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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ORCID:
Journal Title
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Volume Title
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