Influence of tendon transfer site on moment arms of the flexor digitorum longus muscle

H. E J Hui, Timothy C. Beals, N. A T Brown

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Adult acquired flatfoot is a common condition that leads to significant morbidity. Along with bony procedures to operatively treat this condition, transfer of the flexor digitorum longus (FDL) tendon to the medial cuneiform or navicular is routinely performed. The goal of this tendon transfer is to increase the capacity of the FDL to invert the hindfoot and control the transverse tarsal joints. However, it is not known whether this biomechanical goal is met or whether one transfer site produces a larger mechanical advantage compared to another site. The purpose of this study was to calculate FDL muscle moment arms at the hindfoot with two clinically relevant transfer locations to quantify the change in mechanical advantage of the FDL after tendon transfer. Methods: In seven cadaver specimens, muscle moment arms of the FDL with respect to hindfoot motion were measured using the tendon excursion method before and after the FDL was transferred to the plantar aspect of the navicular and medial cuneiform. The position and orientation of the foot and excursion of the FDL tendon were measured with an optoelectronic measurement system. Results: The FDL moment arm did not increase after tendon transfer to either the medial cuneiform or navicular when compared to its native site. There were significant decreases in FDL moment arm when transferred from its native site to the medial cuneiform (56% decrease, p = 0.018) and navicular (46% decrease, p = 0.026). Conclusions: In contrast to the clinical proposition that FDL transfer to the navicular or medial cuneiform increases this muscle's mechanical advantage to invert the hindfoot, this cadaver study suggests that, to the contrary, FDL muscle moment arms decrease after tendon transfer.

Original languageEnglish
Pages (from-to)441-447
Number of pages7
JournalFoot and Ankle International
Volume28
Issue number4
DOIs
Publication statusPublished - 2007
Externally publishedYes

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Tendon Transfer
Tendons
Muscles
Cadaver
Tarsal Joints
Flatfoot
Foot
Morbidity

Cite this

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title = "Influence of tendon transfer site on moment arms of the flexor digitorum longus muscle",
abstract = "Background: Adult acquired flatfoot is a common condition that leads to significant morbidity. Along with bony procedures to operatively treat this condition, transfer of the flexor digitorum longus (FDL) tendon to the medial cuneiform or navicular is routinely performed. The goal of this tendon transfer is to increase the capacity of the FDL to invert the hindfoot and control the transverse tarsal joints. However, it is not known whether this biomechanical goal is met or whether one transfer site produces a larger mechanical advantage compared to another site. The purpose of this study was to calculate FDL muscle moment arms at the hindfoot with two clinically relevant transfer locations to quantify the change in mechanical advantage of the FDL after tendon transfer. Methods: In seven cadaver specimens, muscle moment arms of the FDL with respect to hindfoot motion were measured using the tendon excursion method before and after the FDL was transferred to the plantar aspect of the navicular and medial cuneiform. The position and orientation of the foot and excursion of the FDL tendon were measured with an optoelectronic measurement system. Results: The FDL moment arm did not increase after tendon transfer to either the medial cuneiform or navicular when compared to its native site. There were significant decreases in FDL moment arm when transferred from its native site to the medial cuneiform (56{\%} decrease, p = 0.018) and navicular (46{\%} decrease, p = 0.026). Conclusions: In contrast to the clinical proposition that FDL transfer to the navicular or medial cuneiform increases this muscle's mechanical advantage to invert the hindfoot, this cadaver study suggests that, to the contrary, FDL muscle moment arms decrease after tendon transfer.",
keywords = "Adult Acquired Flatfoot, Biomechanics Study, Cadaver Study, Posterior Tibialis Dysfunction, Tendon Transfer",
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year = "2007",
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pages = "441--447",
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Influence of tendon transfer site on moment arms of the flexor digitorum longus muscle. / Hui, H. E J; Beals, Timothy C.; Brown, N. A T.

In: Foot and Ankle International, Vol. 28, No. 4, 2007, p. 441-447.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Influence of tendon transfer site on moment arms of the flexor digitorum longus muscle

AU - Hui, H. E J

AU - Beals, Timothy C.

AU - Brown, N. A T

PY - 2007

Y1 - 2007

N2 - Background: Adult acquired flatfoot is a common condition that leads to significant morbidity. Along with bony procedures to operatively treat this condition, transfer of the flexor digitorum longus (FDL) tendon to the medial cuneiform or navicular is routinely performed. The goal of this tendon transfer is to increase the capacity of the FDL to invert the hindfoot and control the transverse tarsal joints. However, it is not known whether this biomechanical goal is met or whether one transfer site produces a larger mechanical advantage compared to another site. The purpose of this study was to calculate FDL muscle moment arms at the hindfoot with two clinically relevant transfer locations to quantify the change in mechanical advantage of the FDL after tendon transfer. Methods: In seven cadaver specimens, muscle moment arms of the FDL with respect to hindfoot motion were measured using the tendon excursion method before and after the FDL was transferred to the plantar aspect of the navicular and medial cuneiform. The position and orientation of the foot and excursion of the FDL tendon were measured with an optoelectronic measurement system. Results: The FDL moment arm did not increase after tendon transfer to either the medial cuneiform or navicular when compared to its native site. There were significant decreases in FDL moment arm when transferred from its native site to the medial cuneiform (56% decrease, p = 0.018) and navicular (46% decrease, p = 0.026). Conclusions: In contrast to the clinical proposition that FDL transfer to the navicular or medial cuneiform increases this muscle's mechanical advantage to invert the hindfoot, this cadaver study suggests that, to the contrary, FDL muscle moment arms decrease after tendon transfer.

AB - Background: Adult acquired flatfoot is a common condition that leads to significant morbidity. Along with bony procedures to operatively treat this condition, transfer of the flexor digitorum longus (FDL) tendon to the medial cuneiform or navicular is routinely performed. The goal of this tendon transfer is to increase the capacity of the FDL to invert the hindfoot and control the transverse tarsal joints. However, it is not known whether this biomechanical goal is met or whether one transfer site produces a larger mechanical advantage compared to another site. The purpose of this study was to calculate FDL muscle moment arms at the hindfoot with two clinically relevant transfer locations to quantify the change in mechanical advantage of the FDL after tendon transfer. Methods: In seven cadaver specimens, muscle moment arms of the FDL with respect to hindfoot motion were measured using the tendon excursion method before and after the FDL was transferred to the plantar aspect of the navicular and medial cuneiform. The position and orientation of the foot and excursion of the FDL tendon were measured with an optoelectronic measurement system. Results: The FDL moment arm did not increase after tendon transfer to either the medial cuneiform or navicular when compared to its native site. There were significant decreases in FDL moment arm when transferred from its native site to the medial cuneiform (56% decrease, p = 0.018) and navicular (46% decrease, p = 0.026). Conclusions: In contrast to the clinical proposition that FDL transfer to the navicular or medial cuneiform increases this muscle's mechanical advantage to invert the hindfoot, this cadaver study suggests that, to the contrary, FDL muscle moment arms decrease after tendon transfer.

KW - Adult Acquired Flatfoot

KW - Biomechanics Study

KW - Cadaver Study

KW - Posterior Tibialis Dysfunction

KW - Tendon Transfer

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U2 - 10.3113/FAI.2007.0441

DO - 10.3113/FAI.2007.0441

M3 - Article

VL - 28

SP - 441

EP - 447

JO - Foot and Ankle

JF - Foot and Ankle

SN - 1071-1007

IS - 4

ER -