Split Anterior Tibial Tendon Transfer Research Articles

Functional, clinical, and radiological outcomes of split anterior tibial tendon transfers in patients with sequelae of congenital talipes equinovarus.

This retrospective analysis aimed to assess the effectiveness of Split Tibialis Anterior Tendon Transfer (Split TATT) in treating residual idiopathic congenital talipes equinovarus (CTEV) deformities. 15 patients (20 feet) with CTEV, with a mean age of 6.4 ± 3.2 years, initially treated with Ponseti casting, underwent Split TATT. Clinical and radiological evaluations, including Diméglio and Garceau scores, dorsiflexion, and X-ray measurements, were conducted preoperatively and post-operatively at a minimum 2-year follow-up. Significant improvements were observed in Diméglio and Garceau scores. Dorsiflexion increased by an average of 3°, and radiological analysis revealed nuanced changes. Despite a weak Kappa coefficient, positive trends in dorsiflexion and Garceau scores were noted. Preoperative Garceau scores did not reliably predict postoperative results. Split TATT demonstrates promising results in improving muscular balance and functional outcomes in CTEV. While radiological changes are subtle, positive trends in clinical scores indicate meaningful outcomes. IV Retrospective study.

Split transfer of tibialis anterior for equinovarus foot deformity in cerebral palsy

: Foot deformities in children with cerebral palsy are common. The various foot deformities are equinus, planovalgus, equinovarus, equinovalgus. Treatment for the flexible foot deformity should be with orthotics and manual therapy initially and then with tendon lengthening. Equinovarus deformity of the foot is a result of the muscle imbalance in which invertors of the foot, posterior and anterior tibialis muscle, overpower evertors. Untreated spastic equinovarus deformity may cause severe fixed foot deformity and painful callosities under metatarsal heads and on the lateral side of foot. To evaluate the effectiveness of split transfer of tibialis anterior for equinovarus foot deformity in spastic cerebral palsy children.40 spastic cerebral palsy (13 diplegic and 27 hemiplegic) children between the age of 5-15 years with equinovarus foot deformity were selected. The procedure adopted in all the cases was tendoachilles lengthening and split anterior tibialis tendon transfer to cuboid. The result was graded as good, fair and poor. In 28 of the cases varus deformity of the forefoot and midfoot got corrected with plantigrade foot, in 10 of the cases forefoot and midfoot supination was corrected but heel was in varus and in 2 of the cases there was no improvement.: Spastic T.A. is most often the cause of varus of forefoot. Split transfer utilises the spastic nature of the muscle to counter balance the deformity caused by the original muscle. Hence, it is better solution to the problem. However accurate diagnosis of deforming muscle, i.e, T.A or T.P. is essential to produce good result.

The effects of split tibialis anterior tendon transfer to peroneal tendon for equinovarus foot in children with unilateral cerebral palsy

The effects of split tibialis anterior tendon transfer to peroneal tendon for equinovarus foot in children with unilateral cerebral palsy

Study of Split Tibialis Anterior Tendon Transfer to Peroneus Brevis in Management of Equinovarus Deformity among Children with Cerebral Palsy

Study of Split Tibialis Anterior Tendon Transfer to Peroneus Brevis in Management of Equinovarus Deformity among Children with Cerebral Palsy

Split Transfer of the Tibialis Anterior Tendon Combined With Calcaneocuboid Fusion vs Split Transfer of the Tibialis Anterior Tendon Alone to Treat Equinovarus Foot Deformity in Children With Cerebral Palsy.

The study aimed to compare the outcomes of combined calcaneocuboid arthrodesis and split anterior tibialis tendon transfer (SPLATT) procedure to isolated SPLATT surgery for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP). Forty-one ambulatory CCP with 56 equinovarus feet, with positive flexor withdrawal reflex test results, were studied. The average age was 9.1 ± 3.2 years (range 3-22). Patients were assigned into 2 groups based on the surgical procedures. Patients in group 1 underwent isolated SPLATT surgery, whereas patients in group 2 underwent the SPLATT procedure combined with calcaneocuboid arthrodesis. All feet were followed for at least 12 months after surgery. Patients were evaluated preoperatively and at the most recent follow-up visit. The hindfoot positions were assessed using Chang's criteria, the functional outcomes were assessed using Kling's criteria, and the ambulatory levels were assessed using the Gross Motor Function Classification System (GMFCS). Patients were followed for an average of 30.4 ± 14 (range 14-84) months. We found no difference between the groups in Chang's scoring (P = .550), better clinical outcomes (P = .034) according to the Kling criteria in SPLATT with calcaneocuboid fusion group, and postoperative GMFCS levels better in the SPLATT with calcaneocuboid fusion group (P = .025). In this retrospective comparative study to treat children with spastic equinovarus feet, patients who had the SPLATT procedure combined with calcaneocuboid arthrodesis generally resulted in better functional outcomes compared to isolated SPLATT surgery in spastic equinovarus foot. Level III, retrospective cohort study.

Split anterior tibial tendon transfer (Splatt) to the peroneus brevis/tertius for the correction of varus foot deformity in children: A case series

Objective: The purpose of the study was to determine the safety/efficacy of a split anterior tibialis tendon transfer (SPLATT) to the peroneus brevis/tertius in children with varus feet.Methods: This is a case series of 5children with varus foot who had undergone split anterior tibialis tendon transfer (SPLATT) to the peroneus brevis/tertius. The principal outcome measures were changes in pain (measured by likert scale), difficulty with shoe wear (measured by mean difference in pre and post op scores) and radiological parameters obtained from anteroposterior and lateral radiographs of the affected foot before and after surgery. Each case was followed up for 1 year. Results: After surgery foot pain and problems with shoe wear improved. The radiological criteria also showed a clinically and statistically significant (p

Absence of Peroneus Tertius in Split Anterior Tibialis Tendon Transfer Surgery

Split anterior tibialis tendon transfer is a common orthopedic surgical procedure for varus foot deformities. In the absence of the peroneus tertius, the peroneus brevis may be used in the transfer. Little is known about the prevalence of each transfer type. The goal of this study is to understand trends in tendon transfer for patients who undergo split anterior tibialis tendon transfer. Records of all patients who underwent tibialis anterior tendon split transfer at our institution between January 2004 and September 2020 were reviewed. After, 337 subjects who underwent tibialis anterior tendon split transfer were included. The peroneus tertius was absent in 33.2% (112/337) of subjects. Logistic regressions showed the odds of having a missing peroneus tertius were 66.9% lower for subjects with cerebral palsy and related etiologies (odds ratio [OR]: 0.331, 95% confidence interval [CI]: 0.21, 0.53), 47% lower for white subjects (OR: 0.53, 95% CI: 0.31, 0.91), and 59.1% lower for non-Hispanic subjects (OR: 0.409, 95% CI: 0.25, 0.66). The odds of a missing peroneus tertius tendon were 2.72 times higher for subjects who identified in the other racial category (95% CI: 1.65, 4.49), and 2.41 times greater for subjects who identified as Hispanic (95% CI: 1.51, 3.84). Patients who underwent the procedure who identified as Hispanic or members of other (non-White, -Black, -Asian) racial groups had an increased likelihood of having a missing peroneus tertius tendon. Patients who identified as white, having cerebral palsy or related etiologies, or non-Hispanic had a decreased risk of having a missing peroneus tertius tendon.

Split Tibialis Anterior Transfer for Correction of Residual Dynamic Metatarsus Adductus Following Ponseti Management of Idiopathic Clubfoot

Background: Clubfoot represents one of the most common congenital orthopedic deformities. It affects 1-2/1000 live births all over the world. Cases of dynamic and severe deformity represent a challenging problem. This is because the conservative management is not effective as well as the surgical options are little. Objective: Aim of the present study was to evaluate the better management of split tibialis anterior tendon transfer in the treatment of residual clubfoot. Patients and methods: Eighteen cases (22 feet) with residual dynamic supination deformity following previous Ponseti management underwent split transfer of the anterior tibial tendon. This was a prospective study between March 2020 and February 2021, the cases were collected and the study was carried out at Zagazig University Hospitals. Results: In our study, the mean age was 41.05 months (ranged from 30 to 59 months). Out of the 18 patients, there were 12 males and 6 females. Four cases (22.2%) were bilaterally affected. While 14 patients (77.8%) were one-side affected (5 left foot affected and 9 right foot affected). Our results showed marked improvement of patients according to Garceau and Palmer’s criteria as the mean pre-operative assessment was 2.5 reaching 3.28 post-operatively. 14 patients (88.9%) were either poor or fair and no single patient was excellent pre-operatively, while postoperatively all patients became either excellent mostly or good. Conclusion: Anterior tibial tendon transfer is a reasonable method of achieving the objective, either fully or split transfer because both operations have excellent results with low rate of major complications. It's very simple but yet very effective soft-tissue procedure to correct the muscle imbalance of the foot.

Split tibialis anterior tendon transfer to treat ambulatory children with spastic cerebral palsy who experienced dynamic equino varus deformity

Background: Treatment of ambulatory children with spastic cerebral palsy complaining from dynamic equino varus deformity by split tibialis anterior tendon transfer (STATT), because over activity of tibialis anterior muscle and weak antagonist muscles are the main cause of the deformity. Aim: The purpose of this study is to assess the postoperative results of split tibialis anterior tendon transfer, according to Garceau and Palmer criteria. Patients and Methods: 13 feet in 13 ambulatory children with spastic cerebral palsy complaining from dynamic equino varus deformity, preoperatively 7 of the fair,6 of them were poor, while postoperatively 2 of them became excellent,10 of them good and 1 of the fair. Results: The result of this prospective case series study assessed by using Garceau and Palmer criteria. Conclusion: Split tibialis anterior tendon transfer, is a good method for treating ambulatory children with spastic cerebral palsy complaining of dynamic equinovarus deformity of the forefoot and midfoot which is due to overactivity of tibialis anterior muscle and weak antagonists. Keywords: Dynamic equinovarus foot deformity; Split tibialis anterior tendon transfer; Hoffer’s procedure; and Garceau & Palmer criteria.

Role of Tibial Anterior Tendon Transfer Total or Split in Management of Relapsed Club Foot

ABSTRACT Background: Congenital club foot currently treated by Ponseti technique with excellent long-term outcome. However relapsed deformity developed due to non compliance of bracing wear, evertor, and invertor imbalance. Objectives: Prospective study are the full ,and split tibialis anterior transfer can be correct relapsed club foot following Ponseti technique for idiopathic club foot . Patients ,and Methods: this study was planned to evaluate radiological and functional results of tibialis anterior tendon transfer for relapsed club foot deformity after Ponseti, in 16 patients with 20 feet ,the period of follow up was at least 6 months, The average age of the patients was 6 years, ranging from3 to 9 years, 14 of them were males,6 of them were females. Results: 20 feet with satisfactory results including 13 excellent cases and 7 good cases Thus satisfactory results were found in 20 patients (100%), ,and no unsatisfactory ones. In this study, although there was significant improvement of, anterior talo first metatarsal angle (TFMA1) ,and anterior talocalcaneal angle (Kite’s angle) (TCA1) there was no significant correlation between radiological ,and functional end results. Tibialis anterior transfer has to be effective procedure in relapsed deformity, range of motion of foot and muscle function of children. Conclusion: tibialis tendon transfer either total or split can effectively correct relapsed club foot after management by Ponseti technique. Keywords: club foot , relapsed club foot ,total or split tibialis anterior tendon transfer.

The split transfer of tibialis anterior tendon to peroneus tertius tendon for equinovarus foot in children with cerebral palsy.

The aim of this study was to analyze the results of the split anterior tibialis tendon transfer (SPLATT) to peroneus tertius (PT) for equinovarus foot deformity in children with cerebral palsy (CP). The medical records of 25 ambulatory CP patients (mean age: 8.7±3.2 years, range: 4-16 years) with equinovarus foot (33 feet), who underwent SPLATT to PT surgery between 2014 and 2016, were retrospectively reviewed. A senior surgeon performed all the surgical procedures. SPLATT was performed as part of a single-event multilevel surgery for the lower limb, and the concomitant procedures on the same extremity were recorded. The patients who required any additional foot or ankle surgery that could affect the clinical outcome (except heel cord lengthening) were excluded from the study. The Kling's College Criteria were used to evaluate the procedural outcome of the foot position and gait, and the associated complications were recorded. The mean follow-up time was 28.8±5 months (range: 24-42 months). The postoperative Kling scores were excellent for 27 feet of the patients who had a plantigrade foot, without fixed or postural deformity, in a regular shoe, having no calluses; good for 5 cases for those who walked with less than 5° varus, valgus, or equinus posture of the hind foot, wearing regular shoes, having no callosities; and fair for 1 case for those who had recurrence of the deformity. There was only one wound detachment, which was treated with wound care and dressing. None of the patients had overcorrection, infection, or bone fracture. The dynamic SPLATT to PT surgery for the management of the equinovarus foot deformities in the CP patients is a safe and less complicated surgical alternative with a good functional outcome. It is a safe and effective treatment method for the management of equinovarus foot deformities in CP. Level IV, Therapeutic study.

Split Tibialis Anterior Tendon Transfer to The Peroneus Brevis or Tertius for the Treatment of Varus Foot Deformities in Children with Static Encephalopathy: A retrospective case series.

Introduction:The study purpose was to determine the safety/efficacy of a split anterior tibialis tendon transfer (SPLATT) to the peroneus tertius or brevis in children with static encephalopathy and varus feet.Methods:A retrospective review of short- and long-term complications, change in ankle range of motion, strength, and gait kinematics. Predictors of postoperative varus or valgus were examined.Results:One hundred thirty-three patients were included (average age [SD] 10.3 [3.7]), with an average follow-up of 3.9 (3.4) years. Forefoot/hindfoot eversion range of motion improved (P ≤ 0.05), dorsiflexor strength was maintained or improved in 76.9% of patients, and dorsiflexion in swing phase was maintained. Complications occurred in 6 of 133 patients (4.5%) and included 1 transfer failure, 1 wound dehiscence, and four pressure areas from casts. Successful correction was achieved in 77% of patients. Later onset of recurrent varus (14.4%, 10.6% requiring revision surgery) and pes valgus (8.7%, 4.8% requiring revision surgery) occurred. The length of the follow-up predicted the development of the pes valgus (odds ratio 1.28, 95% CI 1.0 to 1.6).Discussion:SPLATT to the peroneus tertius or brevis is effective, and complications are rare. Subsequent valgus or recurrent varus deformities may occur, possibly requiring repeat surgery.

The split anterior tibialis tendon transfer procedure for spastic equinovarus foot in children with cerebral palsy: results and factors associated with a failed outcome.

The aims of the study were to evaluate the outcomes and predictive factors of the split anterior tibialis tendon transfer (SPLATT) procedure for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP). Forty-five ambulatory CCP with 68 equinovarus feet, positive for the flexor withdrawal reflex test, aged 8.1 ± 2.5 (range four to 15) years were enrolled. All feet underwent a soft tissue release procedure combined with the SPLATT procedure and were followed for at least 12 months after surgery. The functional outcome was rated using the criteria of Kling and co-workers. Pre-treatment gross motor functional classification system (GMFCS) levels were compared to the patients' latest evaluations. Factors associated with outcomes and success rate were assessed. At an average follow-up of 5.5 ± 3.3 (range 1.1-16) years, feet were rated as excellent in 48 cases (70 %), good in ten (15 %) and poor in ten (15 %), respectively. Thirty-four CCP showed an improvement for the GMFCS level, P < 0.001. The factor that could predict a poor outcome was the pre-treatment GMFCS levels 3-4 with an odds ratio (95 % CI) of 4.92 (0.96-25.2), P = 0.03. The ten years success rate of the SPLATT procedure between CCP with GMFCS levels 1-2 and levels 3-4 were not different with a mean ± SD (95 % CI) of 0.85 ± 0.1 (0.5-0.96) versus 0.6 ± 0.1 (0.3-0.8), P = 0.08, respectively. The SPLATT procedure provides a balanced function of the foot, thus improving the ambulatory ability in CCP and should be integrated into the surgical plan. Pre-treatment GMFCS levels 3-4 predicted unfavourable outcomes and should be addressed during pre-operative parental counselling.

Split Anterior Tibialis Tendon Transfer (Splatt) and Achilles Tendon Lengthening for The Correction of The Varus Foot after Stroke a Prospective Longitudinal Study

Background: The imbalance between tibialis anterior and peroneus activation in the swing phase of gait after stroke is responsible for an ankle varus leading to foot instability and poor quality of gait. In such case, a split anterior tibialis tendon transfer (SPLATT) procedure is indicated to correct imbalance. The aim of the study was to prospectively evaluate the effect of the SPLATT procedure in varus foot after stroke. Methods: We prospectively evaluated 26 consecutive hemiplegic patients (mean age 48.3 ± 10.2 years) with a varus foot operated for a SPLATT and an Achilles tendon lengthening procedure with a 6 months follow-up. Before and 6 months after surgery, the spasticity (Ashworth scale), muscle strength (MRC scale), active and passive ankle range of motion, gait parameters (10 meter walking test), gait kinematics (video) and need for assistive device were assessed. Results: A decrease in triceps spasticity and an increase in ankle dorsiflexion were observed. The varus in swing and stance phase of gait was improved. After surgery, 90% of the patients didn’t fit their ankle foot orthosis in comparison with 30% before. In contrast, gait speed, proximal spasticity, hip and ankle gait kinematics and need for crutches remained unchanged. Conclusion: This study is the first prospective study using objective validated scales confirming that the SPLATT procedure in combination with Achilles tendon lengthening is able to correct the varus and to reduce the need for orthosis in stroke patients with varus foot. Level of Evidence: Level IV / Prospective longitudinal case series study

Fixation of split anterior tibialis tendon transfer by anchorage to the base of the 5th metatarsal bone

Split anterior tibialis transfer is a procedure, frequently performed in combination with triceps surae lengthening, to treat equinovarus foot deformity in adult hemiplegia patients. The authors present their surgical technique, with tendon fixation by an anchor to the base of the fifth metatarsal. Although bone-tendon anchor fixation is widespread in orthopedic surgery, it is original in this type of indication. It is simpler, and less traumatic for the bone than a bone tunnel and less traumatic for the sole than transplantar fixation. The very distal attachment to the base of the 5th metatarsal bone solves the common problem of adjusting the tension of tendon transfer. The authors report their experience of 22 split transfers from 2005 to 2008.

Poststroke Spasticity Management

Poststroke spasticity (PSS) is a common complication associated with other signs and symptoms of the upper motor neuron syndrome, including agonist/antagonist co-contraction, weakness, and lack of coordination. Together, they result in impairments and functional problems that can predispose to costly complications. The goal of PSS management should take into consideration not only reduction of muscle hypertonia but also the impact of PSS on function and well-being. Therapeutic interventions focus on peripheral and central strategies, such as physical techniques to increase muscle length through stretching and pharmacological modulation. Although there are few comparative studies on the superiority of one method over another, it appears that optimal management of PSS involves a combined and coordinated compendium of therapies that encompass cost-effective pharmacological and surgical interventions, along with rehabilitative efforts. Spasticity, commonly defined as “a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome,”1 is a common complication of stroke. It contributes to the impairments and disabilities that negatively impact functional recovery. Consequently, PSS, along with weakness and lack of coordination, result in gait abnormalities and problems with arm use. In addition to functional limitations, spasticity, when inappropriately treated, may lead to reduced quality of life, increased pain, and joint contractures. Three community-based studies that followed-up stroke survivors for 3 to 12 months reported an incidence of PSS between 17% and 43%.2–4 Certain factors are recognized as predictors of PSS: stroke lesions in the brain stem; hemorrhagic stroke and younger age;5 and severe paresis and hemihypesthesia at stroke onset.3 To quantify the full impact of PSS, assessment should include a measure of passive stretch, volitional movement, and active/passive function.6,7 The benefit of …

Split anterior tibial tendon transfer for varus equinus spastic foot deformity

Spastic equinovarus foot deformity commonly occurs after stroke or head trauma. Management by split anterior tibial tendon transfer to the lateral border of the foot was chosen by the authors. The purpose of that work was to assess the reliability of this method to improve patient's functional autonomy and investigate the relationship between the initial clinical examination findings and the quality of the functional results. 84 feet, operated in 82 patients out of 130, of mean age 46 years, were reviewed at a mean follow-up of 65 months. Very few complications were observed. Toe deformities remain a commonly associated problem. 80 patients were able to walk barefoot, 74 reported an increase in their walking distance, and 73 could regularly wear normal shoes. There is a strong relationship (p<0.001) between the preservation of deep foot sensitivity and the level of functional autonomy.

Extra-articular Ankle Stabilization

Maintenance of the foot at 90 degrees to the lower leg following posterior calf lengthening or to prevent an equinus contracture in situations in which splint, cast, or external fixation is deemed inappropriate is a challenge. The author presents an observational case series involving 9 extra-articular ankle stabilizations performed in 9 consecutive patients. Each patient underwent his or her index surgery followed by percutaneous placement of 2 smooth 2.8-mm or larger diameter Steinmann pins extra-articular to the ankle joint. There were 6 men and 3 women with a mean age of 56.1 years (range, 31-73 years). Five patients had diabetes with peripheral neuropathy, 2 had critical limb ischemia, 1 had alcohol-induced neuropathy, 1 had lupus, and 1 was an active smoker. Eight patients had posterior calf lengthening, and 1 had open metatarsal fractures with severe soft-tissue disruption with an inability to use splint immobilization. Three patients had a transmetatarsal amputation, 2 patients had Chopart amputations, 2 patients had forefoot plastic surgery reconstructive procedures, 1 had a complex Charcot reconstruction, and 1 had a splittibialis anterior tendon transfer. Extra-articular ankle stabilization fixation was retained for a mean of 5.5 weeks (range, 2-10 weeks). Mean follow-up was 12 months (range, 1-17 months). All extra-articular stabilization procedures were deemed successful. When properly performed, extra-articular stabilization to maintain the foot at 90 degrees to the lower leg represents a safe, simple, reliable, and minimally invasive technique useful in situations in which traditional splint or cast immobilization is not possible and when external fixation is deemed inappropriate.

Split tendon transfers for the correction of spastic varus foot deformity: a case series study

BackgroundOveractivity of anterior and/or posterior tibial tendon may be a causative factor of spastic varus foot deformity. The prevalence of their dysfunction has been reported with not well defined results. Although gait analysis and dynamic electromyography provide useful information for the assessment of the patients, they are not available in every hospital. The purpose of the current study is to identify the causative muscle producing the deformity and apply the most suitable technique for its correction.MethodsWe retrospectively evaluated 48 consecutive ambulant patients (52 feet) with spastic paralysis due to cerebral palsy. The average age at the time of the operation was 12,4 yrs (9-18) and the mean follow-up 7,8 yrs (4-14). Eigtheen feet presented equinus hind foot deformity due to gastrocnemius and soleus shortening. According to the deformity, the feet were divided in two groups (Group I with forefoot and midfoot inversion and Group II with hindfoot varus). The deformities were flexible in all cases in both groups. Split anterior tibial tendon transfer (SPLATT) was performed in Group I (11 feet), while split posterior tibial tendon transfer (SPOTT) was performed in Group II (38 feet). In 3 feet both procedures were performed. Achilles tendon sliding lengthening (Hoke procedure) was done in 18 feet either preoperatively or concomitantly with the index procedure.ResultsThe results in Group I, were rated according to Hoffer's clinical criteria as excellent in 8 feet and satisfactory in 3, while in Group II according to Kling's clinical criteria were rated as excellent in 20 feet, good in 14 and poor in 4. The feet with poor results presented residual varus deformity due to intraoperative technical errors.ConclusionOveractivity of the anterior tibial tendon produces inversion most prominent in the forefoot and midfoot and similarly overactivity of the posterior tibial tendon produces hindfoot varus. The deformity can be clinically unidentifiable in some cases when Achilles shortening co-exists producing foot equinus. By identifying the muscle causing the deformity and performing the appropriate technique, very satisfying results were achieved in the majority of our cases. In three feet both muscles contributed to a combined deformity and simultaneous SPLATT and SPOTT were considered necessary. For complex foot deformities where the component of cavus co-exists, supplementary procedures are required along with the index operation to obtain the best result.

Tendon Transfer Fixation in the Foot and Ankle: A Biomechanical Study

Tendon transfers are often used in foot and ankle surgery. Different fixation devices and techniques have been described. The most recently developed ones are bone anchors and interference screws. A biomechanical study was designed to compare tendon transfer fixation, using Corkscrew bone anchors 5 x 15.5 mm and Bio-interference screws (8 x 23 mm). Fifteen fresh cadaver specimens underwent both fixation techniques for split anterior tibial tendon transfer at the cuboid bone. All the specimens underwent standardized X-rays in order to evaluate mineral bone density using a standardized measurement system. All were tested until maximal load to failure. The ultimate load to failure of the tendon secured to the cuboid using anchors was 103 N (SD, 52), compared with 150 N (SD, 68) for tendons secured to the bone with interference screws (p = 0.003). No difference was found between the techniques that could be related to bone density. Interference screws provided greater strength than bone anchors. This study demonstrated increased strength in securing bone to tendon in vitro for SPLATT tendon transfer with interference screws as compared to suture anchors.