tendon transfer or repair?


Marshfield, MO
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Would you call this a tendon repair? Or a tendon transfer? The doctor called it a repair of the anterior tibialis, but it sounds like as much of a transfer as a repair to me.

Attention was directed along the course of the tibialis anterior tendon from the anterior aspect of the ankle joint to the dorsomedial aspect of the medial cuneiform. Incision was carried through the skin and subcutaneous tissue taking care to bovie and cauterize all bleeders as they were encountered. Further dissection failed to identify viable tendon for primary repair. The distal aspect of the tendon was not identified and the proximal portion was noted to be non salvageable. The extensor hallucis longus tendon was split longitudinally along its course. The medial portion of this was used as a substitute for the tibialis anterior tendon. It was supplemented with tibialis anterior tendon allograft for additional strength. The tendon was inserted into the medial cuneiform using a g force tenodesis screw from Wright Medical Technology. The tendon was noted to be adequately inserted into the medial cuneiform. The remaining portion of the extensor hallucis tendon was supplemented with tibialis anterior tendon allograft as well.

Appreciate any advice.


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I disagree with the above answer. From the procedural description as written, he did a tendon transfer only by using the medial portion of the split EHL tendon, the distal end of which he "transferred" and inserted into the Medial Cuneiform. He "beefed up" both limbs of the split EHL tendon with his Anterior Tibial Tendon Allograft, which I guess was inadequate for use as a tendon graft repair/reconstruction of the damaged Anterior Tibialis tendon. There is no mention of "repairing" the remaining Anterior Tibialis muscle or tendon to anything or any part of the EHL muscle or tendon limbs.

Respectfully submitted, Alan Pechacek, M.D.