Early results after tibialis anterior tendon transfer for severe varus in total ankle replacement.

Abstract

Treatment of severe ankle arthritis with varus malalignment remains controversial. In 14 consecutive total ankle replacements (TAR) with tibiotalar varus malalignment of above 15 (range, 16 to 41) degrees, a complete transfer of the tibialis anterior tendon together with other soft-tissue and bony realignment measures was added to the primary procedure. After mean followup time of 33.4 (range, 21 to 49) months, only one case showed minor tibiotalar tilt in the frontal plane. The overall clinical results were good to excellent in all but two cases with an average AOFAS-score of 86.4 (range, 70 to 98) points. However, three cases of tibial nerve neuropathy due to entrapment or overtensioning were observed; one of these cases developed clinical problems with incomplete recovery. Tibialis anterior tendon transfer can be recommended in conjunction with TAR in cases of varus malalignment with severe muscular or ligamentous imbalance with neuropathy of the tibial nerve being the main complication.