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Anatomical feasibility study of flexor hallucis longus transfer in treatment of Achilles tendon and posteromedial portal of ankle arthroscopy

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Abstract

Purpose

The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus (FHL) muscle, the relationship between FHL tendon or muscle and the tibial neurovascular bundle at the level of the posterior ankle joint in human cadavers.

Methods

Seventy embalmed feet from 20 male and 15 female cadavers, the cadavers’ mean age was 65.4 (range from 14 to 82) years, were dissected and anatomically classified to observe FHL muscle morphology define the relationship between FHL tendon or muscle and the tibial neurovascular bundle. The distance between the musculotendinous junction and the relationship between FHL tendon or muscle and the tibial neurovascular bundle was determined.

Results

Three morphology types of FHL muscle were identified: a long lateral and shorter medial muscle belly, which was observed in 63 specimens (90%); equal length medial and lateral muscle bellies, this variant was only observed in five specimens (7.1%); one lateral and no medial muscle belly, which was observed in two specimens (2.9%). No statistically significant difference was observed according to gender or side (p > 0.05). Two patterns were identified and described between FHL tendon or muscle and the tibial neurovascular bundle. Pattern 1, the distance between the neurovascular bundle and FHL tendon was 3.46 mm (range 2.34–8.84, SD = 2.12) which was observed in 66 specimens (94.3%); Pattern 2, there was no distance which was observed in four specimens (5.7%).

Conclusion

Knowing FHL muscle morphology, variations provide new important insights into secure planning and execution of a FHL transfer for Achilles tendon defect as well as for the interpretation of ultrasound and magnetic resonance images. With posterior arthroscopic for the treatment of various ankle pathologies, posteromedial portal may be introduced into the posterior aspect of the ankle without gross injury to the tibial neurovascular structures because of the gap between the neurovascular bundle and FHL tendon.

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Acknowledgements

This project was supported by Zhejiang Medical Science and Technology Projects Grant (2014RCA025) and Nature Science Foundation of Ningbo city (2016A610133).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Affiliated Hospital of Medical school, Ningbo University, No. 247, Renming Road, Jiangbei District, Ningbo, Zhejiang, China

    Haijiao Mao, Linger Wang, Wenwei Dong & Zhenxin Liu

  2. Department of Anatomy, Medical School of Ningbo University, Ningbo, Zhejiang, China

    Weigang Yin

  3. Department of Anatomy, Southern Medical University, No. 1023 Shatai nan Road, Guangzhou, Guangdong, China

    Dachuan Xu

  4. Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania School of Medicine, Philadelphia, USA

    Keith L. Wapner

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  1. Haijiao Mao
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  2. Linger Wang
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  3. Wenwei Dong
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  4. Zhenxin Liu
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  5. Weigang Yin
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  7. Keith L. Wapner
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Contributions

Haijiao Mao did this research and wrote the main manuscript text. Wenwei Dong and Linger Wang did date collection. Zhenxin Liu performed the study. Weigang Yin and Dachuan Xu offered the cadaver bodies. Keith L Wapner reviewed and revised the manuscript.

Corresponding author

Correspondence to Haijiao Mao.

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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Mao, H., Wang, L., Dong, W. et al. Anatomical feasibility study of flexor hallucis longus transfer in treatment of Achilles tendon and posteromedial portal of ankle arthroscopy. Surg Radiol Anat 40, 1031–1038 (2018). https://doi.org/10.1007/s00276-018-2021-5

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  • DOI: https://doi.org/10.1007/s00276-018-2021-5

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