How to harvest the greatest length of tibialis posterior tendon for tendon transfer: A cadaveric study.

In anterior transfer of the tibialis posterior tendon, the tendon was harvested using two incisions, the first at its attachment point on the navicular bone and second on the medial side of the leg above the medial malleolus. To provide the maximum tendon length, the second incision needs to be as proximal as possible but injury to the muscle origin must be avoided. The purpose of this study is to establish the location of the second incision that yields the greatest tendon length. Forty-five unpaired embalmed cadaveric legs were dissected. Demographic data, gender, age, and side of specimen were recorded. The distance between the tip of the medial malleolus and the muscle origin was measured. Mobile tendon length, muscle origin, foot length, tibial length, and position of ankle were also noted. The mean mobile tendon length was 11.1 (range 10.7-11.4) cm and the distance between the tip of the medial malleolus and the muscle origin was 6.8 (range 6.5-7.0) cm. The mean foot length was 22.2 cm (range 21.7-22.7), tibial length was 31.5 cm (range 30.8-32.2), and muscle origin was 23.7 cm (range 21.0-26.3). The mean angle position was 46 degrees plantar flexion (range 43-49). In subgroup analysis by gender, the mobile tendon length, distance between the tip of the medial malleolus and the muscle origin, and tibial length, were significantly greater in males than females. In conclusion, for anterior transfer of the tibialis posterior tendon, an incision 7.1 cm above the medial malleolus in the male and 6.4 cm above it in the female provides the longest mobile tendon without injury to its origin. Clin. Anat. 30:1083-1086, 2017. © 2017 Wiley Periodicals, Inc. LEVEL OF EVIDENCE: V, Cadaveric descriptive study.

Frequency and Characteristics of Extensor Hallucis Capsularis: A Cadaveric Study.

Background: Extensor hallucis capsularis is an accessory extensor tendon that is sporadically observed at the medial side of the extensor hallucis longus tendon. Knowledge regarding frequency of occurrence and size of the tendon may help surgeons decide whether to use this tendon or not when tendon graft is needed during foot surgery. Conclusion: Extensor hallucis capsularis tendon was found in the vast majority of cadavers evaluated in this study. Most originated from the extensor hallucis longus tendon and inserted into the first metatarsophalangeal joint capsule. Application of this tendon as a tendon graft should be carefully considered due to variations of the length and the narrow width which may limited strength of this tendon graft. Objective: To evaluate the frequency, size, origin, and insertion of the extensor hallucis capsularis tendon in cadaveric study subjects. Material and Method: Extensor hallucis capsularis tendon was examined via dissection of 55 cadaveric feet. Thirty-six male and 19 female cadavers were included, with an age range of 33 to 90 years (mean 67.3±14.0). One foot from each study subject was dissected and evaluated (29 left feet and 26 right feet). Demographic data (gender, age, and height) and outcome data (frequency, origin, insertion, length, and width of the tendon) were recorded. Tendon measurement reliability was evaluated by intraclass correlation coefficient. Results: Extensor hallucis capsularis tendon was found in 90.9% of cadaveric subjects. Mean tendon length and width was 11.3±4.0 cm and 1.6±0.6 mm, respectively. Most tendons branched from the extensor hallucis longus tendon and attached to the first metatarsophalangeal joint capsule. Conclusion: Extensor hallucis capsularis tendon was found in the vast majority of cadavers evaluated in this study. Most originated from the extensor hallucis longus tendon and inserted into the first metatarsophalangeal joint capsule. Application of this tendon as a tendon graft should be carefully considered due to variations of the length and the narrow width which may limited strength of this tendon graft.