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Determination of optimal screw positioning in flexor hallucis longus tendon transfer for chronic tendoachilles
M H Arastu1, R Partridge, A Crocombe
1South West Thames Region, UK. marastu@hotmail.com
Background:
Neglected ruptures of the tendoachilles pose a difficult surgical problem. There are no data to determine the optimal positioning of the FHL tendon to the calcaneus.
Methods:
Two computer programmes (MSC.visualNastran Desktop 2002™ and Solid Edge(®) V19) were used to generate a human ankle joint model. Different attachment points of FHL tendon transfer to the calcaneus were investigated.
Results:
The lowest muscle force to produce plantarflexion (single stance heel rise) was 1355 N. Plantarflexion increased for a more anterior attachment point. The maximum range of plantarflexion was 33.4° for anterior attachment and 24.4° for posterior attachment. There was no significant difference in range of movement when the attachment point was moved to either a medial or lateral position.
Conclusions:
A more posterior attachment point is advantageous in terms of power and the arc of motion (24.4°) is physiological. We recommend that FHL is transferred to the calcaneus in a posterior position.
