| Purpose As regards to the posterior tibial tendon (PTT) transferring through circumtibial route, there are no literatures on the optimal height for the pulling out of the PTT and tendon length discrepancy at different height of level. The cadaveric study was developed to seek out which level of height is optimal and make a comparison of the tendon length discrepancy at different height.Methods Twenty-five fresh normal cadaveric lower legs were used for measurements. Firstly, the PTT was exposed and isolated. An incision along the calf was made for pulling out the PTT outside the fascia. The upper edge of the incision was classified as point "a". The distal tip of the tendon was classified as point "b". The midpoint of the intermediate cuneiform, lateral cuneiform and cuboid was defined as point "c", "d" and "e" respectively. We measured and compared the length of ab, ac, ad, ae at different height of level above the distal tip of medial malleolus. Also, The angles "a", "β", "y" between the tendon outside the fascia to different bones and inside while transferring for different bones at different heights of level. All the data were collected and analyzed.Results Since the 5cm height of level or more than, all PTT can reach the midpoints of the three bones, the length of ac, ad, ae are less than ab, with a significant difference (p<0.05). At the 10cm height of level, the angles "α", "β", "γ" were respectively 177±2.1°,170±3.1°, and 164±3.7° in which the angle has no significant difference from 11cm height of level (p>0.05).Conclusions In the present study, our results have shown that the posterior tibial tendon transfer through the subcutaneous route can achieve adequate length for the insertion of intermediate cuneiform, lateral cuneiform and cuboid since the level of 5cm height above distal tip of medial malleolus or above. The level of 10cm height is optimal for posterior tibial tendon transferred to the three bones through subcutaneous route. |
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