Endoscopically Assisted Percutaneous Harvesting of the Flexor Hallucis Tendon in Zone 2: An Anatomical Study.

IF 2.4 2区 医学 Q2 ORTHOPEDICS
Foot & Ankle International Pub Date : 2023-09-01 Epub Date: 2023-06-09 DOI:10.1177/10711007231177250
Philipp Winter, Ali-Asgar Najefi, Laura Lambert, Stefan Landgraeber, Thomas Tschernig, Joe Wagener
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引用次数: 0

Abstract

Background: Flexor hallucis longus (FHL) transfer is a well-established method for treating chronic Achilles tendon ruptures and tendinopathy. Harvesting of the FHL tendon in zone 2 results in greater length but is also associated with an increased risk of injury to the medial plantar nerve and requires an additional plantar incision. Because of the anatomic proximity of the FHL tendon to the tibial neurovascular bundle in zone 2, the purpose of this study was to investigate the risk of vascular or nerve injury with arthroscopic assisted percutaneous tenotomy in zone 2 of the FHL tendon.

Methods: Endoscopically assisted percutaneous FHL transfer was performed on 10 right lower extremities from 10 cadaveric human specimens. The FHL tendon lengths and the relationship between FHL tendon and the tibial neurovascular bundle at zone 2 was analyzed.

Results: We observed a complete transection of the medial plantar nerve in 1 case (10%). The mean length of the FHL tendon was 54.7 ± 9.5 mm and the mean distance from the distal stump of the FHL tendon to local neurovascular structures was 1.3 ± 0.7 mm.

Conclusion: There is a risk of neurovascular injury after endoscopic FHL tenotomy in zone 2. The tenotomy site is within 2 mm of the local neurovascular structures in the majority of cases. The additional length gained from this technique is unlikely to be required for the majority of FHL tendon transfer procedures. If additional length is needed, we would recommend the use of intraoperative ultrasonography or a mini-open approach to minimize injury risk.

Level of evidence: Level V, expert opinion.

内窥镜辅助下经皮摘取2区的透明屈肌腱:一项解剖学研究。
背景:屈拇长肌(FHL)移植是治疗慢性跟腱断裂和腱病的一种公认方法。在区域2中收获FHL肌腱导致更大的长度,但也与内侧足底神经损伤的风险增加有关,并且需要额外的足底切口。由于FHL肌腱在解剖学上靠近2区的胫骨神经血管束,本研究的目的是研究关节镜辅助下FHL肌腱2区经皮肌腱切开术对血管或神经损伤的风险。方法:对10具尸体标本的10个右下肢进行内镜辅助下经皮FHL移植。分析了FHL肌腱的长度以及FHL肌腱与2区胫骨神经血管束的关系。结果:1例(10%)足底内侧神经完全横断。FHL肌腱的平均长度为54.7 ± 9.5 mm,从FHL肌腱远端残端到局部神经血管结构的平均距离为1.3 ± 0.7 结论:内镜下FHL肌腱切开术后2区存在神经血管损伤的风险。肌腱切开部位在2 mm的局部神经血管结构。从该技术获得的额外长度不太可能用于大多数FHL肌腱转移程序。如果需要额外的长度,我们建议使用术中超声检查或迷你开放式入路,以最大限度地降低损伤风险。证据级别:五级,专家意见。
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来源期刊
Foot & Ankle International
Foot & Ankle International 医学-整形外科
CiteScore
5.60
自引率
22.20%
发文量
144
审稿时长
2 months
期刊介绍: Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers. The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008. The journal focuses on the following areas of interest: • Surgery • Wound care • Bone healing • Pain management • In-office orthotic systems • Diabetes • Sports medicine
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