Letter to the Editor: New Tendon Transfer for Correction of Drop-foot in Common Peroneal Nerve Palsy

Abstract

To the Editor: We congratulate Vigasio et al. [1] for their excellent work on a new tendon transfer for correction of drop-foot in common peroneal nerve palsy. We used this technique several times with good results. Vigasio and colleagues introduced transosseous rerouting of the anterior tibialis tendon at the third cuneiform which permitted tendon-to-tendon suturing between the anterior tibialis tendon and posterior tibialis tendon. They performed this technique proximal to the extensor retinaculum, eliminating tendon length-related and achieving maximum dorsiflexion. In 2010, we performed a modified version of Vigasio tendon transfer. In our modified version, the tibialis anterior tendon is sectioned longitudinally 7 to 8 cm proximal to the ankle joint and a piece of umbilical tape is passed through the split. A long tendon passing clamp is inserted into the tendon sheath from distal to proximal to retrieve the umbilical tape proximal to the retinaculum. The clamp is withdrawn pulling the tape distally, spitting the tendon as the umbilical tape is pulled toward the tendon insertion. After the anterior tibialis tendon has been longitudinally bisected with the passage of the tape, the lateral half of the tendon is cut proximally and the free portion is pulled to the distal insertion. At this point, only the lateral slip of anterior tibialis tendon is transosseous rerouted as the original work and transferred proximal under the retinaculum. Medial half of anterior tibialis tendon is left under the retinaculum and sutured with the rerouted lateral slip with the correct tension. We believe that leaving the medial half and tensioning just the rerouted lateral band of the anterior tibialis tendon can 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.