Tibialis Anterior and The Bridle Procedure




Cronk, Jacob
Fisher, Cara


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Background: The Bridle procedure is a surgical intervention for the treatment of foot drop due to common fibular nerve damage. It involves the transfer of the tibialis posterior tendon through the interosseus membrane and anastomosis to the tendons of the tibialis anterior and fibularis longus muscles. Case Information: A 54-year-old Caucasian male cadaver presented with abnormal anatomy of the tibialis anterior muscle. Dissection revealed a bifurcation of the tibialis anterior tendon at the level of the superior extensor retinaculum with one part of the tendon continuing to its normal insertion on the medial cuneiform and 1st metatarsal and the other part inserting on the lateral aspect of the cuboid. Further dissection revealed sutures at the point of insertion on the cuboid indicating that surgical fixation had been performed and that this was not an anatomical variation. It was subsequently identified as a "Bridle procedure." Atypically, both tibialis posterior and fibularis longus tendons remained attached to their typical insertions, while the tibialis anterior tendon was split longitudinally. The free part of the tibialis anterior was fixed to the cuboid rather than joined with the fibularis longus tendon. The authors suspect a modified version of the Bridle procedure, but identifying the specific name may be difficult given a limited medical history. Conclusions: This cadaveric case study illustrates a unique presentation of the reconstructed anatomy of a surgical procedure used in the treatment of foot drop or steppage gait pathologies.