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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?
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
via Hazel!
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!
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
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?
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.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
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.
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?
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.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
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.
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.
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...
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!!!
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.
Tibialis Anterior tendon rupture
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