How to harvest the greatest length of tibialis posterior tendon for tendon transfer: A cadaveric study.

In anterior transfer of the tibialis posterior tendon, the tendon was harvested using two incisions, the first at its attachment point on the navicular bone and second on the medial side of the leg above the medial malleolus. To provide the maximum tendon length, the second incision needs to be as proximal as possible but injury to the muscle origin must be avoided. The purpose of this study is to establish the location of the second incision that yields the greatest tendon length. Forty-five unpaired embalmed cadaveric legs were dissected. Demographic data, gender, age, and side of specimen were recorded. The distance between the tip of the medial malleolus and the muscle origin was measured. Mobile tendon length, muscle origin, foot length, tibial length, and position of ankle were also noted. The mean mobile tendon length was 11.1 (range 10.7-11.4) cm and the distance between the tip of the medial malleolus and the muscle origin was 6.8 (range 6.5-7.0) cm. The mean foot length was 22.2 cm (range 21.7-22.7), tibial length was 31.5 cm (range 30.8-32.2), and muscle origin was 23.7 cm (range 21.0-26.3). The mean angle position was 46 degrees plantar flexion (range 43-49). In subgroup analysis by gender, the mobile tendon length, distance between the tip of the medial malleolus and the muscle origin, and tibial length, were significantly greater in males than females. In conclusion, for anterior transfer of the tibialis posterior tendon, an incision 7.1 cm above the medial malleolus in the male and 6.4 cm above it in the female provides the longest mobile tendon without injury to its origin. Clin. Anat. 30:1083-1086, 2017.