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Hill Z, Stone R, Holmes T. Tibialis Anterior Tendon Reconstruction Utilizing Split Tendon Turn-down: A Case Report and Technique Guide. Foot Ankle Spec 2024:19386400241235831. [PMID: 38500002 DOI: 10.1177/19386400241235831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Tibialis anterior tendon (TAT) ruptures are rare, equating to less than 1% of all musculotendinous injuries. These injuries can be acute or atraumatic, with the latter often associated with chronic degenerative tendinopathy. Surgical repair is indicated when conservative measures fail in meeting functional demands. Direct end-to-end repair is the preferred method for TAT ruptures but may not be feasible with a large tendon defect. Various surgical techniques have been described to address this pathology, including allograft tendon interposition or extensor hallucis longus (EHL) transfer. The authors present a unique technique utilizing a minimal incision TAT turn-down with dermal matrix allograft augmentation, and, in addition, a case implementing this technique in a patient with a large insertional defect. The patient's postoperative course and outcomes were favorable, with improvements in pain, satisfaction, functional scores, and strength. The surgical technique offers versatility and can be adapted to different tendon defect sizes. It also allows for minimal-incision exposure, beneficial for patients with comorbidities or compromised skin integrity. In conclusion, the authors present a case report and surgical technique for the management of large-deficit, chronic TAT ruptures using split TAT turn-down. This technique provides a potential solution for cases where direct end-to-end repair is not feasible.Level of Evidence: Level V.
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Affiliation(s)
| | - Ryan Stone
- American College of Foot and Ankle Surgeons, Chicago, Illinois
| | - Timothy Holmes
- OhioHealth Grant Medical Center, Columbus, Ohio
- Foot and Ankle Specialists of Central Ohio, Columbus, Ohio
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Desomer L, van Beek N, Van Riet A, Verfaillie S. Outcomes of Platelet-Rich Plasma Infiltration and Weightbearing Cast Immobilization in Distal Tibialis Anterior Tendinopathy: A Prospective Cohort Study. Foot Ankle Int 2024; 45:158-165. [PMID: 37964467 DOI: 10.1177/10711007231210506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Distal tibialis anterior tendinopathy (DTAT) is a chronic condition that may lead to functional impairment and secondary forefoot deformities when left untreated. Current clinical practice is mainly guided by case reports and small retrospective case series; little consensus exists on which treatment protocol is most effective. This study aims to assess a conservative treatment for DTAT consisting of PRP infiltration and walking cast immobilization. METHODS This prospective study included 18 feet in 18 patients, recruited between September 2020 and September 2022 at a single institution. Ultrasonography was performed; leukocyte-poor PRP was infiltrated around the tibialis anterior tendon insertion. Walking cast immobilization was used for 3 weeks after infiltration, followed by eccentric exercises of the DTAT, and gastrocnemius-soleus muscle complex stretching. Clinical findings, visual analog scale (VAS), Foot Function Index (FFI), and American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores were recorded at inclusion, and 6 and 12 weeks after PRP infiltration. Minimal clinically important difference (MCID) limits were researched to assess clinical relevance of statistical outcomes. Means were determined for age, sex, and body mass index (BMI). One-way repeated measures ANOVA was performed over time for FFI, AOFAS, and VAS scores. RESULTS Mean age was 65 years with a mean BMI of 25. Tendon thickening and hypoechogenicity were the most commonly reported ultrasonographic findings. Significant improvement from baseline VAS (VASrest: 4.71 ± 2.7, VASactivity: 5.66 ± 2.5) to 12 weeks follow-up (VASrest: 2.14 ± 2.7, VASactivity: 3.34 ± 2.5) was found. Both AOFAS and FFITotal improved significantly from baseline (AOFAS: 66.9 ± 3.3, FFITotal: 32.9 ± 3.3) to 6-week follow-up (AOFAS6w: 79.4 ± 3.3, P = .019; FFITotal: 19.4 ± 3.3, P = .011). No statistically significant further improvement was found at 12 weeks compared to 6 weeks' follow-up. Two (11%) patients chose operative treatment because of persisting symptoms. CONCLUSION We found that PRP infiltration with walking cast immobilization as a first-line treatment was associated with general early symptom improvement. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Lies Desomer
- Department of Orthopedic Surgery, St-Elisabeth General Hospital, Herentals, Belgium
| | - Nathalie van Beek
- Department of Orthopedic Surgery, St-Elisabeth General Hospital, Herentals, Belgium
| | - Anne Van Riet
- Department of Orthopedic Surgery, St-Elisabeth General Hospital, Herentals, Belgium
| | - Stefaan Verfaillie
- Department of Orthopedic Surgery, St-Elisabeth General Hospital, Herentals, Belgium
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Hoveidaei AH, Hashemi SM, Pazoki S, Nakhostin-Ansari A, Maleki Ghorbani Z, Eghdami S, Bahari H, Sarzaeim M, Forogh B. Effects of whole-body vibration on chronic ankle instability: a systematic review. Ann Med Surg (Lond) 2024; 86:401-411. [PMID: 38222746 PMCID: PMC10783336 DOI: 10.1097/ms9.0000000000001510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/03/2023] [Indexed: 01/16/2024] Open
Abstract
Background and objective Chronic ankle instability (CAI) is one of the most common sports injuries, and whole-body vibration (WBV) training has been used lately as a potential rehabilitation modality for these patients. The authors conducted a systematic review and meta-analysis to assess whether WBV training positively affects patients with CAI. Materials and methods The authors systematically searched four databases, including MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials, for randomized and non-randomized trials evaluating the effects of WBV on individuals with CAI. The authors used Cochrane RoB2 to assess the risk of bias in randomized trials. A meta-analysis was conducted if three or more studies measured the same outcome. Effect estimates were pooled using a random-effects model. Results Results were retrieved from seven articles encompassing 288 participants who had CAI. The reach distance of the Star Excursion Balance Test (SEBT) was regarded as the study's main finding. The authors saw a significant training effect on certain planes of motion on dynamic balance. The findings showed that the post-intervention measurements in the WBV group compared to control groups showed improvements in the posterolateral, posteromedial, and medial directions, respectively. There were also promising results on improvements in muscle activity, strength, and proprioception sense measurements with a great diversity in the reported parameters. Conclusion The authors observed a significant WBV training effect on dynamic balance over posterolateral, posteromedial, and medial reach distances. These findings suggest future studies on the effects of WBV on muscle activity, strength, and proprioception in addition to dynamic and static balance.
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Affiliation(s)
- Amir Human Hoveidaei
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences
- Sports Medicine Research Center, Neuroscience Institute
| | | | - Shayan Pazoki
- Students’ Scientific Research Center, Exceptional Talents Development Center, Tehran University of Medical Sciences
| | - Amin Nakhostin-Ansari
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences
- Sports Medicine Research Center, Neuroscience Institute
| | - Zahra Maleki Ghorbani
- Students’ Scientific Research Center, Exceptional Talents Development Center, Tehran University of Medical Sciences
| | - Shayan Eghdami
- Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran
| | - Hossein Bahari
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Bijan Forogh
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences
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Hirai T, Edama M, Togashi R, Osanami H, Saito R, Kato K, Shagawa M, Sekine C, Yokota H, Hirabayashi R, Ishigaki T, Akuzawa H, Yamada Y, Toriumi T, Kageyama I. Anatomical study of type classification and surface area of attachment sites for tibialis anterior tendon. BMC Musculoskelet Disord 2023; 24:631. [PMID: 37537571 PMCID: PMC10401820 DOI: 10.1186/s12891-023-06753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to clarify the attachment types of the tibialis anterior tendon (TAT) in Japanese fixed cadavers and to determine the attachment site area in three dimensions. METHODS We examined 100 feet from 50 Japanese cadavers. The TAT was classified according to differences in the number of fiber bundles as: Type I, with one fiber bundle; Type II, with two fiber bundles; and Type III, with three fiber bundles. The attachment site area of the TAT was measured using a three-dimensional scanner. RESULTS Cases were Type II in 95% and Type III in 5%, with no cases of Type I identified. In Type II, mean attachment site areas were 85.2 ± 18.2 mm2 for the medial cuneiform bone (MCB) and 72.4 ± 19.0 mm2 for the first metatarsal bone (1 MB), showing a significantly larger area for MCB than for 1 MB. CONCLUSIONS These findings suggest the possibility of ethnic differences in TAT attachment types and suggest that TAT attachments in Japanese individuals are highly likely to be Type II, with rare cases of Type III. Accurate measurement of attachment site areas is possible with appropriate three-dimensional measurements.
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Affiliation(s)
- Tomoki Hirai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan.
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan.
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Haruki Osanami
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Rina Saito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Koyo Kato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Mayuu Shagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Tomonobu Ishigaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Hiroshi Akuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-Cho, 1398, Kita-Ku, Niigata City, Niigata, 950-3198, Japan
| | - Taku Toriumi
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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