SLR - August 2010 - Evan Cichelli

Anterior Transplantation of the Posterior Tibial Tendon for Persistent Palsy of the Common Peroneal Nerve

Reference: 
Lipscomb, P., Sanchez, J., Anterior Transplantation of the Posterior Tibial Tendon for Persistent Palsy of the Common Peroneal Nerve.  The Journal of Bone and Joint Surgery (American).  1961; 43: 60-66

Scientific Literature Reviews

Reviewed by: Evan Cichelli, DPM
Residency Program: Roxborough Memorial Hospital

Podiatric Relevance:  
This study demonstrates the effectiveness of the posterior tibial tendon transfer for use with patients with drop foot secondary to common peroneal nerve damage. 

Methods:
Ten patients with post-traumatic palsy of the common peroneal nerve underwent anterior transplantation of the posterior tibial tendon.  The posterior tibial tendon was rerouted around the medial surface of the tibia to and transferred to one of the cuneiforms on the dorsum of the foot.  Nine of 10 patients also received a triple arthrodesis at the time of the tendon transfer.  The other patient received a triple arthrodesis as a separate procedure.  All patients were placed in a plaster cast for 3 to 4 months.  Four patients wore a leg brace for an additional 3 months.  All patients were then instructed by physical medicine on re-education of the transferred tendon. 

Results: 
Nine of 10 patients had satisfactory dorsiflexion at the end of the study period.  The one patient who did not have satisfactory dorsiflexion had a weak tibialis posterior from an injury to the sciatic nerve.  One patient was given a fair result because 5.5 months post-operatively, he could only use the transferred tendon during weight bearing when he consciously thought about it.  The patients who had a good results had at least 90 degrees of dorsiflexion and 20 degrees of plantarflexion of the ankle.  The triple arthrodeses fused in 9 of 10 patients. 

Conclusions: 
According to the authors of this study, transfer of the posterior tibial tendon to the dorsum of the foot can restore ankle dorsiflexion in patients with persistent palsy of the common peroneal nerve.  They also recommend that transfer of the posterior tibial tendon should be performed with a triple arthrodesis . 

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