Tendon Transfer Fixation in Patients With Neuromuscular Disease

Historically, tendon transfers about the foot and ankle in the neursomuscular population have been secured with sutures or with sutures tied over a button. These strategies usually require non-weight-bearing (NWB) immobilization, and buttons pose the risk of pressure sores. Interference screw fixation (ISF) uses a small-diameter bioabsorbable screw to secure fixation after a tendon transfer, enabling early weight-bearing (WB). Our goal was to determine the success rate and complications of ISF in neuromuscular patients undergoing tendon transfers about the foot and ankle and further compare ISF with suture fixation.

Patients with neuromuscular etiologies who underwent a tendon transfer of the foot or ankle at a single tertiary care children's hospital between 2013 and 2023 were included. Demographics such as age, race, sex, neurological diagnosis, and surgical procedures were collected for all patients. An ISF failure was defined as either the screw pulling out intraoperatively, instability of the initial fixation with the screw necessitating supplementary suture or button fixation, or abandonment of ISF fixation.

A total of 102 patients (52 female, 50 male) with a mean age of 12.9 ± 4.6 years met inclusion criteria. Overall, 98 (79%) tendon transfers occurred in patients who were ambulatory at baseline. Seventy-five percent of tendon transfers utilized ISF, 8.1% used button fixation, 11.3% used suture fixation alone, and 5.6% used ISF and a button. There was an overall failure rate of 8.9% for ISF. We found no evidence of any relationship between preoperative ambulation and screw fixation failure (P > .05). There was a significant difference in postoperative WB status by fixation type (P < .001), with ISF patients weight-bearing at a higher rate immediately following surgery. We did not appreciate a significant difference in postoperative skin breakdown by fixation type or WB status (P > .05).

ISF is a viable option for neuromuscular patients undergoing a tendon transfer of the foot or ankle and may be used successfully irrespective of ambulatory status. We did not appreciate a difference in skin breakdown between fixation strategies but did find that patients with ISF were released to full WB significantly earlier.

(1)ISF may be successfully used irrespective of ambulatory status in tendon transfers of the foot or ankle for neuromuscular patients.(2)Patients with ISF were released to full weightbearing significantly earlier.(3)We did not appreciate a difference in skin breakdown between fixation strategies.

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