1454–1466.)
Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR® or the Association of Bone and Joint Surgeons®.
References
- 1.Goh JC, Lee PY, Lee EH, Bose K. Biomechanical study on tib-ialis posterior tendon transfers. Clin Orthop Relat Res. 1995;319:297–302. [PubMed] [Google Scholar]
- 2.Hove LM, Nilsen PT. Posterior tibial tendon transfer for drop-foot: 20 cases followed for 1–5 years. Acta Orthop Scand. 1998;69:608–610. doi: 10.3109/17453679808999265. [DOI] [PubMed] [Google Scholar]
- 3.McCall RE, FredericK HA, McCluskey GM, Riordan DC. The Bridle Procedure: A new treatment for equinus and equinovarus deformities in children. J Pediatric Orthop. 1991;11:83–89. doi: 10.1097/01241398-199101000-00016. [DOI] [PubMed] [Google Scholar]
- 4.Mulier T, Moens P, Molonaers G, Spaepen D, Dereymaeker G, Fabry G. Split posterior tibial tendon transfer through the interosseous membrane in spastic equinovarus deformity. Foot Ankle Int. 1995;16:754–759. doi: 10.1177/107110079501601203. [DOI] [PubMed] [Google Scholar]
- 5.Rodriguez RP. The Bridle procedure in the treatment of paralysis of the foot. Foot Ankle. 1992;13:63–69. doi: 10.1177/107110079201300203. [DOI] [PubMed] [Google Scholar]
- 6.Srinivasan H, Mukherjee SM, Subramaniam RA. Two-tailed transfer of tibialis posterior for correction of drop foot in leprosy. J Bone Joint Surg Br. 1968;50:623–628. [PubMed] [Google Scholar]
- 7.Vigasio A, Marcoccio I. Correction of drop-foot in common peroneal nerve palsy: The anterior tibialis tendon rerouting technique. Tech Foot Ankle Surg. 2012;3:140–149. doi: 10.1097/BTF.0b013e318261eca2. [DOI] [Google Scholar]
- 8.Vigasio A, Marcoccio I, Patelli A, Mattiuzzo V, Prestini G. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res. 2008;466:1454–1466. doi: 10.1007/s11999-008-0249-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Yeap JS, Singh D, Birch R. A method for evaluating the results of tendon transfers for foot drop. Clin Orthop Relat Res. 2001;383:208–213. doi: 10.1097/00003086-200102000-00024. [DOI] [PubMed] [Google Scholar]