Flexor digitorum longus tendon transfer to the navicular: tendon-to-tendon repair is stronger compared with interference screw fixation
File(s)
Published version
Author(s)
Marsland, Daniel
Stephen, Joanna M
Calder, Toby
Amis, Andrew A
Calder, James DF
Type
Journal Article
Abstract
PURPOSE: To assess whether early rehabilitation could be safe after flexor digitorum longus (FDL) tendon transfer, the current biomechanical study aimed to measure tendon displacement under cyclic loading and load to failure, comparing a traditional tendon-to-tendon (TT) repair with interference screw fixation (ISF). METHODS: 24 fresh-frozen cadaveric below knee specimens underwent FDL tendon transfer. In 12 specimens a TT repair was performed via a navicular bone tunnel. In a further 12 specimens ISF was performed. Using a materials testing machine, the FDL tendon was cycled 1000 times to 150 N and tendon displacement at the insertion site measured. A final load to failure test was then performed. Statistical analysis was performed using two-way ANOVA and an independent t test, with a significance level of p < 0.05. RESULT: No significant difference in tendon displacement occurred after cyclic loading, with mean tendon displacements of 1.9 ± 1.2 mm (mean ± SD) in the TT group and 1.8 ± 1.5 mm in the ISF group (n.s.). Two early failures occurred in the ISF group, none in the TT group. Mean load to failure was significantly greater following TT repair (459 ± 96 N), compared with ISF (327 ± 76 N), p = 0.002. CONCLUSION: Minimal tendon displacement of less than 2 mm occurred during cyclic testing in both groups. The two premature failures and significantly reduced load to failure observed in the ISF group, however, indicate that the traditional TT technique is more robust. Regarding clinical relevance, this study suggests that early active range of motion and protected weight bearing may be safe following FDL tendon transfer for stage 2 tibialis posterior tendon dysfunction.
Date Issued
2020-01-01
Date Acceptance
2018-03-26
Citation
Knee Surgery Sports Traumatology Arthroscopy, 2020, 28, pp.320-325
ISSN
0942-2056
Publisher
Springer Verlag
Start Page
320
End Page
325
Journal / Book Title
Knee Surgery Sports Traumatology Arthroscopy
Volume
28
Copyright Statement
© The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29627930
PII: 10.1007/s00167-018-4936-0
Subjects
Flexor digitorum longus
Interference screw
Navicular
Pes planus
Tendon transfer
Tibialis posterior tendon dysfunction
Publication Status
Published
Coverage Spatial
Germany
Date Publish Online
2018-04-07