Interosseous membrane window size for tibialis posterior tendon transfer—Geometrical and MRI analysis

Date

2016

Type:

Artículo

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4

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Publisher

Elsevier

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Abstract

BACKGROUND: Tibialis posterior (TP) tendon transfer through the interosseous membrane is commonly performed in Charcot-Marie-Tooth disease. In order to avoid entrapment of this tendon, no clear recommendation relative to the interosseous membrane (IOM) incision size has been made. OBJECTIVE: Analyze the TP size at the transfer level and therefore determine the most adequate IOM window size to avoid muscle entrapment. METHODS: Eleven lower extremity magnetic resonances were analyzed. TP muscle measurements were made in axial views, obtaining the medial-lateral and antero-posterior diameter at various distances from the medial malleolus tip. The distance from the posterior to anterior compartment was also measured. These measurements were applied to a mathematical model to predict the IOM window size necessary to allow an ample TP passage in an oblique direction. RESULTS: The average tendon diameter (confidence-interval) at 15cm proximal to the medial malleolus tip was 19.47mm (17.47-21.48). The deep posterior compartment to anterior compartment distance was 10.97mm (9.03-12.90). Using a mathematical model, the estimated IOM window size ranges from 4.2 to 4.9cm. CONCLUSION: The IOM window size is of utmost importance in trans-membrane TP transfers, given that if equal or smaller than the transposed tendon oblique diameter, a high entrapment risk exists. A membrane window of 5cm or 2.5 times the size of the tendon diameter should be performed in order to theoretically diminish this complication.

Description

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Citation

Wagner P, Ortiz C, Vela O, Arias P, Zanolli D, Wagner E. Interosseous membrane window size for tibialis posterior tendon transfer-Geometrical and MRI analysis. Foot Ankle Surg. 2016 Sep;22(3):196-199.

Keywords

Drop foot, Interosseous membrane, Tendon entrapment, Tendon transfer, Tibialis posterior tendon transfer

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