TENDON TRANSPLANTATIONS IN THE LOWER EXTREMITY

A Review of End Results in Poliomyelitis I. Tendon Transplantations about the Foot and Ankle

¹ BOSTON, MASSACHUSETTS

1. The long-term end results of tendon transplantations about the foot and ankle in 100 poliomyelitic patients have been studied.

2. In all but a few instances, the transplantation was an adjunct to bone stabilization of the foot.

3. The peroneal tendons were most frequently transplanted.

4. Transplantations to reinforce power in dorsiflexion were done more frequently and in general were more successfull than were the posterior transplantations which were done to improve plantar flexion.

5. Approximately one third of the transplantations were rated as failures, one third as fair, and one third as good to excellent.

6. The presence of good muscle power before operation favorably influenced the end result.

7. Operations done before the age of eleven were likely to be unsuccessful, and re-operation was necessary in 60 per cent. of these cases.

8. It would appear from our studies that, in the presence of good muscle power about the foot and ankle, triple arthrodesis without tendon transplant produces an excellent functional result. This is especially true if the deformity or instability can be treated conservatively until the patient is at least thirteen years old.

9. There is some evidence that arthrodesis of the interphalangeal joints of the toes may be sufficient to correct the deformity of "cock-up" toes and to permit the toe extensors to doreiflex the foot without transplanting the tendons to the metatarsal necks.

10. In general, the combined operation of arthrodesis and tendon transplantation should be reserved for feet with marked muscle imbalance. In properly selected cases, tendon transplantation improves the result of arthrodesis by reinforcing power in dorsiflexion or plantar flexion and may prevent recurrence of deformity caused by unbalanced muscle pull.

11. In this study we have learned that no two cases of poliomyelitis are identical; that restoration of a weakened foot to normal strength and function is impossible. Nevertheless, tendon transplantation, when combined with stabilization procedures, may markedly improve function of the foot.

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