The Plantaris Tendon in Surgery: A Scoping Review of Reconstructive Roles Beyond Orthopedics.

INTRODUCTION

The plantaris tendon, a slender and often vestigial structure of the posterior leg, has long been recognized in orthopedic surgery for its favorable properties as an autograft. However, its role beyond musculoskeletal applications remains under characterized. This scoping review synthesizes the existing literature on the surgical use of the plantaris tendon in nonorthopedic procedures, highlighting patterns, outcomes, and evidence gaps across clinical specialties.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, a systematic search of PubMed, Scopus, and Embase was conducted from inception through final search date. Studies were eligible if they described nonorthopedic surgical applications of the plantaris tendon or muscle and reported procedural detail or outcomes. Data were extracted using a standardized charting form and summarized narratively by surgical domain.

RESULTS

Ten studies met inclusion criteria, encompassing facial reanimation, ophthalmic surgery, hand reconstruction, cardiac valve repair, visceral grafting, and cadaveric feasibility assessments. The most common use was static suspension for facial paralysis, with 55 patients undergoing tendon sling procedures and reporting improved symmetry and oral competence. In comparative studies, plantaris tendon grafts showed superior lip excursion versus alternative techniques. Experimental data supported tendon viability for esophageal grafting and cardiac repair. Across studies, the plantaris was favored for its length, tensile strength, and low donor site morbidity. Outcome reporting varied and was most robust in facial applications.

CONCLUSIONS

The plantaris tendon demonstrates promising versatility in reconstructive and experimental surgery beyond orthopedics. Despite encouraging results, the literature remains sparse and heterogeneous. Broader adoption may benefit from greater anatomical familiarity, standardized outcomes, and further comparative studies.