open access
Surface localisation of master knot of Henry, in situ and ex vivo length of flexor hallucis longus tendon: pertinent data for tendon harvesting and transfer
Affiliations- PhD Candidate, Medical Science Programme, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
- Faculty of Physical Therapy, Huachiew Chalermprakiet University, Samutprakan, Thailand
- Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
open access
Abstract
Background: Length of flexor hallucis longus (FHL), localisation of master knot of Henry (MKH) and relationship between MKH and neurovascular bundle are essential for the achievement of FHL tendon transfer. The purpose of this study is to define the localisation of MKH in reference to bony landmarks of the foot, its relationship to plantar neurovascular bundle and to investigate in situ and ex vivo length of FHL tendon in single incision, double incision and minimally invasive techniques. Materials and methods: Foot length was examined in 62 feet of 31 soft cadavers (9 males, 22 females). Various parameters including the relationship between MKH and neurovascular bundle, the distances from MKH to medial malleolus (MM), navicular tuberosity (NT) and the first interphalangeal joint of great toe (IP) were measured. Surface localisation of MKH in relation to a line joining the medial end of plantar flexion crease at the base of great toes (MC) to NT (MC-NT line) was determined. Lengths of FHL tendon graft from three surgical techniques were examined. In situ length was measured in the plantar surface of foot and ex vivo length was measured after tendon was cut from its insertion. Results: The mean length of foot was 230.98 ± 15.35 mm with a statistically significant difference between genders in both sides (p < 0.05). No distance was found between medial plantar neurovascular bundle (MPNVB) and MKH. Mean distance of 17.13 ± 3.55 mm was found between lateral plantar neurovascular bundle (LPNVB) and MKH. MKH was located at a mean distance of 117.11 ± 1.00 mm proximal to IP, 26.28 ± 4.75 mm under NT and 59.58 ± 7.51 mm distal to MM with a statistically significant difference of MKH-IP distance between genders in both sides and MKH-NT in right side. MKH was located anterior to NT (66.1%), at NT (27.4%) and posterior to NT (6.5%) on the MC-NT line. Surface localisation of MKH was 94.75 ± 8.43% of MC-NT line from MC with a perpendicular distance of 25.11 ± 5.37 mm below MC-NT line. The in situ and ex vivo tendon lengths from MTJ to ST, to MKH and to IP were 39.05 ± 10.88 mm and 34.43 ± 10.23 mm, 73.45 ± 9.91 mm and 68.63 ± 9.43 mm, 197.98 ± 13.89 and 191.79 ± 14.00 mm, respectively. A statistically significant difference between genders was found in MTJ-IP of in situ and ex vivo length of both sides (p < 0.05). The mean length of tendon between in situ and ex vivo was significantly different in all techniques (p < 0.05). A moderate positive correlation between foot length and tendon length was found in MTJ-IP of both in situ and ex vivo tendon length. Conclusions: A statistically significant difference between in situ and ex vivo tendon length was shown in all harvesting techniques. Surface location of MKH was approximately at 95% of MC-NT line from MC with a perpendicular distance of 25 mm from MC-NT line.
Abstract
Background: Length of flexor hallucis longus (FHL), localisation of master knot of Henry (MKH) and relationship between MKH and neurovascular bundle are essential for the achievement of FHL tendon transfer. The purpose of this study is to define the localisation of MKH in reference to bony landmarks of the foot, its relationship to plantar neurovascular bundle and to investigate in situ and ex vivo length of FHL tendon in single incision, double incision and minimally invasive techniques. Materials and methods: Foot length was examined in 62 feet of 31 soft cadavers (9 males, 22 females). Various parameters including the relationship between MKH and neurovascular bundle, the distances from MKH to medial malleolus (MM), navicular tuberosity (NT) and the first interphalangeal joint of great toe (IP) were measured. Surface localisation of MKH in relation to a line joining the medial end of plantar flexion crease at the base of great toes (MC) to NT (MC-NT line) was determined. Lengths of FHL tendon graft from three surgical techniques were examined. In situ length was measured in the plantar surface of foot and ex vivo length was measured after tendon was cut from its insertion. Results: The mean length of foot was 230.98 ± 15.35 mm with a statistically significant difference between genders in both sides (p < 0.05). No distance was found between medial plantar neurovascular bundle (MPNVB) and MKH. Mean distance of 17.13 ± 3.55 mm was found between lateral plantar neurovascular bundle (LPNVB) and MKH. MKH was located at a mean distance of 117.11 ± 1.00 mm proximal to IP, 26.28 ± 4.75 mm under NT and 59.58 ± 7.51 mm distal to MM with a statistically significant difference of MKH-IP distance between genders in both sides and MKH-NT in right side. MKH was located anterior to NT (66.1%), at NT (27.4%) and posterior to NT (6.5%) on the MC-NT line. Surface localisation of MKH was 94.75 ± 8.43% of MC-NT line from MC with a perpendicular distance of 25.11 ± 5.37 mm below MC-NT line. The in situ and ex vivo tendon lengths from MTJ to ST, to MKH and to IP were 39.05 ± 10.88 mm and 34.43 ± 10.23 mm, 73.45 ± 9.91 mm and 68.63 ± 9.43 mm, 197.98 ± 13.89 and 191.79 ± 14.00 mm, respectively. A statistically significant difference between genders was found in MTJ-IP of in situ and ex vivo length of both sides (p < 0.05). The mean length of tendon between in situ and ex vivo was significantly different in all techniques (p < 0.05). A moderate positive correlation between foot length and tendon length was found in MTJ-IP of both in situ and ex vivo tendon length. Conclusions: A statistically significant difference between in situ and ex vivo tendon length was shown in all harvesting techniques. Surface location of MKH was approximately at 95% of MC-NT line from MC with a perpendicular distance of 25 mm from MC-NT line.
Keywords
flexor hallucis longus, master knot of Henry, tendon transfer
About this articleTitle
Surface localisation of master knot of Henry, in situ and ex vivo length of flexor hallucis longus tendon: pertinent data for tendon harvesting and transfer
Journal
Issue
Article type
Original article
Pages
415-424
Published online
2020-04-10
Page views
1132
Article views/downloads
2410
DOI
Pubmed
Bibliographic record
Folia Morphol 2021;80(2):415-424.
Keywords
flexor hallucis longus
master knot of Henry
tendon transfer
Authors
P. Wan-ae-loh
P. Danginthawat
T. Huanmanop
S. Agthong
V. Chentanez
References (32)- Alhaug OK, Berdal G, Husebye EE, et al. Flexor hallucis longus tendon transfer for chronic Achilles tendon rupture. A retrospective study. Foot Ankle Surg. 2019; 25(5): 630–635.
- Beger O, Elvan Ö, Keskinbora M, et al. Anatomy of Master Knot of Henry: A morphometric study on cadavers. Acta Orthop Traumatol Turc. 2018; 52(2): 134–142.
- Chaiwanichsiri D, Tantisiriwat N, Janchai S. Proper shoe sizes for Thai elderly. Foot (Edinb). 2008; 18(4): 186–191.
- Coughlin MJ, Saltzman CL, Anderson RB. Mann's surgery of the foot and ankle. 9th ed. Elsevier Inc., Philadelphia 2014: 1617–1620.
- Donovan A, Rosenberg ZS, Bencardino JT, et al. Plantar tendons of the foot: MR imaging and US. Radiographics. 2013; 33(7): 2065–2085.
- Hahn F, Meyer P, Maiwald C, et al. Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings. Foot Ankle Int. 2008; 29(8): 794–802.
- Herbst SA, Miller SD. Transection of the medial plantar nerve and hallux cock-up deformity after flexor hallucis longus tendon transfer for Achilles tendinitis: case report. Foot Ankle Int. 2006; 27(8): 639–641.
- Hockenbury R, Sammarco G. Medial sliding calcaneal osteotomy with flexor hallucis longus transfer for the treatment of posterior tibial tendon insufficiency. Foot and Ankle Clinics. 2001; 6(3): 569–581.
- Jurca A, Žabkar J, Džeroski S. Analysis of 1.2 million foot scans from North America, Europe and Asia. Sci Rep. 2019; 9(1): 19155.
- Kouchi M. Foot dimensions and foot shape: differences due to growth,generation and ethnic origin. Anthropol Sci. 1998; 106(Suppl.): 161–188.
- Lake JE, Ishikawa SN. Conservative treatment of Achilles tendinopathy: emerging techniques. Foot Ankle Clin. 2009; 14(4): 663–674.
- Lopez RG, Jung HG. Achilles tendinosis: treatment options. Clin Orthop Surg. 2015; 7(1): 1–7.
- Mao H, Shi Z, Wapner KL, et al. Anatomical study for flexor hallucis longus tendon transfer in treatment of Achilles tendinopathy. Surg Radiol Anat. 2015; 37(6): 639–647.
- Mao H, Dong W, Shi Z, et al. Anatomical study of the neurovascular in flexor hallucis longus tendon transfers. Sci Rep. 2017; 7(1): 14202.
- Mauch M, Grau S, Krauss I, et al. A new approach to children's footwear based on foot type classification. Ergonomics. 2009; 52(8): 999–1008.
- Mulier T, Rummens E, Dereymaeker G. Risk of neurovascular injuries in flexor hallucis longus tendon transfers: an anatomic cadaver study. Foot Ankle Int. 2007; 28(8): 910–915.
- Murphy RL, Womack JW, Anderson T. Technique tip: a new technique for harvest of the flexor hallucis longus tendon. Foot Ankle Int. 2010; 31(5): 457–459.
- Myerson MS, Corrigan J. Treatment of posterior tibial tendon dysfunction with flexor digitorum longus tendon transfer and calcaneal osteotomy. Orthopedics. 1996; 19(5): 383–388.
- O'Sullivan E, Carare-Nnadi R, Greenslade J, et al. Clinical significance of variations in the interconnections between flexor digitorum longus and flexor hallucis longus in the region of the knot of Henry. Clin Anat. 2005; 18(2): 121–125.
- Pichler W, Tesch NP, Grechenig W, et al. Anatomical variations of the flexor hallucis longus muscle and the consequences for tendon transfer. A cadaver study. Surg Radiol Anat. 2005; 27(3): 227–231.
- Razeghi M, Batt M. Foot type classification: a critical review of current methods. Gait Posture. 2002; 15(3): 282–291.
- Romphothonga M, Traithepchanapai P. Sex determination through anthropometry of hand and foot in Thais. Chula Med J. 2019; 63(1): 47–55.
- Sangchay N. The soft cadaver (thiel’s method) : the new type of cadaver of department of anatomy, siriraj hospital. Siriraj Med J. 2014; 66(Suppl): S228–S231.
- Shu Y, Mei Q, Fernandez J, et al. Foot morphological difference between habitually shod and unshod runners. PLoS One. 2015; 10(7): e0131385.
- Sigvard T, Hansen J. Functional reconstruction of the foot and ankle. Lippincott Williams & Wilkins, a Wolters Kluwer Business, Philadelphia 2000: 422–429.
- Suttinark P, Suebpongsiri P. Clinical outcomes of flexor hallucis longus transfer for the treatment of Achilles tendinosis rupture. J Med Assoc Thai. 2009; 92 Suppl 6: S226–S231.
- Tashjian RZ, Hur J, Sullivan RJ, et al. Flexor hallucis longus transfer for repair of chronic achilles tendinopathy. Foot Ankle Int. 2003; 24(9): 673–676.
- Vasudha TK, Vani PC, Sankaranarayanan G, et al. Communications between the tendons of flexor hallucis longus and flexor digitorum longus: a cadaveric study. Surg Radiol Anat. 2019; 41(12): 1411–1419.
- Wapner KL, Pavlock GS, Hecht PJ, et al. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle. 1993; 14(8): 443–449.
- Williams D, McClay I. Measurements used to characterize the foot and the medial longitudinal arch: reliability and validity. Physl Ther. 2000; 80(9): 864–871.
- Wong CK, Weil R, de Boer E. Standardizing foot-type classification using arch index values. Physiother Can. 2012; 64(3): 280–283.
- Wulker N, Stephens MM, Cracchiolo A. An atlas of foot and ankle surgery. 2nd ed. Talor & Francis, London 2005: 377–386.
