Comparative Biomechanical and Anatomical Analysis of Anchor, Endobutton and Tunnel Methods in Tibialis Anterior Tendon Transfer Fixation
Abstract
Introduction: Tendon transfers are frequently used techniques in orthopedic surgery to increase functional capacity, especially after pediatric deformities and nerve damage. Tendon transfers are shaped around a few basic principles. These principles are that the joint in which movement is expected after the transfer is flexible, the soft tissue to be transferred is suitable for healing, the donor tendon must have sufficient excursion and strength, it must have a linear traction axis, and it must also be sacrificial. While most of these principles express the limits that can be followed with good preoperative planning, the main variables that can be changed intraoperatively are the nature of the tissue in the area to be transferred and the interaction of the transfer technique with this tissue.
Materials and Methods: In our study, we aimed to compare 3 different fixation methods in tibialis anterior transfer applications, which are transferred and fixed to the tarsal bones with the expectation of an osseotendinous recovery. These techniques are: 1) Fixation with endobutton 2) Fixation with Suture Anchor 3) Fixation with tunnel technique. For this purpose, 3 different surgical techniques were applied to 3 different cadavers in total. As the result parameters, the maximum force that the transferred tendon could resist with the traction force after fixation and the displacement at the moment the maximum force acted were evaluated. After the biomechanical test was completed, the medial part of the tibialis anterior transferred ankle was dissected and it was investigated whether the median plantar nerve was damaged.
Result: According to the results obtained in the experiments, it was revealed that there was no significant difference between the groups in the maximum force before rupture and the amount of displacement when the maximum force was applied. The median plantar nerve was not damaged in any of the nine cadavers.
Conclusion: The proposed technique is an effective and safe method because it offers similar biomechanical strength to the compared techniques, has no implant cost, does not require leaving permanent fixation material, and does not pose a risk of neurovascular damage
Project Number
30777
References
- A.A.A. Ayub, G.B. Firth, G.L. Green, P. Bijlsma, M. Ramachandran, Tibialis anterior tendon transfer using bone anchor for dynamic supination in congenital talipes equinovarus, J Pediatr Orthop B 32 (2023) 15–20. https://doi.org/10.1097/BPB.0000000000000997.
- G.T. Liu, B.C. Balldin, J.R. Zide, C.T. Chen, A Biomechanical Analysis of Interference Screw Versus Bone Tunnel Fixation of Flexor Hallucis Longus Tendon Transfers to the Calcaneus, J Foot Ankle Surg 56 (2017) 813–816. https://doi.org/10.1053/J.JFAS.2017.04.014.
- O. Bilge, S. Celik, Cadaver embalming fluid for surgical training courses: modified Larssen solution, Surg Radiol Anat 39 (2017) 1263–1272. https://doi.org/10.1007/S00276-017-1865-4.
- M. Pekedis, M.D. Yoruk, E. Binboga, H. Yildiz, O. Bilge, S. Celik, Characterization of the mechanical properties of human parietal bones preserved in modified larssen solution, formalin and as fresh frozen, Surg Radiol Anat 43 (2021) 1933–1943. https://doi.org/10.1007/S00276-021-02762-1.
- M. Ayzenberg, D. Arango, G.E. Gershkovich, P.S. Samuel, M. Saing, Pullout strength of a novel hybrid fixation technique (Tape Locking ScrewTM) in soft-tissue ACL reconstruction: A biomechanical study in human and porcine bone, Orthop Traumatol Surg Res 103 (2017) 591–595. https://doi.org/10.1016/J.OTSR.2017.01.006.
- L. Walton, M.F. Villani, Principles and Biomechanical Considerations of Tendon Transfers, Clin Podiatr Med Surg 33 (2016) 1–13. https://doi.org/10.1016/J.CPM.2015.06.001.
- S. Núñez-Pereira, D. Pacha-Vicente, M. Llusá-Pérez, J. Nardi-Vilardaga, Tendon transfer fixation in the foot and ankle: a biomechanical study, Foot Ankle Int 30 (2009) 1207–1211. https://doi.org/10.3113/FAI.2009.1207.
- E.P. Sabonghy, R.M. Wood, C.G. Ambrose, W.C. McGarvey, T.O. Clanton, Tendon transfer fixation: comparing a tendon to tendon technique vs. bioabsorbable interference-fit screw fixation, Foot Ankle Int 24 (2003) 260–262. https://doi.org/10.1177/107110070302400311.
- K. Masrouha, A. Chu, W. Lehman, Narrative review of the management of a relapsed clubfoot, Ann Transl Med 9 (2021) 1102–1102. https://doi.org/10.21037/ATM-20-7730.
- J.L. Mulhern, N.M. Protzman, S.A. Brigido, Tibialis Anterior Tendon Transfer, Clin Podiatr Med Surg 33 (2016) 41–53. https://doi.org/10.1016/J.CPM.2015.06.003.
- C. Bibbo, S.S. Jaglan, Tendon transfers for equinovarus deformity in adults and children, Foot Ankle Clin 16 (2011) 401–418. https://doi.org/10.1016/J.FCL.2011.07.001.
- J. Hochstetter-Owen, S. Stott, S.A. Williams, The efficacy of split tibial tendon transfers on functional gait outcomes for children and youth with cerebral palsy and spastic equinovarus foot deformities, Bone Jt Open 4 (2023) 283–298. https://doi.org/10.1302/2633-1462.45.BJO-2023-0005.R1.
- J.A. Vova, L.T. Davidson, Nerve and Tendon Transfers After Spinal Cord Injuries in the Pediatric Population: Clinical Decision Making and Rehabilitation Strategies to Optimize Function, Phys Med Rehabil Clin N Am 31 (2020) 455–469. https://doi.org/10.1016/J.PMR.2020.04.006.
Tibialis anterior tendon transferi tespitinde çapa dikiş, askı düğme sistemi ve tünel yöntemlerinin karşılaştırmalı biyomekanik ve anatomik analizi
Abstract
Amaç: Tendon transferleri, ortopedik cerrahide özellikle pediatrik deformiteler ve sinir hasarı sonrası fonksiyonel kapasiteyi arttırmak amacıyla sık kullanılan tekniklerdir. Tendon transferleri birkaç temel prensip etrafında şekillenmiştir. Bu prensipler transfer sonrası hareket beklenen eklemin esnek olması, transfer yapılacak yumuşak dokunun iyileşmeye elverişli olması, donor tendonun yeterli ekskürsiyona ve kuvvete sahip olması, doğrusal bir çekiş eksenine sahip olması ve aynı zamanda feda edilebilir olmasıdır. Bu prensiplerin çoğu iyi bir preoperatif planlama ile uyulabilecek sınırları ifade ederken intraoperatif değiştirilebilir temel değişken olarak transfer edilecek bölgedeki dokunun mahiyeti ve uygulanacak transfer tekniğinin bu doku ile etkileşimi olarak öne çıkmaktadır.
Gereç ve Yöntem: Çalışmamızda osseotendinöz bir iyileşme beklentisi ile tarsal kemiklere transfer edilerek tespit edilen tibialis anterior transferi uygulamalarında 3 farklı tespit yöntemini kıyaslamayı amaçladık. Bu teknikler: 1) Askı düğme sistemi ile tespit 2) Çapa dikiş ile tespit 3) Tünel tekniği ile tespit. Bunun için toplam 9 kadavrada 3 farklı cerrahi teknik 3er farklı kadavrada uygulanmıştır. Sonuç parametresi olarak tespit sonrası transfer edilen tendonun traksiyon kuvveti ile direnebildiği maksimum kuvvet, maksimum kuvvet etki ettiği andaki deplasman değerlendirilmiştir. Biyomekanik testin tamamlanmasının ardından tibialis anterior transfer edilen ayak bileği mediali disseke edilerek median plantar sinirin hasarlanıp hasarlanmadığı araştırılmıştır.
Bulgular: Deneylerde elde edilen sonuçlara göre gruplar arasında kopma öncesi maksimum kuvvet değerinde ve maksimum kuvvet uygulandığı andaki deplasman miktarında anlamı bir fark olmadığı ortaya konulmuştur. Dokuz kadavranın hiçbirinde median plantar sinir hasar görmemiştir.
Sonuç: Önerilen tekniğin karşılaştırılan teknikler ile benzer biyomekanik dayanım sunması, implant maliyeti olmaması, kalıcı tespit materyali bırakılmasını gerektirmemesi ve nörovasküler hasar yaratma olasılığı açısından risk oluşturmaması sebebiyle etkin ve güvenli bir yöntemdir.
Ethical Statement
Proje için Etik kurul onay Ege Üniversitesi Tıbbi Araştırmalar Etik Kurulu’ndan alınmıştır (Karar Nu: 23-10T/42 Tarih: 05.10.2023).
Supporting Institution
Ege Üniversitesi Bilimsel Araştırmalar Proje Koordinatörlüğü
Project Number
30777
Thanks
Ege Üniversitesi Rektörlüğü'ne, Ege Üniversitesi Bilimsel Araştırmalar Proje Koordinatörlüğüne, Ege Üniversitesi Anatomi Anabilim Dalı'na teşekkür ederiz.
References
- A.A.A. Ayub, G.B. Firth, G.L. Green, P. Bijlsma, M. Ramachandran, Tibialis anterior tendon transfer using bone anchor for dynamic supination in congenital talipes equinovarus, J Pediatr Orthop B 32 (2023) 15–20. https://doi.org/10.1097/BPB.0000000000000997.
- G.T. Liu, B.C. Balldin, J.R. Zide, C.T. Chen, A Biomechanical Analysis of Interference Screw Versus Bone Tunnel Fixation of Flexor Hallucis Longus Tendon Transfers to the Calcaneus, J Foot Ankle Surg 56 (2017) 813–816. https://doi.org/10.1053/J.JFAS.2017.04.014.
- O. Bilge, S. Celik, Cadaver embalming fluid for surgical training courses: modified Larssen solution, Surg Radiol Anat 39 (2017) 1263–1272. https://doi.org/10.1007/S00276-017-1865-4.
- M. Pekedis, M.D. Yoruk, E. Binboga, H. Yildiz, O. Bilge, S. Celik, Characterization of the mechanical properties of human parietal bones preserved in modified larssen solution, formalin and as fresh frozen, Surg Radiol Anat 43 (2021) 1933–1943. https://doi.org/10.1007/S00276-021-02762-1.
- M. Ayzenberg, D. Arango, G.E. Gershkovich, P.S. Samuel, M. Saing, Pullout strength of a novel hybrid fixation technique (Tape Locking ScrewTM) in soft-tissue ACL reconstruction: A biomechanical study in human and porcine bone, Orthop Traumatol Surg Res 103 (2017) 591–595. https://doi.org/10.1016/J.OTSR.2017.01.006.
- L. Walton, M.F. Villani, Principles and Biomechanical Considerations of Tendon Transfers, Clin Podiatr Med Surg 33 (2016) 1–13. https://doi.org/10.1016/J.CPM.2015.06.001.
- S. Núñez-Pereira, D. Pacha-Vicente, M. Llusá-Pérez, J. Nardi-Vilardaga, Tendon transfer fixation in the foot and ankle: a biomechanical study, Foot Ankle Int 30 (2009) 1207–1211. https://doi.org/10.3113/FAI.2009.1207.
- E.P. Sabonghy, R.M. Wood, C.G. Ambrose, W.C. McGarvey, T.O. Clanton, Tendon transfer fixation: comparing a tendon to tendon technique vs. bioabsorbable interference-fit screw fixation, Foot Ankle Int 24 (2003) 260–262. https://doi.org/10.1177/107110070302400311.
- K. Masrouha, A. Chu, W. Lehman, Narrative review of the management of a relapsed clubfoot, Ann Transl Med 9 (2021) 1102–1102. https://doi.org/10.21037/ATM-20-7730.
- J.L. Mulhern, N.M. Protzman, S.A. Brigido, Tibialis Anterior Tendon Transfer, Clin Podiatr Med Surg 33 (2016) 41–53. https://doi.org/10.1016/J.CPM.2015.06.003.
- C. Bibbo, S.S. Jaglan, Tendon transfers for equinovarus deformity in adults and children, Foot Ankle Clin 16 (2011) 401–418. https://doi.org/10.1016/J.FCL.2011.07.001.
- J. Hochstetter-Owen, S. Stott, S.A. Williams, The efficacy of split tibial tendon transfers on functional gait outcomes for children and youth with cerebral palsy and spastic equinovarus foot deformities, Bone Jt Open 4 (2023) 283–298. https://doi.org/10.1302/2633-1462.45.BJO-2023-0005.R1.
- J.A. Vova, L.T. Davidson, Nerve and Tendon Transfers After Spinal Cord Injuries in the Pediatric Population: Clinical Decision Making and Rehabilitation Strategies to Optimize Function, Phys Med Rehabil Clin N Am 31 (2020) 455–469. https://doi.org/10.1016/J.PMR.2020.04.006.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Orthopaedics |
| Journal Section | Research Articles |
| Authors | |
| Project Number | 30777 |
| Publication Date | December 9, 2024 |
| Submission Date | April 19, 2024 |
| Acceptance Date | June 10, 2024 |
| Published in Issue | Year 2024 |