Modified Putti Procedure for the Surgical Management of Patients with Adult Acquired Cavo-Varus Resulting from Peroneal Tendon Rupture
- Peroneal Rupture, Cavovarus; tendon transfer; Posterior Tibial Transfer; Acquired Cavovarus; Putti
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Background: Peroneal pathology, including trauma, can result in Cavovarus-Drop Foot type deformity, precluding patients from functioning in or attempting bracing. Lateral ankle stabilization and other associated procedures sometimes are not enough to address the resultant deformity, thus many CavoVarus-Dropfoot patients still have gait abnormalities, function minimally in a brace and still have secondary ambulatory pain and loss of function even when braced. We review the results of 9 patients meeting this criteria and electing for a Modified Putti Procedure and lower extremity reconstruction.
Materials and Methods: The charts of 9 patients with adult-acquired CavoVarus deformity foot type after peroneal rupture were reviewed, all but 1 had failed previous AFO/bracing. These patients underwent surgical correction all consisting of the Modified Putti procedure, along with other ancillary procedures and the results and outcomes were collected. Additionally, surgical technique was documented.
Results: The mean VAS score improved from 9.1 to 2.4 pre- and post-operatively, respectively. The average time to weight bearing was 7.2 weeks. Four of 9 (44.44%) patients experienced some form of complication. Eight of 9 (88.88%) patients relayed the surgery was a success and would opt to undergo it again, given the choice.
Conclusion: The Modified Putti Procedure showed promising results, great patient satisfaction and marked improvement in pre-operative and post-operative pain rating. This technique, utilized after severe peroneal trauma and resultant deformity is present, is a considerable option to have in the foot and ankle surgeon’s armament.
- Brodsky JW, Zide JR, Kane JM. Acute Peroneal Injury. Foot Ankle Clin. 2017;22(4):833?841. doi:10.1016/j.fcl.2017.07.013
- DiGiovanni BF, Fraga CJ, Cohen BE, et al. As-sociated injuries found in chronic lateral ankle in-stability. Foot Ankle Int. 21(10):809-815, 2000.
- Redfern D, Myerson M. The management of concomitant tears of the peroneus longus and brevis tendons. Foot Ankle Int. 2004;25(10):695?707. doi:10.1177/107110070402501002
- Stamatis ED, Karaoglanis GC. Salvage options for peroneal tendon ruptures. Foot Ankle Clin. 2014;19(1):87?95. doi:10.1016/j.fcl.2013.10.006
- Ryssman DB, Myerson MS. Tendon transfers for the adult flexible cavovarus foot. Foot Ankle Clin. 2011;16(3):435–450. doi:10.1016/j.fcl.2011.08.001
- Anderson JJ, Grzywa S, Keeter E, Peresko GP, Anderson BL. Re-routing the Posterior Tibial Tendon and Transfer to Dorsal-Lateral Foot: Treatment for Post-Spinal Surgery Patients with Adult Acquired Cavo-Varus Foot with Out of Phase Tendon Transfer (Modified Putti Proce-dure). EC Orthopaedics 11.8 (2020): 62-71
- Maskill MP, Maskill JD, Pomeroy GC. Surgical management and treatment algorithm for the subtle cavovarus foot. Foot Ankle Int. 2010; 31(12):1057?1063. doi:10.3113/FAI.2010.1057
- Mayer L. The physiologic method of tendon transplantation. I. Historical, anatomy and physi-ology of tendons. Surg Gynecol Obstet. 1916;22.
- Watkins MB, Jones JB, Ryder CT Jr, et al. Transplantation of the posterior tibial tendon. J Bone Joint Surg. 1954;36A:1181-9.
- Hsu J, Hoffer M. Posterior tibial tendon transfer anteriorly through the interosseous membrane: a modification of the technique. Clin Orthop Relat Res. 1978:131:202-4.
- Wagner E, Wagner P, Zanolli D, Radkievich R, Redenz G, Guzman R. Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot. Foot Ankle Int. 2018;39(7):843–849. doi:10.1177/1071100718760845
- Shah RK. Tibialis posterior transfer by interos-seous route for the correction of foot drop in leprosy. Int Orthop. 2009;33(6):1637?1640. doi:10.1007/ s00264-008-0704-y
- Soares D. Tibialis posterior transfer for the cor-rection of foot drop in leprosy. Long-term out-come. J Bone Joint Surg Br. 1996;78(1):61?62.
- Wagenaar FC, Louwerens JW. Posterior tibial tendon transfer: results of fixation to the dorsiflexors proximal to the ankle joint. Foot Ankle Int. 2007;28(11):1128?1142. doi:10.3113/ FAI.2007.1128
- Drakos MC, Gott M, Karnovsky SC, et al. Bio-mechanical Analysis of Suture Anchor vs Te-nodesis Screw for FHL Transfer. Foot Ankle Int. 2017;38(7):797?801. doi:10.1177/10711007177 02848