A NEW TECHNIQUE FOR TIBIALIS POSTERIOR TE NDON TRANSFER

Purpose of the study The purpose of the study was to adjust a palliati ve transfer using the Tibialis Posterior (TP) tendon in case of foot d orsiflexion palsy. The surgical procedure emphasized some functional f eatures, in an attempt to lessen parasitical motion of the foot in abd uction or in adduction when patients bear the ankle joint in dorsiflex ion, and to strenghten the transfer. Material and methods The surgical technique was carried out four times in patients, with a follow-up of six to eighteen months. One 20 cm long leg incision, on the antero-la teral part of tibia, up to the retinaculum of extensors tendons, allow ed a section of Tibialis Anterior (TA) tendon as proximal as possible, and an aperture through the tibiofibular fascia in its lower third. O ne 15 cm long leg incision, along the postero-medial edge of the tibia , toward medial malleolus, allowed a release of the TP tendon after di stal section. The tendon was rerouted across the former fascia apertur e. One 6 cm foot medial incision face to navicuiar bone, where the TA tendon was thoroughly extracted and diverted, close to the sole side o f the medial cuneiforme, and the two medial metatarsal bones. One 5 cm foot dorsal incision was performed, opposite to the 2d intermetatarsa l space, where the diverted TA tendon end was recovered and pulled alo ng a tunnel beneath the retinaculum of extensors. It was thus sutured, with a satisfactory tension to the TP tendon transfered across the ti biofibular fascia. Weight bearing in a short leg cast was allowed. Res ults, Discussion, Conclusion In the four cases, the results fulfilled the goal, with a satisfactory evaluation of the efficacy of the transf er, even the TA tendon was once intentionally diverted through the Ist metatarsal space instead of the second one, without any damage for th e vessels pedicle. Among the widespread use of TP tendon, we think tha t a more neutral position of the tendon should be adopted with a curse coming along the extension of the leg axis, to the 2d intermetatarsal space. The more distally the transfer may be bound, the much efficien t it will be. Obviously, there is no change in a correct automatic use of the transfer in gait. Even though it requires more experience and much longer follow-up time, this technique ensure a reliable and comfo rtable attachment of the transfered tendon, by a tendon-to-tendon sutu re, and secure a better restored foot dorsiflexion.