Surgical Repair of Acute and Chronic Tibialis Anterior Tendon Ruptures

• Published in: Journal of bone and joint surgery. American volume Vol. 91; no. 2; pp. 325 - 332
• Main Authors: Sammarco, V James, Sammarco, G James, Henning, Carlo, Chaim, Solomon
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01-02-2009; Journal of Bone and Joint Surgery Incorporated
• Subjects: Adult; Aged; Ankle Joint - physiopathology; Biological and medical sciences; Diseases of the osteoarticular system; Female; Gait; Humans; Injuries of the limb. Injuries of the spine; Lacerations - surgery; Male; Medical sciences; Middle Aged; Muscle Strength; Orthopedic Procedures; Posterior Tibial Tendon Dysfunction - physiopathology; Posterior Tibial Tendon Dysfunction - surgery; Recovery of Function; Retrospective Studies; Rupture; Tendon Injuries - surgery; Traumas. Diseases due to physical agents; Treatment Outcome; Young Adult; Chronic; Treatment; Acute; Surgery; Orthopedics; Tissue rupture; Anterior tibial muscle; Repair; Tendon
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.G.01386

BackgroundRupture 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.MethodsNineteen 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.ResultsThe 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.ConclusionsSurgical 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.Level of EvidenceTherapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.