Biomechanical study of tibialis anterior tendon transfer

The tibialis anterior tendon transfer has been used in the treatment of recurrent congenital clubfoot and paralytic equinovarus foot deformities in cerebral palsy. This study attempts to determine the optimal site of tibialis anterior tendon insertion for ankle and foot motion and to compare the split and whole tendon transfer. Ten fresh normal anatomic leg specimens were used. The lateral half of the tibialis anterior tendon was detached from its insertion, passed beneath the extensor retinaculum, and anchored to the appropriate tarsal bone by a barbed staple. Tension was applied, and ankle and foot motions were measured. The experiment was done by anchoring the tendon to the tarsal bones along the axis of the second metatarsal and serially through to the axis of the fifth' metatarsal. The entire experiment was repeated using the whole tibialis anterior tendon. For split tendon transfer, insertion onto the fourth metatarsal axis was the most effective route; it produced maximal dorsiflexion with minimal supination and pronation. For whole tendon transfer, the ideal site of insertion was along the third metatarsal axis. However, the difference between the average maximum dorsiflexion achieved by the split tendon transfer and that of total tendon transfer is not statistically significant.