Sullivan Raymond J, Gladwell Heather A, Aronow Michael S, Nowak Michael D
University of Connecticut School of Medicine, Orthopaedic Associates of Hartford, Farmington 06032, USA.
Foot Ankle Int. 2006 May;27(5):363-6. doi: 10.1177/107110070602700508.
The surgical management of posterior tibial tendon dysfunction often includes transfer of the flexor digitorum longus (FDL) tendon through a tunnel in the navicular. Fixation often is obtained by sewing the tendon back onto itself. The purpose of this study was to compare this standard method of fixation with suture anchor fixation, a technique that may be associated with less surgical morbidity, because it requires the harvesting of less tendon length.
FDL tendon transfer to the navicular was done in 13 fresh-frozen cadaver specimens. In six feet comprising the standard group, the FDL tendon was transected distal to the master knot of Henry, placed through a drill hole into the navicular, and sutured back onto itself. In seven feet the FDL tendon was transected proximal to the master knot of Henry, placed into a drill hole into the navicular, and fixed with a suture anchor. Load was applied to the proximal FDL muscle and tendon using a materials testing system (MTS) machine and peak load to failure was measured.
The mean load to failure was 142.48 N +/- 38.06 N for the standard group and 142.12 N +/- 59.26 N for the suture anchor group (p = 0.305 for the Student-t test and p = 0.945 for the Mann-Whitney test).
Transfer of the FDL tendon to the navicular using suture anchor fixation requires less tendon length yet provides similar fixation strength as compared to sewing the tendon back onto itself. However, suture anchors are considerably more expensive than sutures.
Suture anchors allow comparable fixation of FDL tendon transfer into a navicular without the need to disrupt the master knot of Henry. This technique may be associated with less morbidity including a shorter incision, decreased risk of medial plantar nerve injury, and decreased loss of lesser toe plantarflexion strength secondary to maintenance of the normal interconnections between the flexor hallucis longus (FHL) and FDL tendons.
胫后肌腱功能障碍的手术治疗通常包括通过舟骨隧道转移趾长屈肌腱（FDL）。固定通常是通过将肌腱缝回自身来实现。本研究的目的是将这种标准固定方法与缝线锚钉固定进行比较，缝线锚钉固定技术可能与较低的手术发病率相关，因为它所需的肌腱长度较短。
对13个新鲜冷冻尸体标本进行FDL肌腱向舟骨的转移。在组成标准组的6只足中，FDL肌腱在亨利主结远侧切断，通过钻孔置入舟骨，然后缝回自身。在7只足中，FDL肌腱在亨利主结近侧切断，置入舟骨钻孔，并用缝线锚钉固定。使用材料测试系统（MTS）机器向FDL近端肌肉和肌腱施加负荷，并测量至失效的峰值负荷。
标准组至失效的平均负荷为142.48 N±38.06 N，缝线锚钉组为142.12 N±59.26 N（t检验p = 0.305，曼-惠特尼检验p = 0.945）。
与将肌腱缝回自身相比，使用缝线锚钉固定将FDL肌腱转移至舟骨所需的肌腱长度较短，但提供相似的固定强度。然而，缝线锚钉比缝线贵得多。
缝线锚钉可对FDL肌腱转移至舟骨进行相当的固定，而无需破坏亨利主结。该技术可能与较低的发病率相关，包括切口较短、内侧足底神经损伤风险降低以及由于维持长屈肌（FHL）和FDL肌腱之间的正常连接而导致的小趾跖屈力量损失减少。
