Anatomical and biomechanical characteristics of plantaris tendon and its application in ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHONG Shijiang ¹ , XU Guijun ² ,  ZHAO Jiaguo ³

1. Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P. R. China;
2. Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P. R. China;
3. Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, P. R. China;

Corresponding author：

ZHAO Jiaguo, Email: orthopaedic@163.com

Keywords：

Plantaris tendon; ligament reconstruction; autologous; biomechanics; applied anatomy

DOI：

10.7507/1002-1892.202311032

Video：

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Objective To improve the clinical utility of the plantaris tendon mainly by summarizing its anatomical characteristics, biomechanical properties, harvesting methods, and its applications in ligament reconstruction. Methods The relevant literature from domestic and international databases regarding the anatomical and biomechanical characteristics of the plantaris tendon and its applications in ligament reconstruction was comprehensively reviewed and systematically summarized. Results The plantaris tendons have an absence. The majority of plantaris tendon forms a fan-shape on the anterior and medial sides of the Achilles tendon and terminates at the calcaneal tuberosity. There are significant differences in biomechanical parameters between plantaris tendon with different numbers of strands, and multi strand plantaris tendon have significant advantages over single strand tendon. The plantaris tendon can be harvested through proximal and distal approaches, and it is necessary to ensure that there are no obvious anatomical variations or adhesions in the surrounding area before harvesting. The plantaris tendon is commonly utilized in ligament reconstruction around the ankle joint or suture reinforcement for Achilles tendon rupture, with satisfactory effectiveness. There is limited research on the use of plantar tendon in the reconstruction of upper limb and knee joint ligaments. Conclusion The plantaris tendon is relatively superficial, easy to be harvested, and has less impact on local function. The plantaris tendon is commonly utilized in ligaments reconstruction around the ankle joint or suture reinforcement for Achilles tendon rupture. The study on the plantaris tendon for upper limbs and knee joints ligament reconstruction is rarely and require further research.

Citation： ZHONG Shijiang, XU Guijun, ZHAO Jiaguo. Anatomical and biomechanical characteristics of plantaris tendon and its application in ligament reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(2): 234-239. doi: 10.7507/1002-1892.202311032 Copy

1.	Annamalai A, Iwanaga J, Olewnik Ł, et al. Simultaneous duplication of the tendon of plantaris with multiple tendinous connections into the crural fascia. Morphologie, 2021, 105(350): 247-251.
2.	Kurtys K, Gonera B, Olewnik Ł, et al. A highly complex variant of the plantaris tendon insertion and its potential clinical relevance. Anat Sci Int, 2020, 95(4): 553-558.
3.	Olewnik Ł, Wysiadecki G, Polguj M, et al. Anatomic study suggests that the morphology of the plantaris tendon may be related to Achilles tendonitis. Surg Radiol Anat, 2017, 39(1): 69-75.
4.	Smędra A, Olewnik Ł, Łabętowicz P, et al. A bifurcated plantaris muscle: another confirmation of its high morphological variability? Another type of plantaris muscle. Folia Morphol (Warsz), 2021, 80(3): 739-744.
5.	Meyer P, Pesquer L, Boudahmane S, et al. Evaluation of the plantaris tendon: cadaver anatomy study with ultrasonographic and clinical correlation with tennis leg injury in 759 calves. Skeletal Radiol, 2022, 51(9): 1797-1806.
6.	Spang C, Alfredson H, Docking SI, et al. The plantaris tendon: a narrative review focusing on anatomical features and clinical importance. Bone Joint J, 2016, 98-B(10): 1312-1319.
7.	Yammine K, Saghie S, Assi C. A meta-analysis of the surgical availability and morphology of the plantaris tendon. J Hand Surg (Asian Pac Vol), 2019, 24(2): 208-218.
8.	Shiva B, Rai R, Agarwal P, et al. Assessment of prevalence and morphology of plantaris tendon in Indian population by ultrasound. J Orthop, 2022, 35: 107-110.
9.	马双陶, 陈卫军, 王文生, 等. 跖肌腱移植的应用解剖. 中国临床解剖学杂志, 2007, 25(3): 262-265.
10.	Dos Santos MA, Bertelli JA, Kechele PR, et al. Anatomical study of the plantaris tendon: reliability as a tendo-osseous graft. Surg Radiol Anat, 2009, 31(1): 59-61.
11.	Dittmar JP, Schmiedl A, Bingöl A, et al. The use of plantaris muscle flap for facial reanimation: a comprehensive anatomical study. Facial Plast Surg Aesthet Med, 2023, 25(5): 431-437.
12.	Park J, Park KR, Kwon HW, et al. Evaluating the suitability of the plantaris tendon for sports trauma reconstruction and a predictive model of tendon length based on height and leg length. J Clin Med, 2023, 12(21): 6932.
13.	Daseler EH, Anson BJ. The plantaris muscle: an anatomical study of 750 specimens. J Bone Joint Surg, 1943, 25(4): 822-827.
14.	van Sterkenburg MN, Kerkhoffs GM, Kleipool RP, et al. The plantaris tendon and a potential role in mid-portion Achilles tendinopathy: an observational anatomical study. J Anat, 2011, 218(3): 336-341.
15.	Olewnik Ł, Wysiadecki G, Podgórski M, et al. The plantaris muscle tendon and its relationship with the achilles tendinopathy. Biomed Res Int, 2018, 31: 9623579.
16.	Park JH, Cho J, Kim D, et al. Anatomical classification for plantaris tendon insertion and its clinical implications: a cadaveric study. Int J Environ Res Public Health, 2022, 19(10): 5795.
17.	马双陶, 陈卫军. 人跖肌腱的力学性质测试与组织学观察. 第三军医大学学报, 2007, 29(19): 1889-1891.
18.	Jackson JB, Philippi MT, Kolz CW, et al. Characterization of plantaris tendon constructs for ankle ligament reconstruction. Foot Ankle Int, 2014, 35(9): 922-928.
19.	Vlaic J, Josipovic M, Bohacek I, et al. Plantaris tendon is valuable graft for the medial patellofemoral ligament reconstruction: A biomechanical study. Knee, 2022, 38: 212-219.
20.	Arendt EA. Anatomy and biomechanics of the patellar ligaments. Tecniche Chirurgiche in Ortopedia E Traumatologia, 2007, 5: 13-18.
21.	Atkinson P, Atkinson T, Huang C, et al. A comparison of the mechanical and dimensional properties of the human medial and lateral patellofemoral ligaments. Trans Orthop Res Soc, 2000, 46: 0776. http://works.bepress.com/theresa-atkinson/63/.
22.	Mountney J, Senavongse W, Amis AA, et al. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg (Br), 2005, 87(1): 36-40.
23.	He W, Yang YM, Liu M, et al. Reconstruction of the medial patellofemoral ligament using hamstring tendon graft with different methods: a biomechanical study. Chin Med Sci J, 2013, 28(4): 201-205.
24.	Herbort M, Hoser C, Domnick C, et al. MPFL reconstruction using a quadriceps tendon graft: part 1: biomechanical properties of quadriceps tendon MPFL reconstruction in comparison to the Intact MPFL. A human cadaveric study. Knee, 2014, 21(6): 1169-1174.
25.	Criscenti G, De Maria C, Sebastiani E, et al. Material and structural tensile properties of the human medial patello-femoral ligament. J Mech Behav Biomed Mater, 2016, 54: 141-148.
26.	Hinckel BB, Gobbi RG, Demange MK, et al. Medial patellofemoral ligament, medial patellotibial ligament, and medial patellomeniscal ligament: anatomic, histologic, radiographic, and biomechanical study. Arthroscopy, 2017, 33(10): 1862-1873.
27.	LaPrade MD, Kallenbach SL, Aman ZS, et al. Biomechanical evaluation of the medial stabilizers of the patella. Am J Sports Med, 2018, 46(7): 1575-1582.
28.	Huber C, Zhang Q, Taylor WR, et al. Properties and function of the medial patellofemoral ligament: a systematic review. Am J Sports Med, 2020, 48(3): 754-766.
29.	Bohnsack M, Sürie B, Kirsch IL, et al. Biomechanical properties of commonly used autogenous transplants in the surgical treatment of chronic lateral ankle instability. Foot Ankle Int, 2002, 23(7): 661-664.
30.	Zwirner J, Koutp A, Vidakovic H, et al. Assessment of plantaris and peroneus tertius tendons as graft materials for ankle ligament reconstructions—A cadaveric biomechanical study. J Mech Behav Biomed Mater, 2021, 115: 104244.
31.	Pagenstert G, Valderrabano V, Hintermann B. Lateral ankle ligament reconstruction with free plantaris tendon graft. Techniques in Foot & Ankle Surgery, 2005, 4(2): 104-112.
32.	De Vries J, Struijs PA, Raaymakers EL, et al. Long-term results of the Weber operation for chronic ankle instability: 37 patients followed for 20-30 years. Acta Orthop, 2005, 76(6): 891-898.
33.	Egan KG, Emanuelli E, Przylecki W, et al. Variant plantaris anatomy during tendon harvest. J Hand Surg (Am), 2021, 46(5): 431.e1-431.e4.
34.	Morrison WA, Schlicht SM. The plantaris tendon as a tendo-osseous graft. Part Ⅱ. Clinical studies. J Hand Surg (Br), 1992, 17(4): 471-475.
35.	Bertelli JA, Santos MA, Kechele PR, et al. Flexor tendon grafting using a plantaris tendon with a fragment of attached bone for fixation to the distal phalanx: a preliminary cohort study. J Hand Surg (Am), 2007, 32(10): 1543-1548.
36.	Azar FM, Andrews JR, Wilk KE, et al. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med, 2000, 28(1): 16-23.
37.	Hechtman KS, Zvijac JE, Wells ME, et al. Long-term results of ulnar collateral ligament reconstruction in throwing athletes based on a hybrid technique. Am J Sports Med, 2011, 39(2): 342-347.
38.	贾志科, 郭银吉, 尹二成. 跖肌腱重建喙锁韧带联合钩钢板治疗肩锁关节脱位的效果观察. 实用临床医药杂志, 2020, 24(13): 41-43.
39.	Seok HG, Park SG. Radiologic and clinical outcomes of an arthroscopic bridging graft for irreparable rotator cuff tears with a modified MasonAllen stitch using a plantaris tendon autograft: a case series with minimum 2-year outcomes. Clin Shoulder Elb, 2023, 26(4): 406-415.
40.	Josipović M, Vlaić J, Serdar J, et al. Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures. Knee Surg Sports Traumatol Arthrosc, 2020, 28(8): 2604-2608.
41.	Tsuha Y, Oshiro H, Mizuta K, et al. Reconstruction of the lateral collateral ligament using the plantaris tendon after wide excision of soft tissue sarcoma of the knee: A case report. Mol Clin Oncol, 2023, 18(3): 23.
42.	Nordenholm A, Senorski EH, Westin O, et al. Surgical treatment of chronic Achilles tendon rupture results in improved gait biomechanics. J Orthop Surg Res, 2022, 17(1): 67.
43.	潘哲尔, 顾湘杰, 黄加张, 等. 跖肌腱扇形膜片和腓肠肌腱瓣V-Y成形术治疗陈旧性跟腱断裂. 骨与关节损伤杂志, 2004, 19(12): 815-817.
44.	Toker S, Kilincoglu V, Yurtgun MF. Repairing an achilles tendon rupture using the partial lindholm technique augmented by the plantaris tendon: a case report. Eurasian J Med, 2008, 40(3): 148-150.
45.	周祖忠, 赵伟明, 赵萌, 等. 跖肌腱转位编织缝合联合Lindholm法治疗陈旧性跟腱断裂疗效分析. 中国骨与关节损伤杂志, 2015, 30(4): 436-437.
46.	Sadek AF, Fouly EH, Laklok MA, et al. Functional and MRI follow-up after reconstruction of chronic ruptures of the Achilles tendon Myerson type III using the triple-loop plantaris tendon wrapped with central turndown flap: a case series. J Orthop Surg Res, 2015, 10: 109.
47.	黄敬文, 王涛, 马冠医, 等. 自体跖肌腱编织缝合法修复跟腱损伤的临床观察. 世界最新医学信息文摘, 2019, 19(60): 63-64.
48.	Anderson ME. Reconstruction of the lateral ligaments of the ankle using the plantaris tendon. J Bone Joint Surg (Am), 1985, 67(6): 930-934.
49.	Lopes R, Andrieu M, Molinier F, et al. PT4: New arthroscopic technique for isolated reconstruction of the anterior talofibular ligament using a quadrupled plantaris tendon. Orthop Traumatol Surg Res, 2021, 107(6): 102995.
50.	Hansen BH. Reconstruction of the peroneal retinaculum using the plantaris tendon: a case report. Scand J Med Sci Sports, 1996, 6(6): 355-358.
51.	张功林, 甄平, 陈克明, 等. 应用跖肌腱转移治疗腓骨肌腱滑脱症. 生物骨科材料与临床研究, 2015, 12(4): 8-10.
52.	Boyer MI, Bowen V, Weiler P. Reconstruction of a severe grinding injury to the medial malleolus and the deltoid ligament of the ankle using a free plantaris tendon graft and vascularized gracilis free muscle transfer: case report. J Trauma, 1994, 36(3): 454-457.
53.	Anastasopoulos N, Paraskevas G, Lazaridis N, et al. Reconstruction of neglected flexor hallucis longus tendon rupture: a case report. J Foot Ankle Surg, 2018, 57(6): 1256-1258.

1. Annamalai A, Iwanaga J, Olewnik Ł, et al. Simultaneous duplication of the tendon of plantaris with multiple tendinous connections into the crural fascia. Morphologie, 2021, 105(350): 247-251.
2. Kurtys K, Gonera B, Olewnik Ł, et al. A highly complex variant of the plantaris tendon insertion and its potential clinical relevance. Anat Sci Int, 2020, 95(4): 553-558.
3. Olewnik Ł, Wysiadecki G, Polguj M, et al. Anatomic study suggests that the morphology of the plantaris tendon may be related to Achilles tendonitis. Surg Radiol Anat, 2017, 39(1): 69-75.
4. Smędra A, Olewnik Ł, Łabętowicz P, et al. A bifurcated plantaris muscle: another confirmation of its high morphological variability? Another type of plantaris muscle. Folia Morphol (Warsz), 2021, 80(3): 739-744.
5. Meyer P, Pesquer L, Boudahmane S, et al. Evaluation of the plantaris tendon: cadaver anatomy study with ultrasonographic and clinical correlation with tennis leg injury in 759 calves. Skeletal Radiol, 2022, 51(9): 1797-1806.
6. Spang C, Alfredson H, Docking SI, et al. The plantaris tendon: a narrative review focusing on anatomical features and clinical importance. Bone Joint J, 2016, 98-B(10): 1312-1319.
7. Yammine K, Saghie S, Assi C. A meta-analysis of the surgical availability and morphology of the plantaris tendon. J Hand Surg (Asian Pac Vol), 2019, 24(2): 208-218.
8. Shiva B, Rai R, Agarwal P, et al. Assessment of prevalence and morphology of plantaris tendon in Indian population by ultrasound. J Orthop, 2022, 35: 107-110.
9. 马双陶, 陈卫军, 王文生, 等. 跖肌腱移植的应用解剖. 中国临床解剖学杂志, 2007, 25(3): 262-265.
10. Dos Santos MA, Bertelli JA, Kechele PR, et al. Anatomical study of the plantaris tendon: reliability as a tendo-osseous graft. Surg Radiol Anat, 2009, 31(1): 59-61.
11. Dittmar JP, Schmiedl A, Bingöl A, et al. The use of plantaris muscle flap for facial reanimation: a comprehensive anatomical study. Facial Plast Surg Aesthet Med, 2023, 25(5): 431-437.
12. Park J, Park KR, Kwon HW, et al. Evaluating the suitability of the plantaris tendon for sports trauma reconstruction and a predictive model of tendon length based on height and leg length. J Clin Med, 2023, 12(21): 6932.
13. Daseler EH, Anson BJ. The plantaris muscle: an anatomical study of 750 specimens. J Bone Joint Surg, 1943, 25(4): 822-827.
14. van Sterkenburg MN, Kerkhoffs GM, Kleipool RP, et al. The plantaris tendon and a potential role in mid-portion Achilles tendinopathy: an observational anatomical study. J Anat, 2011, 218(3): 336-341.
15. Olewnik Ł, Wysiadecki G, Podgórski M, et al. The plantaris muscle tendon and its relationship with the achilles tendinopathy. Biomed Res Int, 2018, 31: 9623579.
16. Park JH, Cho J, Kim D, et al. Anatomical classification for plantaris tendon insertion and its clinical implications: a cadaveric study. Int J Environ Res Public Health, 2022, 19(10): 5795.
17. 马双陶, 陈卫军. 人跖肌腱的力学性质测试与组织学观察. 第三军医大学学报, 2007, 29(19): 1889-1891.
18. Jackson JB, Philippi MT, Kolz CW, et al. Characterization of plantaris tendon constructs for ankle ligament reconstruction. Foot Ankle Int, 2014, 35(9): 922-928.
19. Vlaic J, Josipovic M, Bohacek I, et al. Plantaris tendon is valuable graft for the medial patellofemoral ligament reconstruction: A biomechanical study. Knee, 2022, 38: 212-219.
20. Arendt EA. Anatomy and biomechanics of the patellar ligaments. Tecniche Chirurgiche in Ortopedia E Traumatologia, 2007, 5: 13-18.
21. Atkinson P, Atkinson T, Huang C, et al. A comparison of the mechanical and dimensional properties of the human medial and lateral patellofemoral ligaments. Trans Orthop Res Soc, 2000, 46: 0776. http://works.bepress.com/theresa-atkinson/63/.
22. Mountney J, Senavongse W, Amis AA, et al. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg (Br), 2005, 87(1): 36-40.
23. He W, Yang YM, Liu M, et al. Reconstruction of the medial patellofemoral ligament using hamstring tendon graft with different methods: a biomechanical study. Chin Med Sci J, 2013, 28(4): 201-205.
24. Herbort M, Hoser C, Domnick C, et al. MPFL reconstruction using a quadriceps tendon graft: part 1: biomechanical properties of quadriceps tendon MPFL reconstruction in comparison to the Intact MPFL. A human cadaveric study. Knee, 2014, 21(6): 1169-1174.
25. Criscenti G, De Maria C, Sebastiani E, et al. Material and structural tensile properties of the human medial patello-femoral ligament. J Mech Behav Biomed Mater, 2016, 54: 141-148.
26. Hinckel BB, Gobbi RG, Demange MK, et al. Medial patellofemoral ligament, medial patellotibial ligament, and medial patellomeniscal ligament: anatomic, histologic, radiographic, and biomechanical study. Arthroscopy, 2017, 33(10): 1862-1873.
27. LaPrade MD, Kallenbach SL, Aman ZS, et al. Biomechanical evaluation of the medial stabilizers of the patella. Am J Sports Med, 2018, 46(7): 1575-1582.
28. Huber C, Zhang Q, Taylor WR, et al. Properties and function of the medial patellofemoral ligament: a systematic review. Am J Sports Med, 2020, 48(3): 754-766.
29. Bohnsack M, Sürie B, Kirsch IL, et al. Biomechanical properties of commonly used autogenous transplants in the surgical treatment of chronic lateral ankle instability. Foot Ankle Int, 2002, 23(7): 661-664.
30. Zwirner J, Koutp A, Vidakovic H, et al. Assessment of plantaris and peroneus tertius tendons as graft materials for ankle ligament reconstructions—A cadaveric biomechanical study. J Mech Behav Biomed Mater, 2021, 115: 104244.
31. Pagenstert G, Valderrabano V, Hintermann B. Lateral ankle ligament reconstruction with free plantaris tendon graft. Techniques in Foot & Ankle Surgery, 2005, 4(2): 104-112.
32. De Vries J, Struijs PA, Raaymakers EL, et al. Long-term results of the Weber operation for chronic ankle instability: 37 patients followed for 20-30 years. Acta Orthop, 2005, 76(6): 891-898.
33. Egan KG, Emanuelli E, Przylecki W, et al. Variant plantaris anatomy during tendon harvest. J Hand Surg (Am), 2021, 46(5): 431.e1-431.e4.
34. Morrison WA, Schlicht SM. The plantaris tendon as a tendo-osseous graft. Part Ⅱ. Clinical studies. J Hand Surg (Br), 1992, 17(4): 471-475.
35. Bertelli JA, Santos MA, Kechele PR, et al. Flexor tendon grafting using a plantaris tendon with a fragment of attached bone for fixation to the distal phalanx: a preliminary cohort study. J Hand Surg (Am), 2007, 32(10): 1543-1548.
36. Azar FM, Andrews JR, Wilk KE, et al. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med, 2000, 28(1): 16-23.
37. Hechtman KS, Zvijac JE, Wells ME, et al. Long-term results of ulnar collateral ligament reconstruction in throwing athletes based on a hybrid technique. Am J Sports Med, 2011, 39(2): 342-347.
38. 贾志科, 郭银吉, 尹二成. 跖肌腱重建喙锁韧带联合钩钢板治疗肩锁关节脱位的效果观察. 实用临床医药杂志, 2020, 24(13): 41-43.
39. Seok HG, Park SG. Radiologic and clinical outcomes of an arthroscopic bridging graft for irreparable rotator cuff tears with a modified MasonAllen stitch using a plantaris tendon autograft: a case series with minimum 2-year outcomes. Clin Shoulder Elb, 2023, 26(4): 406-415.
40. Josipović M, Vlaić J, Serdar J, et al. Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures. Knee Surg Sports Traumatol Arthrosc, 2020, 28(8): 2604-2608.
41. Tsuha Y, Oshiro H, Mizuta K, et al. Reconstruction of the lateral collateral ligament using the plantaris tendon after wide excision of soft tissue sarcoma of the knee: A case report. Mol Clin Oncol, 2023, 18(3): 23.
42. Nordenholm A, Senorski EH, Westin O, et al. Surgical treatment of chronic Achilles tendon rupture results in improved gait biomechanics. J Orthop Surg Res, 2022, 17(1): 67.
43. 潘哲尔, 顾湘杰, 黄加张, 等. 跖肌腱扇形膜片和腓肠肌腱瓣V-Y成形术治疗陈旧性跟腱断裂. 骨与关节损伤杂志, 2004, 19(12): 815-817.
44. Toker S, Kilincoglu V, Yurtgun MF. Repairing an achilles tendon rupture using the partial lindholm technique augmented by the plantaris tendon: a case report. Eurasian J Med, 2008, 40(3): 148-150.
45. 周祖忠, 赵伟明, 赵萌, 等. 跖肌腱转位编织缝合联合Lindholm法治疗陈旧性跟腱断裂疗效分析. 中国骨与关节损伤杂志, 2015, 30(4): 436-437.
46. Sadek AF, Fouly EH, Laklok MA, et al. Functional and MRI follow-up after reconstruction of chronic ruptures of the Achilles tendon Myerson type III using the triple-loop plantaris tendon wrapped with central turndown flap: a case series. J Orthop Surg Res, 2015, 10: 109.
47. 黄敬文, 王涛, 马冠医, 等. 自体跖肌腱编织缝合法修复跟腱损伤的临床观察. 世界最新医学信息文摘, 2019, 19(60): 63-64.
48. Anderson ME. Reconstruction of the lateral ligaments of the ankle using the plantaris tendon. J Bone Joint Surg (Am), 1985, 67(6): 930-934.
49. Lopes R, Andrieu M, Molinier F, et al. PT4: New arthroscopic technique for isolated reconstruction of the anterior talofibular ligament using a quadrupled plantaris tendon. Orthop Traumatol Surg Res, 2021, 107(6): 102995.
50. Hansen BH. Reconstruction of the peroneal retinaculum using the plantaris tendon: a case report. Scand J Med Sci Sports, 1996, 6(6): 355-358.
51. 张功林, 甄平, 陈克明, 等. 应用跖肌腱转移治疗腓骨肌腱滑脱症. 生物骨科材料与临床研究, 2015, 12(4): 8-10.
52. Boyer MI, Bowen V, Weiler P. Reconstruction of a severe grinding injury to the medial malleolus and the deltoid ligament of the ankle using a free plantaris tendon graft and vascularized gracilis free muscle transfer: case report. J Trauma, 1994, 36(3): 454-457.
53. Anastasopoulos N, Paraskevas G, Lazaridis N, et al. Reconstruction of neglected flexor hallucis longus tendon rupture: a case report. J Foot Ankle Surg, 2018, 57(6): 1256-1258.

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