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Tibialis Anterior tendon rupture

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  #1  
Old 17th July 2007, 09:23 PM
hazelnoakes hazelnoakes is offline
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Default Tibialis Anterior tendon rupture

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I'm after some info regarding Tibialis Anterior tendon rupture. A client presented 8 days after feeling something "snap" when rushing to the car. Initial x-rays taken by the hospital showed no problem. I referred back to his GP with recommendation of further scans which apparently showed the Tib Ant tendon has torn off the bone.

What is the likelyhood of surgical intervention and if so, what is the chance of a full recovery?

His GP has referred to a surgeon and his appointment is one month after initial injury - is there an urgent need to bring this appt forward?

Thea Lawson
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Old 17th July 2007, 09:38 PM
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Default Re: Tibialis Anterior tendon rupture

Quote:
Originally Posted by hazelnoakes
I'm after some info regarding Tibialis Anterior tendon rupture. A client presented 8 days after feeling something "snap" when rushing to the car. Initial x-rays taken by the hospital showed no problem. I referred back to his GP with recommendation of further scans which apparently showed the Tib Ant tendon has torn off the bone.

What is the likelyhood of surgical intervention and if so, what is the chance of a full recovery?

His GP has referred to a surgeon and his appointment is one month after initial injury - is there an urgent need to bring this appt forward?

Thea Lawson
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If it were my anterior tibial tendon that had just ruptured, I would be seeing my friendly orthopedic surgeon the same day for surgical repair. If the patient waits a month, then the tendon will be retracted into the leg and will be more difficult to reattach without a more complicated grafting procedure. Get the referral NOW!
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Old 18th July 2007, 05:06 PM
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Default Re: Tibialis Anterior tendon rupture

Will put in a few calls and see what I can wrangle! Given that it is almost 2 weeks post injury, would the tendon have already retracted fully into the leg?
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Old 18th July 2007, 05:33 PM
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Default Re: Tibialis Anterior tendon rupture

Thanks Kevin. Thea is contacting our local orthopaedic surgeon as I type this email.
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  #5  
Old 18th July 2007, 08:48 PM
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Default Re: Tibialis Anterior tendon rupture

Quote:
Originally Posted by hazelnoakes
Will put in a few calls and see what I can wrangle! Given that it is almost 2 weeks post injury, would the tendon have already retracted fully into the leg?
The tendon will be more difficult to be pulled back into anatomical position the longer the time that has elapsed from the date of rupture due to accommodative shortening of the muscle fibers/connective tissue elements of the muscle/tendon unit. Muscle-tendon units tends to shorten when not stretched regularly. Time is of the essence in this condition to allow normal restoration of anterior tibial function by surgical repair.
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Old 3rd February 2009, 02:52 PM
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Default Re: Tibialis Anterior tendon rupture

Surgical repair of acute and chronic tibialis anterior tendon ruptures.
Sammarco VJ, Sammarco GJ, Henning C, Chaim S.
J Bone Joint Surg Am. 2009 Feb;91(2):325-32.
Quote:
BACKGROUND: Rupture of the tibialis anterior tendon is an uncommon disorder that can cause a substantial functional deficit as a result of loss of ankle dorsiflexion strength. We are not aware of any reports on a large clinical series of patients undergoing surgical repair of this injury.

METHODS: Nineteen tibialis anterior tendon ruptures were surgically repaired in eighteen patients ranging in age from twenty-one to seventy-eight years. Early repair was performed for one traumatic and seven atraumatic ruptures three days to six weeks after the injury. Delayed reconstruction was performed for two traumatic and nine atraumatic ruptures that had been present for seven weeks to five years. Direct tendon repair was possible for four of the early repairs and three of the delayed reconstructions. An interpositional autogenous tendon graft was used for four early repairs and eight delayed reconstructions. Patients were reassessed clinically and with the American Orthopaedic Foot and Ankle Society hindfoot score at an average of 53.3 months after surgery.

RESULTS: The average hindfoot score improved significantly from 55.5 points preoperatively to 93.6 points postoperatively. The surgical results did not appear to vary according to patient age, sex, or medical comorbidity. Complications requiring a second surgical procedure occurred in three patients. Recovery of functional dorsiflexion and improvement in gait was noted in eighteen of the nineteen cases. Ankle dorsiflexion strength was graded clinically as 5/5 in fifteen of the nineteen cases. Three patients regained 4/5 ankle dorsiflexion strength, and one patient had 3/5 strength with a poor clinical result.

CONCLUSIONS: Surgical restoration of the function of the tibialis anterior muscle can be beneficial regardless of age, sex, medical comorbidity, or delay in diagnosis. Early surgical treatment may be less complicated than delayed treatment, and an intercalated free tendon graft and/or gastrocnemius recession may be necessary to achieve an appropriately tensioned and balanced repair.
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Old 3rd February 2009, 05:29 PM
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Default Re: Tibialis Anterior tendon rupture

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Originally Posted by Kevin Kirby View Post
If it were my anterior tibial tendon that had just ruptured, I would be seeing my friendly orthopedic surgeon the same day for surgical repair. If the patient waits a month, then the tendon will be retracted into the leg and will be more difficult to reattach without a more complicated grafting procedure. Get the referral NOW!
Eh? "Orthopedic surgeon"? What's wrong with YOUR hands Kevin? Do you not work with podiatric colleagues familiar with this surgery if you don't want to do it? I'm not having a go at you, or our orthopaedic friends, but I was just wondering why you specified an orthopaedic surgeon?
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Old 3rd February 2009, 06:06 PM
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Default Re: Tibialis Anterior tendon rupture

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Originally Posted by bob View Post
Eh? "Orthopedic surgeon"? What's wrong with YOUR hands Kevin? Do you not work with podiatric colleagues familiar with this surgery if you don't want to do it? I'm not having a go at you, or our orthopaedic friends, but I was just wondering why you specified an orthopaedic surgeon?
I have worked in a group practice with orthopedic surgeons for the past 24 years. They do excellent tendon surgery and do a lot of it. And by the way, I don't think I would want to do my OWN surgery on my own ruptured anterior tibial tendon, if I was unfortunate enough to develop this pathology.
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  #9  
Old 3rd February 2009, 06:27 PM
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Default Re: Tibialis Anterior tendon rupture

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Originally Posted by Kevin Kirby View Post
I have worked in a group practice with orthopedic surgeons for the past 24 years. They do excellent tendon surgery and do a lot of it. And by the way, I don't think I would want to do my OWN surgery on my own ruptured anterior tibial tendon, if I was unfortunate enough to develop this pathology.
Ha haa! Yes, obviously you're not going to do your own surgery, but you know what I meant. I'm sure you realised that what I was really saying is - why specify an ortho and not a pod (especially when you are a pod)? And you answered this to a point - you work in a group practice and they do most of the tendon surgery. Fair enough.
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  #10  
Old 25th February 2009, 08:59 PM
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Default Re: Tibialis Anterior tendon rupture

Over the last 9 months, I have repaired 2 acute and one old Tib Ant. rupture. In all cases the tendon had retracted under the superior extensor retinaculum. I all cases, I lengthened the tendon at the myotendinous junction from 4-12 cm. The tendon was re-attached under physiologic tension to its insertion. NWB 6 weeks, PT at 3 weeks and FWB in a AFO by 8 weeks. The AFO was DC'd after 3 months. All patients had 4+/5 strength returned, no pain and no tendon graft was used.
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Old 6th March 2009, 03:20 PM
Mareesha Mareesha is offline
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Default Re: Tibialis Anterior tendon rupture

Jeff: My orthopedic surgeon says he may have to do a graft to repair my severed ATT; would you be willing to comment on how you repaired your ruptured ATTs without grafts? thanks...
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Old 6th March 2009, 03:48 PM
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Default Re: Tibialis Anterior tendon rupture

Sure: as part of the repair, the edges of the torn tendon need to be removed/debrided to a fresh, healthy surface. If the amount of damaged tendon removed is excessive in length (>2 cm), something needs to be done to make up the missing length. I prefer to lengthen the tendon rather than sacrifice a normal tendon or use cadaver graft (dead tendon) to accomplish this task. I lengthen the anterior tibial tendon in the front of the leg near the shin bone. It is right under the skin and very easy to get at. Best of luck!!!
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Old 9th November 2009, 11:20 AM
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Default Re: Tibialis Anterior tendon rupture

I trained in the Bay area and know many of the guys there. Tom Chang is in the San Rafel area and Steve Paladino is in East Bay. Dee, every surgeon has their preference for surgical repair of a particular problem; so I can't guarantee that they would use this method. I know they are both highly compentent and very well trained and respected. So if either one recommended a graft, it will be done perfectly! Otherwise, you may be making a trip to Philly...lol...Best of Luck.

Jeff Siegel, DPM, FACFAS
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  #14  
Old 6th February 2010, 03:12 PM
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Default Re: Tibialis Anterior tendon rupture

The Operative Treatment of the Degenerative Rupture of the Anterior Tibialis Tendon.
Schneppendahl J, Gehrmann SV, Stosberg U, Regenbrecht B, Windolf J, Wild M.
Z Orthop Unfall. 2009 Nov 12. [Epub ahead of print]
Quote:
AIM: A degenerative tear of the anterior tibial tendon is a rare event compared to other tendons. The purpose of this study was to evaluate the functional results after surgical refixation.

METHOD: In a retrospective study, we report the functional outcome of five consecutive operatively treated patients suffering from a tear close to the insertion site of the anterior tibial tendon. All patients were assessed postoperatively, the AOFAS and Richter scores were obtained and the range of motion in the ankle joint was evaluated.

RESULTS: Preoperatively all patients presented with a significant walking impairment due to a reduced active dorsiflexion, so the decision for surgical refixation was made. In all cases an MRI scan was performed preoperatively. Postoperative immobilisation without weight-bearing was done for six weeks. All patients returned to their former activity level, were satisfied with the postoperative result and had a normal gait in the follow-up examination. The range of motion was equal on both sides, the median AOFAS score was 86 and the median Richter score was 90 out of 100. There were no postoperative complications.

DISCUSSION: Untreated tears of the anterior tibial tendon lead to significant impairment of the ankle joint and deformities of the foot. There is no consensus about the treatment with recommendations for operative and non-operative treatment. Various surgical procedures have been described. The surgical reconstruction of the tendon leads to a restored function of the ankle joint and allows a normal gait and is therefore desirable. Due to the loss of function and the good results after surgical treatment in our study, the non-operative treatment is not advisable.

CONCLUSION: Surgical repair of degenerative tears of the anterior tibial tendon leads to very good functional results and high patient satisfaction
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Old 13th May 2010, 07:39 AM
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Default Re: Tibialis Anterior tendon rupture

Surgical outcome following tibialis anterior tendon repair.
Ellington JK, McCormick J, Marion C, Cohen BE, Anderson RB, Davis WH, Jones CP.
Foot Ankle Int. 2010 May;31(5):412-7.
Quote:
BACKGROUND: Tibialis anterior tendon rupture is an uncommon injury that can cause significant functional deficit. Recent series have supported surgical reconstruction in younger, more active patients. We investigated our clinical outcomes of patients having undergone surgical management of tibialis anterior tendon ruptures.

MATERIALS AND METHODS: Fifteen tibialis anterior tendon ruptures in 14 patients were retrospectively reviewed after surgical management. Five had primary repair, while 10 had tendon transfers. Average age at time of surgery was 70.6 years with an average followup of 27.2 months. Patients were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) and SF-36 clinical outcome scores. Strength measurements utilizing a dynamometer and range of motion (ROM) were documented on the operative and non-operative ankles. Patient satisfaction surveys were performed.

RESULTS: Average postoperative AOFAS hindfoot score was 88.8 and SF-36 score was 76.4. There was a statistically significant difference in average dorsiflexion strength of 21.8 lbs/in(2) on the operative side and 28.8 lbs/in(2) on the non-operative limb, and in dorsiflexion ROM of patients that received a gastrocnemius recession. There was no statistically significant difference between primary tendon repair versus tendon transfer groups nor plantarflexion strength or ROM among any group. Patient surveys revealed that seven patients were completely satisfied, six had minor reservations, and one had major reservations. There were no complications.

CONCLUSION: This study supports the surgical repair or reconstruction of the tibialis anterior tendon ruptures to restore functional strength and ROM.
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Old 26th June 2010, 12:12 PM
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Default Re: Tibialis Anterior tendon rupture

The operative treatment of the degenerative rupture of the anterior tibialis tendon
Schneppendahl J, Gehrmann SV, Stosberg U, Regenbrecht B, Windolf J, Wild M.
Z Orthop Unfall. 2010 May;148(3):343-7.
Quote:
AIM: A degenerative tear of the anterior tibial tendon is a rare event compared to other tendons. The purpose of this study was to evaluate the functional results after surgical refixation.

METHOD: In a retrospective study, we report the functional outcome of five consecutive operatively treated patients suffering from a tear close to the insertion site of the anterior tibial tendon. All patients were assessed postoperatively, the AOFAS and Richter scores were obtained and the range of motion in the ankle joint was evaluated.

RESULTS: Preoperatively all patients presented with a significant walking impairment due to a reduced active dorsiflexion, so the decision for surgical refixation was made. In all cases an MRI scan was performed preoperatively. Postoperative immobilisation without weight-bearing was done for six weeks. All patients returned to their former activity level, were satisfied with the postoperative result and had a normal gait in the follow-up examination. The range of motion was equal on both sides, the median AOFAS score was 86 and the median Richter score was 90 out of 100. There were no postoperative complications.

DISCUSSION: Untreated tears of the anterior tibial tendon lead to significant impairment of the ankle joint and deformities of the foot. There is no consensus about the treatment with recommendations for operative and non-operative treatment. Various surgical procedures have been described. The surgical reconstruction of the tendon leads to a restored function of the ankle joint and allows a normal gait and is therefore desirable. Due to the loss of function and the good results after surgical treatment in our study, the non-operative treatment is not advisable.

CONCLUSION: Surgical repair of degenerative tears of the anterior tibial tendon leads to very good functional results and high patient satisfaction.
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Old 5th July 2012, 05:37 PM
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Default Re: Tibialis Anterior tendon rupture

Repair of Lacerated Anterior Tibial Tendon with Acellular Tissue Graft Augmentation
Lawrence A. DiDomenico, Gregory A. Blasko, Laurence Cane, Davina J. Cross
Journal of Foot and Ankle Surgery (in press)
Quote:
In the present case report, we describe the surgical repair of a complete laceration of the anterior tibial tendon using acellular human dermal tissue matrix. A 17-year-old, elite league hockey player was injured in the locker room when a teammate still clad in ice skates stepped on his bare left foot. After evaluation at a local emergency department, the patient presented to our office the next day for additional evaluation. It was determined that surgery would be performed using acellular tissue graft augmentation, followed by physical therapy. Within 7 weeks of the injury, the athlete returned to his original level of activity. At 3 years of follow-up, he was playing Division 1 hockey at the university level. We believe that augmentation of the tendon repair with the grafting material enhanced the tendon tensile strength and promoted ingrowth through vascular channels. This, combined with the patient’s dedication to physical therapy, led to excellent recovery in less time than anticipated.
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Old 8th March 2013, 05:02 PM
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Default Re: Tibialis Anterior tendon rupture

Gait Analysis after Tibialis Anterior Tendon Rupture Repair Using Z-Plasty
Jürgen Goetz, MD, Johannes Beckmann, MD, PhD, Franz Koeck, MD, PhD, Joachim Grifka, MD, PhD, Silvia Dullien, Guido Heers, MD, PhD
Journal of Foot and Ankle Surgery; Article in Press
Quote:
Other than limited reports regarding surgical outcomes, little information is available regarding whether Z-plasty of the tibialis anterior results in normal gait kinematics. We included 5 patients with spontaneous ruptures in the present retrospective study. The mean interval between rupture and operative treatment was 2.6 ± 2.6 months (standard deviation). The mean age of the patients was 63 (range 40 to 80) years. All patients were treated operatively with Z-plasty. Gait analysis was used to study the outcome, comparing the operated and nonoperated limbs. The patients were tested after a mean follow-up of 22 (range 12 to 33) months. No repeat ruptures were noted. Plantarflexion was significantly diminished during the preswing phase and initial swing phase in the operated limbs compared with the uninjured limbs. Plantarflexion was significantly increased during the terminal swing phase on the operated side. Knee flexion was nearly symmetrical. No significant differences regarding the temporospatial parameters were noted. We recommend Z-plasty for ruptures of the tibialis anterior tendon as a safe and effective procedure. However, this technique does not fully restore a physiologic gait pattern.
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Old 7th June 2013, 07:51 PM
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Default Re: Tibialis Anterior tendon rupture

Traumatic tibialis anterior tendon rupture: treatment with a two-stage silicone tube and an interposition hamstring tendons graft protocol
Vasileios Kontogeorgakos, et al
Knee Surgery, Sports Traumatology, Arthroscopy; June 2013
Quote:
A novel technique for managing ruptured tibialis anterior tendon complicated by infection and tendon substance loss in a young adult is described. A two-stage reconstruction technique with a silicon tube and tendon autograft was performed. At first, after local control of the infection, scar excision and placement of a silicone tube was performed. Ten weeks later, ipsilateral hamstrings tendons were harvested and bridged the 7 cm tendon gap. Eighteen months later, the patient has excellent clinical and functional outcome
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Old 6th September 2013, 06:24 PM
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Default Re: Tibialis Anterior tendon rupture

Reconstruction using an autograft with near complete preservation of the extensor retinaculum for chronic tibialis anterior tendon disruption
Youichi Yasui, Masato Takao, Wataru Miyamoto, Takashi Matsu****a
Archives of Orthopaedic and Trauma Surgery; September 2013
Quote:
We present the case of a 42-year-old woman with chronic disruption of the tibialis anterior tendon who was treated by reconstructive surgery using autologous semitendinosus tendon grafting. Two incisional approaches, proximal and distal of the degenerative scar tissue between each ruptured stump, made it possible to preserve most of the extensor retinaculum, except for the inferior Y-shaped medial segment that was excised to prevent adhesion between the reconstructed tendon and the extensor retinaculum. Furthermore, by placing the proximal and distal suture knots far from the ends of the extensor retinaculum, impingement could be avoided between the knots using the Pulvertaft weave technique, and of the extensor retinaculum through movement of the ankle joint. Although some types of tendon transfer technique or interpositional autologous tendon grafting have been reported to show good outcomes for chronic tibialis anterior tendon disruption with a large defect, the recent trend has been toward reconstructive surgery using autografts. The surgical technique presented seems applicable for achieving minimum surgical complications in this rare condition.
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Old 12th November 2013, 02:08 AM
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Default Re: Tibialis Anterior tendon rupture

Chronic Tibialis Anterior Tendon Tear Treated With an Achilles Tendon Allograft Technique
Ezequiel Palmanovich, MD; Yaron S. Brin, MD; Lior Laver, MD; Dror Ben David, MD; Sabri Massrawe, MD; Meir Nyska, MD; Iftach Hetsroni, MD
Orthopedics; November 2013 - Volume 36 · Issue 11: 850-853
Quote:
Tibialis anterior tendon tear is an uncommon injury. Nontraumatic or degenerative tears are usually seen in the avascular zone of the tendon. Treatment can be conservative or surgical. Conservative treatment is adequate for low-demand older patients. For active patients, surgical treatment can be challenging for the surgeon because after debridement of degenerative tissue, a gap may be formed that can make side-to-side suture impossible. The authors present allograft Achilles tendon insertion for reconstruction of chronic degenerative tears. Using Achilles tendon allograft has the advantage of bone-to-bone fixation, allowing rapid incorporation and earlier full weight bearing.
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Old 24th December 2013, 02:54 PM
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Default Re: Tibialis Anterior tendon rupture

Minimally Invasive Repair of the Tibialis Anterior Tendon Using a Semitendinosus Autograft.
Michels F, Van Der Bauwhede J, Oosterlinck D, Thomas S, Guillo S.
Foot Ankle Int. 2013 Dec 20
Quote:
BACKGROUND:
Ruptures of the tibialis anterior tendon are rare but can cause substantial functional deficiencies. The literature regarding the treatment of such injuries is very limited. Atraumatic ruptures often occur in the presence of an abnormal tendon structure, and retraction often makes end-to-end repair impossible. With traumatic lesions, the risk of developing both adhesions and scar tissue is high.
METHODS:
This study assesses the results of a surgical reconstruction using the interposition of a semitendinosus tendon autograft in 12 patients. Three patients had a traumatic rupture, and 9 patients had an atraumatic rupture. In 8 patients, the procedure was carried out using a minimally invasive technique.
RESULTS:
The average postoperative American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score was 95.7 in the atraumatic group and 94.7 in the traumatic group. Active dorsiflexion was possible after 2 to 3 weeks. We believe that the interposition of a strong, healthy tendon facilitated healing and allowed early weight bearing. All patients had good recovery of dorsiflexion and gait.
CONCLUSIONS:
Repairing a ruptured tibialis anterior tendon using a semitendinosus autograft was a reliable technique and offered a good result. With the minimally invasive approach, there was no need to divide the extensor retinaculum, which we believe allowed faster recovery and reduced the risk of adhesions and wound healing problems.
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