Posterior Tibial Tendon Transfer Research Articles

Combined distal tibial nerve transfer and tibialis posterior tendon transfer for foot drop correction: A surgical technique and case illustration

Tendon transfers have traditionally been the mainstay for treating foot drop and improving gait and mobility. Recently, distal nerve transfers from the tibial to the deep peroneal nerve have been explored, but with limited success in achieving ankle dorsiflexion. We present a novel surgical technique combining both distal tibial nerve transfers (to both deep and superficial peroneal nerves) and tibialis posterior tendon transfer to the tibialis anterior (internal splint). This dual approach aims to achieve comprehensive foot drop correction through the reinnervation of foot dorsiflexors and improved ankle function. A case illustration highlights this combined technique’s surgical steps and potential benefits.

Functional Outcome of Tibialis Posterior Tendon Transfer to Tibialis Anterior & Peroneus Longus among Foot Drop Patients- a Prospective Study

Introduction: Foot drop is described as the loss of active ankle dorsiflexion due to neurologic, systemic, or traumatic causes. The purpose of this study was to assess the functional outcome of tibialis posterior tendon transfer to tibialis anterior and peroneus longus in patients with foot drop. Aim of the study: The aim of this study was to evaluate the functional outcome of tibialis posterior tendon transfer to tibialis anterior and peroneus longus in patients with foot drop. Methods: This study was a randomized clinical trial that evaluate the results of tibialis posterior tendon transfer surgeries for patients with foot drop. The patients met certain inclusion and exclusion criteria, and gave written consent before the surgeries. The patients were followed up for six months after the surgery, and evaluated using the Stanmore assessment questionnaire and other measures. Result: The study enrolled 30 patients (26 males and 4 females) with mean age being 35.40 years. We evaluate tibialis posterior tendon transfer to tibialis anterior and peroneus longus for foot drop in the patients. After 24 weeks, all patient improved in foot dorsiflexion, eversion, function, posture, and satisfaction. 26 (86.70%) patients did not need orthosis and 28 (93.30%) had balanced foot posture with no deformity. Conclusion: The results showed all patient had significant improvement after the surgery. Therefore, this study concluded that tibialis posterior tendon transfer can be used effectively and safely for the management of foot drop.

Bilateral Foot Drop Treated with Posterior Tibial Tendon Transfer: A Case Report

Bilateral Foot Drop Treated with Posterior Tibial Tendon Transfer: A Case Report

Anterior or Posterior Tibial Tendon Transfer to the Peroneus Tertius for Equinovarus Deformity.

Equinovarus deformity correction was performed by soft tissue release and bone deformity correction, and tendon transfer to maintain deformity correction. Because of the high complication rate of tendon fixation methods, partial or total anterior tibial tendon or posterior tibial tendon transfer to the peroneus tertius tendon was reported. The purpose of this study was (i) to review the results of this tendon transfer technique after release and correction of talipes equinovarus, and (ii) to analyze the complication of this technique. Between February 2017 and May 2022, 176 patients (210 feet) with equinus and/or varus foot and ankle deformities underwent anterior or posterior tibial tendon transfer to the peroneus tertius in our institute. Preoperative and postoperative foot and ankle range of motion (passive and active) were checked. The postoperative radiographic assessment included antero-posterior (AP), lateral, and hindfoot alignment radiographs. Preoperative and postoperative lateral tibio-talar, talo-calcaneal, talo-first metatarsal, tibial-sole angles, hindfoot alignment, and anterior subluxation of the talus were checked. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and visual analog scale (VAS) were used to assess pain. Paired Student's t-test was used to compare the clinical scores and radiographic angles before the operation and at the last follow-up. The mean age of the patients was 23.27 ± 13.44 years (range, 3-69 years). The mean follow-up time was 25.56 ± 16.37 months (range, 12-68 months). There were significant differences between the preoperative and postoperative measurements of the lateral tibio-talar angle, lateral talo-calcaneal angle, lateral talo-first metatarsal angle, lateral tibial-sole angle, and hindfoot alignment (p < 0.001). There was significant difference between the preoperative and postoperative AOFAS and VAS scores (p < 0.001). The early complications included infection in one patient, skin necrosis in two patients, and plantar numbness in three patients. The late complications included pin infection in three patients, tibio-talar joint compression in four patients, forefoot pain in two patients, toe flexion in two patients, and plantar numbness in one patient. There were three cases of complications (1.43%) related to the transferred tendons. Tibialis anterior or posterior tendon transfer to the peroneus tertius is a safe and effective method for equinovarus deformity correction. It yielded excellent outcomes that produced high patient satisfaction and few complications.

Comparative Study of Functional Outcome of Posterior Tibialis Tendon Transfer to Middle Cuneiform Bone and Anterior Tibialis Tendon with Other Techniques for Management of Foot Drop

Comparative Study of Functional Outcome of Posterior Tibialis Tendon Transfer to Middle Cuneiform Bone and Anterior Tibialis Tendon with Other Techniques for Management of Foot Drop

Effect of split posterior tibialis tendon transfer on foot progression angle in children with cerebral palsy

ObjectivesA common orthopedic issue for patients with spastic cerebral palsy (CP) is hindfoot varus deformity. One method of treatment is the split posterior tibialis tendon transfer (SPOTT). There is limited literature on the effect of SPOTT on foot progression angle (FPA) in children with CP who have equinovarus deformities. The objective of our study was to evaluate the change in FPA after SPOTT to determine if this procedure can improve FPA. Research QuestionThis study aims to determine what axial changes are generated from a split posterior tibial tendon transfer in children with CP. MethodsWe performed a retrospective analysis of all ambulatory children with a diagnosis of CP who underwent SPOTT at our institution. Patients with bony rotational procedures were excluded. Descriptive statistics including mean and standard deviation (SD) were used to characterize continuous variables. Paired t-tests were used to evaluate outcomes, in which a target outcome was defined as a post-operative FPA between 0–10° of external rotation. Results44 limbs were included. Demographics were as follows: 26/13 female/male; mean age[SD] (years): 9.8[3.5]; 30 hemiplegic, 9 diplegic, and 1 triplegic. Of the 44 limbs, 18 limbs had a target outcome, 4 had no change, and 22 had a non-target outcome. Of the 22 with an outcome outside of the target, 4 limbs trended away from a target outcome. The overall change in FPA measured was − 10.9 ± 14.7° (p < 0.0001) Age at time of surgery, CP involvement, pre-operative FPA, and GMFCS level were not predictors of outcome (p > 0.05). ConclusionsSPOTT produced a change of 10.9° external rotation in FPA post-operatively and its effects should be considered when planning a SEMLS.

Comparison of Staple, Anchor, and Tenodesis Screw for Posterior Tibialis Tendon Fixation: A Biomechanical Analysis

Various posterior tibialis tendon fixation techniques are described in literature. Suture anchor, staple and tenodesis screws are widely used for posterior tibialis tendon transfer, but their stiffness and the maximal ultimate failure load were not tested before. We aimed to compare the initial ultimate failure load and stiffnesses of suture anchor, staple and tenodesis screws on bovine tendon fixation to bovine metaphyseal bone. Thirty-five fresh bovine ankle joints and hooves were obtained from a local abattoir. Metatarsals bones with long extensor tendons were harvested. Staple group had 15, suture anchor group had 10, and tenodesis screw group had 10 samples. All fixations were tested with Instron® ElectroPuls® E10000 Test Instrument. Ultimate failure load and failure location were noted. Staple group's median ultimate failure load was 210.03 N (IQR: 133.43), suture anchor group's was 124.33 N (IQR: 63.67), and tenodesis screw group's was 394.46 N (IQR:115.09). Median stiffness of the staple group was 19.87 N/m (IQR: 15.29); the tenodesis screw group's was 20.28 N/m (IQR: 6.18), the anchor group's was 8.54 N/m (IQR: 4.35). Staples' failure occurred on tendon-staple interface, while suture anchors' occurred on anchor-suture interface and tenodesis screws' occurred on tendon-suture interface. Tenodesis screws' ultimate failure load was the highest (tenodesis vs anchor and staple p < .001 and p=.032, respectively). Staple fixation is less expensive than the other methods and can provide sufficient fixation strength but was weaker than the tenodesis screw fixation. Staples are still a good choice for tendon to bone fixation, whereas the suture anchors provide lower fixation strength at a higher cost.

Posterior Tibial Tendon Transfer with Combined Tendon-Tendon and Tendon-Bone Fixation using the Circum-Tibial Route and Superficial Retinacular Passage in the Foot Drop

Foot drop is a condition that makes walking difficult and interferes with active living [1,2]. Tendon transfers, such as the tibialis posterior tendon, are the most important adjunctive procedures in the treatment of foot drop [3,4]. It is important to apply the increasingly popular tendon transfer techniques and to understand the functional consequences of the type of surgical technique [5-7].

Techniques for the treatment and reversion of tendon injuries in the ankle complex literature review

Drop foot is a clinical condition resulting from the blockage of nerve impulses, causing the inability to dorsiflex the ankle, causing a reduction in functional capacity. There are techniques such as the transfer of the posterior tibial tendon via interosseous transmembrane. Objective: To evaluate the best technique for foot drop therapy and relate it to clinical practice. Methodology: literature review by searching the Virtual Health Library databases and the Google Scholar browser, consulting published and indexed journals using the descriptors: “posterior tibial tendon” and “traumatic lesions” and “drop foot” and “tendon transfer” and “tendon transfer techniques”. Results: selected 13 articles published in the period between 2012 and 2021, 6 retrospective studies, 1 cross-sectional, 1 prospective, 2 review and update articles, 2 systematic reviews and a case study. Conclusion: The clinical evidence favors the use of posterior tibial tendon transfer techniques, or another suitable tendon, via the interosseous membrane, and studies with better quality methodological designs are required. In Brazil, a group of researchers chose their own evaluation material, which reinforces the need for standardization for the practice of the national clinic. There was little production and publication of studies on the subject. It is essential to develop more research, when limitations of more up-to-date studies are seen.

The efficacy of split tibial tendon transfers on functional gait outcomes for children and youth with cerebral palsy and spastic equinovarus foot deformities

To systematically review the efficacy of split tendon transfer surgery on gait-related outcomes for children and adolescents with cerebral palsy (CP) and spastic equinovarus foot deformity. Five databases (CENTRAL, CINAHL, PubMed, Embase, Web of Science) were systematically screened for studies investigating split tibialis anterior or split tibialis posterior tendon transfer for spastic equinovarus foot deformity, with gait-related outcomes (published pre-September 2022). Study quality and evidence were assessed using the Methodological Index for Non-Randomized Studies, the Risk of Bias In Non-Randomized Studies of Interventions, and the Grading of Recommendations Assessment, Development and Evaluation. Overall, 17 studies (566 feet) were included: 13 studies used clinical grading criteria to report a postoperative 'success' of 87% (75% to 100%), 14 reported on orthotic use with 88% reduced postoperative use, and one study reported on ankle kinematics improvements. Ten studies reported post-surgical complications at a rate of 11/390 feet (2.8%), but 84 feet (14.8%) had recurrent varus (68 feet, 12%) or occurrence of valgus (16 feet, 2.8%). Only one study included a patient-reported outcome measure (pain). Split tendon transfers are an effective treatment for children and youth with CP and spastic equinovarus foot deformities. Clinical data presented can be used for future study designs; a more standardized functional and patient-focused approach to evaluating outcomes of surgical intervention of gait may be warranted.

Severe equinus cavo-varus correction through triplanar tarsectomy and posterior tibial tendon transfer based on 3D-printed biomodel

Surgery for severe equine cavo-varus is complex and must be individualized. The interindividual phenotypic variability demands a personalized planning of each foot to be operated. The study's primary goal was to evaluate the function and satisfaction of a series of patients with severe equinus cavo-varus deformity who underwent a triplanar tarsectomy and transposition of the posterior tibial tendon in a single stage surgery after a patient specific 3D biomodel planning. A series of 12 feet (5 patients bilaterally) operated with this technique was analyzed. The cohort comprised 2 females (28.5 %) and 5 males (71.4 %). The median follow-up time was 38.5 months (interquartile range: 24.75–48.75). The Foot and Ankle Disability Index pre (median 32.85; interquartile range: 20–46) and postsurgery (median 72; interquartile range: 56–75.5) were collected and statistically significant differences were observed (p < 0.002). Furthermore, the main variable evaluated was obtaining a plantigrade stable foot. This was clinically evaluated and was achieved in all patients except 1 patient who presented a residual equinus of 5º. This study shows that triplanar tarsectomy and posterior tibial tendon transfer in a single surgical procedure after patient-specific 3D biomodel planning allows for improved function in patients with severe equinus cavus varus foot deformity.

A Systematic Review of Lower Extremity Muscle Synergies During Gait: Identifying Potential Nerve and Tendon Donors for Functional Reconstruction

PURPOSE: Technical advances in functional tendon and nerve transfers, most recently in the lower extremity, have improved patient outcomes following limb salvage. However, rigorous research defining and comparing clinical outcomes for the multiple available surgical options remains lacking. In the absence of such data to guide surgical decision making, we aim to gain a better understanding of the neuromuscular organization of gait (i.e. muscle synergies) to glean insights into donor-recipient pairings for functional lower extremity reconstruction aiming to restore walking. METHODS: A MEDLINE search (2000-2020) was performed using terms such as ‘motor module’, ‘synergy’, and ‘walking’. Studies with extractable data on muscle synergies in healthy human subjects during a walking gait were included. RESULTS: Thirty-eight studies were included, incorporating data from 416 participants. Muscle activity was measured using surface EMG in all but two studies. Muscle synergies were extracted using several computational techniques, including non-negative matrix factorization, principal component analysis, torque decomposition, and factor analysis. Each study identified between three and seven muscle synergies, with an average of 4.5 +/- 0.9. 82% of studies reported four or five synergies. The synergies observed across studies could be reclassified into four temporally-independent synergies. Synergy A was active at weight acceptance and included vastus lateralis (reported in 63% of studies), rectus femoris (63%), gluteus medius (58%), vastus medialis (53%), and gluteus maximus (39%). Synergy B, active during late stance, included soleus (87%), medial (79%) and lateral (53%) heads of the gastrocnemius, and peroneus (37%). Synergy C, active at early swing, included tibialis anterior (84%), rectus femoris (41%), erector spinae (32%), and adductors (27%). Synergy D, active at late swing, included biceps femoris (86%), semitendinosus (65%), semimembranosus (24%), and tibialis anterior (22%). CONCLUSIONS: This is the first study to systematically review the neuromuscular organization of gait and apply these findings to surgical decision making. In cases of quadriceps weakness, obturator to femoral nerve transfers have been described with favorable reliability in outcomes.1,2 The obturator nerve plays an important role in hip stabilization and thus fires synergistically in early stance with the quadriceps during synergy A. In deficiencies of plantar flexion, the ankle cannot stabilize against natural dorsiflexion in late stance. The peroneus, providing ankle stability and firing synergistically with plantar flexors in synergy B, may serve as a donor nerve/tendon to reconstruct injuries of the superficial posterior compartment. Even in the absence of obvious synergies, built-in redundancy in lower extremity function provides several expendable donors that may restore range of motion and stability; these data inform which pairings are least antagonistic and most likely to be successful. For example, while transfers of the tibialis posterior,3 FDL/FHL,4 and gastrocenemius5 have been described in cases of foot drop, we prefer simultaneous nerve/tendon transfer of the lateral gastrocnemius because it is expendable, leaving the medial head and soleus intact, and less antagonistic than other transfers, allowing the tendon to more naturally and effectively dorsiflex. Surgical plans aiming to restore the four basic synergies identified herein could allow for restoration of independent gait following significant lower extremity injury. REFERENCES: 1. Dubois E, Popescu IA, Sturbois Nachef N, Teboul F, Goubier JN. Repair of the femoral nerve by two motor branches of the obturator nerve: A case report. Microsurgery. Mar 2020;40(3):387-390. doi:10.1002/micr.30527 2. Rastrelli M, Tocco-Tussardi I, Tropea S, Rossi CR, Rizzato S, Vindigni V. Transfer of the anterior branch of the obturator nerve for femoral nerve reconstruction and preservation of motor function: A case report. Int J Surg Case Rep. 2018;51:58-61. doi:10.1016/j.ijscr.2018.08.004 3. Agarwal P, Gupta M, Kukrele R, Sharma D. Tibialis posterior (TP) tendon transfer for foot drop: A single center experience. J Clin Orthop Trauma. May-Jun 2020;11(3):457-461. doi:10.1016/j.jcot.2020.03.007 4. Movahedi Yeganeh M. Triple Tendon Transfer for Correction of Foot Deformity in Common Peroneal Nerve Palsy. Foot Ankle Int. Jun 2016;37(6):665-9. doi:10.1177/1071100716629779 5. Leclere FM, Badur N, Mathys L, Vogelin E. Neurotized lateral gastrocnemius muscle transfer for persistent traumatic peroneal nerve palsy: Surgical technique. Neurochirurgie. Aug 2015;61(4):292-7. doi:10.1016/j.neuchi.2014.08.001

A Study of Treatments of Congenital Clubfoot in Cerebral Palsy: A Systematic Review

Category: Ankle; Other Introduction/Purpose: Cerebral palsy (CP) can lead to various foot deformities, including equinovarus, or clubfoot position. Patients with CP present a challenge when treating clubfoot as there is aberrant muscle tone and motor dysfunction. Many interventions with variable outcomes are available for patients with clubfoot and cerebral palsy, however, no studies exist that compare existing treatments and outcome measures. The purpose of this study is to investigate the existing body of evidence surrounding the treatments and outcomes of clubfoot in cerebral palsy by way of a systematic review. Methods: Using PRISMA guidelines a comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science. Publications were collected which represent all available literature on clubfoot. Articles were screened at the title, abstract, and then full-text level. Only articles that detailed the treatment of pediatric patients with clubfoot, CP, and contained three or more human subjects were included. Publications were excluded from further screening if they were found to be duplicate articles, historical reviews, professional opinions, case reports, or if subjects were non-human. At each level of screening, articles were screened by two independent reviewers to verify that each paper met the predetermined inclusion criteria. Following this, data extraction from primary sources was conducted for; number of patients, age of patients, follow-up length, treatment modality applied, and outcome measures. T-tests were performed using SAS statistical software to determine the relationship between age and type of intervention. Results: An initial search yielded 6,469 articles, after review and cross selection, 32 remained as shown in Table 1. Of these, 53.13% (n=17) articles documented surgical tibial tendon transfer (TT): anterior TT (n=5) (mean-age 10.12 +-3.40yrs), posterior TT (n=12) (mean-age 9.30 +-2.57yrs). Botox &amp; casting was referenced in 15.63% (n=5) articles (mean age 5.34 +-1.21yrs), lengthening of tendon or muscle procedures 12.50% (n=4) (mean age 6.30 +-1.69yrs), botox alone 12.50% (n=4) (mean age 6.83 +-1.72yrs), and osteotomy 6.25% (n=2) (mean age 10.94 +-1.51yrs). There was a difference in age for patients receiving TT versus those receiving botox &amp; casting (9.54+-2.75 years old vs 5.34 +-1.21yrs years, p&lt;.05). Conclusion: These results indicate the preferred modality of clubfoot correction in the setting of cerebral palsy is tibial transfer. The average age of patients receiving surgical treatments was higher than those with casting, Botox, or orthotics. Due to a lack of standardized outcome measurements reported across studies, we recommend further research aimed specifically at evaluating intervention selection based on patient desired functional outcomes.

A novel implantable mechanism-based tendon transfer surgery for adult acquired flatfoot deformity: Evaluating feasibility in biomechanical simulation.

Adult acquired flatfoot deformity becomes permanent with stage III posterior tibialis tendon dysfunction and results in foot pain and difficulty walking and balancing. To prevent progression to stage III posterior tibialis tendon dysfunction when conservative treatment fails, a flexor digitorum longus to posterior tibialis tendon transfer is often conducted. However, since the flexor digitorum longus only has one-third the force-capability of the posterior tibialis, an osteotomy is typically also required. We propose the use of a novel implantable mechanism to replace the direct attachment of the tendon transfer with a sliding pulley to amplify the force transferred from the donor flexor digitorum longus to the foot arch. In this work, we created four OpenSim models of an arched foot, a flatfoot, a flatfoot with traditional tendon transfer, and a flatfoot with implant-modified tendon transfer. Paired with these models, we developed a forward dynamic simulation of the stance phase of gait that reproduces the medial/lateral distribution of vertical ground reaction forces. The simulation couples the use of a fixed tibia, moving ground plane methodology with simultaneous activation of nine extrinsic lower limb muscles. The arched foot and flatfoot models produced vertical ground reaction forces with the characteristic double-peak profile of gait, and the medial/lateral distribution of these forces compared well with the literature. The flatfoot model with implant-modified tendon transfer produced a 94.2% restoration of the medial/lateral distribution of vertical ground reaction forces generated by our arched foot model, which also represents a 2.1X improvement upon our tendon transfer model. This result demonstrates the feasibility of a pulley-like implant to improve functional outcomes for surgical treatment of adult acquired flatfoot deformity with ideal biomechanics in simulation. The real-world efficacy and feasibility of such a device will require further exploration of factors such as surgical variability, soft tissue interactions and healing response.

Posterior Tibial Tendon Transfer for Central Foot Drop: A Case Report

INTRODUCTION: Peripheral causes of foot drop are widely known. However, causes stemming from the central nervous system are rare. Posterior tibial tendon (PTT) transfer has been widely used for treating peripheral causes of foot drop but not central causes. We report a case of central foot drop (CFD) that was corrected with PTT transfer. CASE REPORT: A 68-year-old female presented with progressive weakness and numbness of both feet due to old compression fracture of the 12th thoracic spine. She also had Parkinson disease with gait rigidity. The patient was diagnosed with central foot drop. The left foot PTT transfer was done through the interosseous membrane and fixed to the navicular bone with an interference screw. Three months after the procedure, there is an improvement on the gait, and the foot drop is corrected. PTT transfer has a good outcome in peripheral foot drop. However, it is still questionable for the CFD case. In our case, PTT transfer was considered because it is less invasive, and tenodesis or ankle fusion still could be performed later if the PTT transfer outcome is not favorable. CONCLUSION: PTT transfer is a possible option to correct CFD. It is less invasive and has a good outcome.

Posterior Tibial Transfer to the Lateral Cuneiform in a Young, Active Patient with Foot Drop: A Case Report

Category:Ankle; Midfoot/Forefoot; Sports; OtherIntroduction/Purpose:We report the case of a 23-year-old male who underwent a posterior tibial tendon (PTT) transfer after suffering foot drop secondary to a traumatic knee dislocation five years earlier. The common peroneal nerve is a commonly injured peripheral nerve due to its anatomic location. Peroneal nerve palsy leads to the inability to clear the foot during the swing phase of gait due to paralysis of the tibialis anterior- the strongest dorsiflexor of the foot. In the event that nerve function does not spontaneously return, tendon transfer surgeries are an established definitive treatment. Despite this, the optimal method of tendon transfer has not yet been determined. Thus, pre-operative assessment and planning remains crucial in determining which method is to be used.Conclusion:Surgeons must decide which tendon to transfer, which route to utilize, and where to insert in effort to maximize biomechanical outcomes. Careful consideration must be made to ensure maximum strength and optimal forefoot balance to allow patients undergoing tendon transfer to become brace free. Our patient underwent a PTT transfer via the interosseous route to the lateral cuneiform- a common option for those with traumatic peroneal nerve injury. By three months post-operation, our patient achieved adequate dorsiflexion to clear swing phase. By one year post-operation and beyond, our patient has participated in physical activity brace free without any complications.

Traumatic Peroneal Nerve Injuries: A Systematic Review

Category:TraumaIntroduction/Purpose:The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in trauma patients. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, though recent outcome data appear promising. Given the variety of underlying injury modalities, treatment options, and prognostic variables, this study sought to evaluate and summarize current literature on traumatic CPN injuries and provide recommendations for treatment and future research.Methods:A systematic review was performed using PubMed, Embase and Cochrane databases per PRISMA guidelines. Search terms consisted of variations of 'peroneal nerve' and 'fibular nerve' combined with 'injury,' or 'laceration,' or 'entrapment,' or 'repair,' or 'neurolysis.' Information regarding treatment modality, outcomes and patient demographics were recorded and analyzed.Results:2,301 articles were identified in the initial search, 42 met eligibility criteria (Figure 1). Factors associated with better clinical outcomes included shorter pre-operative interval, shorter graft length when an interposed graft was used, nerve continuity and younger patient age. Sex or gender did not affect outcomes in any studies in this review. Motor grades of M3 or greater on the MRC scale are typically considered successful outcomes. In studies we analyzed, this was achieved in 81.2% of patients who underwent neurolysis, 78.8% of patients who underwent end to end suture, 49.8% of patients who underwent nerve grafting, 62.9% of patients who underwent nerve transfer, 86.0% of patients who underwent posterior tibial tendon transfer (PTTT) and 73.9% of patients who underwent surgery with concurrent PTTT.Conclusion:Included studies were heterogenous, complicating our ability to further analyze the data. It is not possible to uniformly advocate for the best treatment option given diverse injury modalities, presentations and prognostic factors. Many studies do not report outcomes with respect to specific injury modality. Future studies should clearly report outcomes based on injury modality and surgical treatment option. This would allow for greater analysis on the most appropriate treatment option for a given mechanism of injury. Newer surgical techniques, such as addition of growth factors to nerve repairs and concurrent tendon transfer are promising and should be further explored.

Traumatic Peroneal Nerve Injuries: A Systematic Review.

The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in patients with trauma. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, although improved surgical technique and novel procedures appear to improve outcomes. Given the variety of underlying injury modalities, treatment options, and prognostic variables, we sought to evaluate and summarize the current literature on traumatic CPN injuries and to provide recommendations from an analysis of the included studies for treatment and future research. A systematic review was performed using PubMed, Embase, and Cochrane databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms consisted of variations of "peroneal nerve" or "fibular nerve" combined with "injury," "laceration," "entrapment," "repair," or "neurolysis." Information with regard to treatment modality, outcomes, and patient demographic characteristics was recorded and analyzed. The initial search yielded 2,301 articles; 42 met eligibility criteria. Factors associated with better outcomes included a shorter preoperative interval, shorter graft length when an interposed graft was used, nerve continuity, and younger patient age. Gender or sex was not mentioned as a factor affecting outcomes in any study. Motor grades of ≥M3 on the British Medical Research Council (MRC) scale are typically considered successful outcomes. This was achieved in 81.4% of patients who underwent neurolysis, 78.8% of patients who underwent end-to-end suturing, 49.0% of patients who underwent nerve grafting, 62.9% of patients who underwent nerve transfer, 81.5% of patients who underwent isolated posterior tibial tendon transfer (PTTT), and 84.2% of patients who underwent a surgical procedure with concurrent PTTT. Studies included in this review were heterogenous, complicating our ability to perform further analysis. It is not possible to uniformly advocate for the best treatment option, given diverse injury modalities and patient presentations and a variety of prognostic factors. Many studies do not show outcomes with respect to injury modality. Future studies should show preoperative muscle strengths and should clearly define outcomes based on the injury modality and surgical treatment option. This would allow for greater analysis of the most appropriate treatment option for a given mechanism of injury. Newer surgical techniques are promising and should be further explored. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

CORRELATION BETWEEN QUALITY OF LIFE AND THE CLINICAL RESULTS OF PATIENTS WITH LEPROSY WITH DROP FOOT AFTER TENDON TRANSFER.

ABSTRACTObjective: To evaluate the functional results of surgically correcting drop foot in patients with leprosy and compare their SALSA, Social Participation, and AOFAS score.Methods: Overall, 22 patients were subjected to posterior tibial tendon transfer via the subcutaneous route to the foot dorsum with an average follow-up of 56 months (min 12, max 70). In our sample, 15 of the enrolled patients were men and seven, women, aged between 20 and 73 years old who were operated on from January 2014 to December 2017. The Pearson’s correlation test (r) was used to measure the correlation among those scales. A p < 0.05 was considered significant between the pre- and pos-operative AOFAS scale scores.Results: Pre-operative average AOFAS score was 59.6 (min 35, max 74) and 77.2 postoperative (min 36, max 97) (p < 0.0001), postoperative Salsa and Social Participation scale, 30.6 and 22.5, respectively. Statistical analysis suggests a strong positive correlation between AOFAS and Salsa scales (r = −0.83) and AOFAS and social participation (r = −0.78). Average dorsiflexion was 5.4 degrees.Conclusion: The surgical correction of drop foot positively affects the quality of life and social participation of patients with leprosy. Level of Evidence III, Retrospective Study.

Posterior Tibial Tendon Transfer for the Correction of Drop Foot.

Drop foot is a crippling condition that often requires surgical intervention to restore functional dorsiflexion. Although transfer of the posterior tibial (PT) tendon has been well described for the treatment of drop foot, there is no consensus on whether tendon transfers affecting the ankle joint sufficiently restore functional status for daily activities. In addition, most studies have focused on drop foot caused by peripheral nerve disorders. The purpose of this study was to evaluate the functional outcomes and patient satisfaction following PT tendon transfer for the correction of drop foot resulting from both peripheral and central neurologic causes. Patients with drop foot who underwent a PT tendon transfer were followed for a minimum of 1 year and investigated retrospectively. Outcome measures included the American Orthopaedic Foot & Ankle Society ankle and hindfoot scoring system, a patient satisfaction questionnaire, postoperative ankle range of motion, and postoperative ambulatory status. We evaluated 15 feet in 14 patients at a median follow-up of 50 months. The median postoperative American Orthopaedic Foot & Ankle Society ankle and hindfoot score was 85.0. Thirteen patients (92.9%) reported that they would undergo the procedure again. The median postoperative passive ankle dorsiflexion was 5.0°, and the median postoperative passive ankle plantarflexion was 30.0°. Thirteen patients (92.9%) were able to ambulate postoperatively. Ten (71.4%) ambulated without the use of an ankle-foot orthosis (AFO), and three (21.4%) ambulated with the use of an AFO. Overall, orthoses were able to be discontinued in 73.3% of the cases. Our results suggest that the PT tendon transfer is an effective procedure for the treatment of drop foot that can improve the patient's functional status and ability to ambulate. The majority of patients were able to discontinue the use of their AFO postoperatively.