Equinovarus of the foot is the most common lower extremity deformity following traumatic brain injury. We evaluated outcomes
of the split anterior tibialis tendon transfer (SPLATT) for correction of equinovarus in 47 patients with hemiplegic traumatic
brain injury and specifically studied differences in outcomes with two tendon fixation techniques. Seventeen patients constituting
Group I underwent fixation with one technique and 30 constituting Group II had another technique. Patients in both groups
had appropriate procedures based on dynamic electromyography and gait analyses. Both groups were demographically comparable.
All 47 feet were corrected to plantigrade position. Thirty-six of 47 patients became brace-free at final followup. There was
a notable decrease in the use of ambulatory aids and ambulatory status improved in both groups. There were three fixation-related
complications in Group I and none in Group II. Surgical correction of the spastic equinovarus with SPLATT, in the appropriate
patient, with or without associated tendon procedures helps to achieve and maintain correction, improves the ambulatory status
of the patient, and eliminates the need for bracing in as much as 77% of patients. We recommend the Group II construct owing
to the considerably lower complication rate.
Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Each author certifies that his or her institution has approved the reporting of these cases, and that all investigations were
conducted in conformity with ethical principles of research.