Featuring : Thomas O . Clanton , M.D., and William McGarvey , M.D., Houston TX on Tenodesis Technique for Foot & Ankle Reconstruction
Q : In foot and ankle reconstructions what distinct advantages have you found in performing the technical procedure as well as patient recovery using the principles of interference screw fit fixation with the tenodesis technique versus predicate bone tunnel and tendon to tendon suture repair ?
A : The tenodesis technique allows for smaller incisions for exposure , less dissection,less bone destruction with drill holes. If immediate tendon fixation is unsatisfactory , it can be taken out and replaced after changing tension of tendon fixation. The Bio-Tenodesis Screws aviod metal that can make revision surgery difficult and can produce artifact on MRI.
Q : For which procedures in foot and ankle reconstructions have you found the tenodesis technique to be effective and what biomechanical testing have you performed to support these indications?
A : The Bio-Tenodesis Technique is effective for lateral ankle ligament reconstructions with free tendon graft (semitendinosus or gracilis) for revision reconstructions , and also for FHL to calcaneus for chronic Achilles rupture , FDL or FHL to navicular for posterior tibial tendon reconstruction and posterior tibial tendon through interosseous membrane to lateral cuneiform for drop foot . We have done mechanical testing in the lab and shown pull-out strengths greater than the 50N strength that is necessary for such procedures.
Q : Given the various planes and degree of motion in the foot and ankle explain the advantages of anatomically tensioning the tendon prior to proceeding with final tenodesis screw fixation for the more common procedures?
A : It is necessary to tension the graft anatomically to confirm that the graft will not “Capture the joint ” and prevent normal range of motion. This is particularly important for lateral ankle ligament reconstruction where limiting subtalar motion excessively can lead to postoperative pain. The tenodesis technique allows the surgeon the opportunity to test tension of the fixation prior to final fixation. See the In the Loop section for more information.
Q : What technical pearls would you offer your colleagues regarding the use of the tenodesis technique for foot and ankle reconstruction and does the stronger fixation principle lend to a more fuctional rehabilition program?
A : It is important to become familiar with the instrumentation and method for utilizing it prior to getting into O.R. Proper sizing of the graft and screw is important for rigid fixation. Such fixational recovery.
Q : What role do suture anchors play in foot and ankle surgery versus the tenodesis technique?
A : Certain situations such as acute ligament avulsion directly from bone lend themselves to easier fixation with suture anchors.