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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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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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Emerging Treatment Options for Chronic Tendinopathy of the Foot: A Clinical Vignette. Am J Phys Med Rehabil 2023; 102:e18-e20. [PMID: 36634241 DOI: 10.1097/phm.0000000000002110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
ABSTRACT The patient is a 65-year-old female recreational skier and avid walker who presented with a several-month history of right ankle and foot pain. The patient's pain began without inciting event and was described as a constant aching pain aggravated by downhill walking and alleviated with rest. She was diagnosed with right distal tibialis anterior tendinopathy with partial thickness tear noted on magnetic resonance imaging and musculoskeletal ultrasound. Given symptoms recalcitrant to conservative measures, the patient opted to pursue an ultrasound-guided prolotherapy injection and a course of physical therapy; unfortunately, she did not have any improvement in symptoms. The patient subsequently underwent ultrasound-guided percutaneous ultrasonic tenotomy and debridement of the distal tibialis anterior tendon, followed by a postprocedure rehabilitation protocol of physical therapy with transition to home exercise program with complete resolution of her pain. Prolotherapy, and percutaneous ultrasonic tenotomy and debridement are two treatment modalities that show promise in the treatment of painful, chronic tendinopathy.
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Comadoll S, Ray L, Overman K, Yoon P. Delayed Bilateral Tibialis Anterior Tendon Repair in an Older Man: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00066. [PMID: 36947639 DOI: 10.2106/jbjs.cc.22.00468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
CASE We report a 67-year-old healthy man who sustained bilateral hyper-plantarflexion injuries falling off a ladder that resulted in bilateral tibialis anterior tendon tears one month prior to presentation. His injuries were effectively managed with bilateral delayed operative treatment. After non-weightbearing for three months, the patient was subsequently permitted to full weight bear in CAM boots for three months. At three-year follow-up he was fully functional with excellent Foot and Ankle Ability Measure (FAAM scores). CONCLUSION The management delayed tibialis anterior tendon ruptures, whether due to traumatic or degenerative mechanisms is challenging and surgical repair can be effective when this injury occurs bilaterally.
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Affiliation(s)
- Shea Comadoll
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Lucas Ray
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Kelsey Overman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Patrick Yoon
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Idiopathic Tibialis Anterior Tendinopathy Necessitating Tendon Debridement With Adjunctive Autograft Fixation: A Unique Case. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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7
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Evaluation and Management of Adult Footdrop. J Am Acad Orthop Surg 2022; 30:747-756. [PMID: 36067460 DOI: 10.5435/jaaos-d-21-00717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/15/2022] [Indexed: 02/01/2023] Open
Abstract
Footdrop is a common musculoskeletal condition defined by weakness in ankle joint dorsiflexion. Although the etiology varies, footdrop is characterized by specific clinical and gait abnormalities used by the patient to overcome the loss of active ankle dorsiflexion. The condition is often associated with deformity because soft-tissue structures may become contracted if not addressed. Patients may require the use of special braces or need surgical treatment to address the notable level of physical dysfunction. Surgical treatment involving deformity correction to recreate a plantigrade foot along with tendon transfers has been used with notable success to restore a near-normal gait. However, limitations and postoperative dorsiflexion weakness have prompted investigation in nerve transfer as a possible alternative surgical treatment.
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Andronic O, Unterfrauner I, Jud L, Fritz B, Viehöfer AF, Fröhlich S, Imhoff FB, Wirth SH. Outcomes of Tibialis Anterior Tendon Reconstruction with Autograft or Allograft. Foot Ankle Int 2022; 43:2-11. [PMID: 34308695 DOI: 10.1177/10711007211029956] [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: 02/01/2023]
Abstract
BACKGROUND In cases of tibialis anterior tendon (TAT) ruptures associated with significant tendon defect, an interposition graft is often needed for reconstruction. Both auto- and allograft reconstructions have been described in the literature. Our hypothesis was that both graft types would have a good integrity and provide comparable outcomes. METHODS Patients who underwent TAT reconstruction using either an auto- or allograft were identified. Patient-reported outcomes (PROs) were collected using the 12-Item Short Form Health Survey (SF-12) questionnaire, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the Foot Function Index (FFI), and the Karlsson-Peterson score. Functional outcome was assessed by isokinetic strength measurement. Outcomes were further assessed with magnetic resonance imaging (MRI) evaluation of graft integrity. All measurements were also performed for the contralateral foot. RESULTS Twenty-one patients with an average follow-up of 82 months (20-262 months), comprising 12 allograft and 9 autograft TAT reconstructions, were recruited. There were no significant differences in patient-reported outcomes between allograft reconstructions and autografts: SF-12 (30.7 vs 31.1, P = .77); AOFAS (83 vs 91.2, P = .19); FFI (20.7% vs 9.5%, P = .22); and Karlsson-Peterson (78.9 vs 87.1, P = .23). All grafts (100%) were intact on MRI with a well-preserved integrity and no signs of new rupture. There were no major differences in range of motion and functional outcomes as measured by strength testing between the operative and nonoperative side. CONCLUSION Reconstructions of TAT achieved good PROs, as well as functional and imaging results with a preserved graft integrity in all cases. There were no substantial differences between allograft and autograft reconstructions. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ines Unterfrauner
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Arnd F Viehöfer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stefan Fröhlich
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Florian B Imhoff
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stephan H Wirth
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Zielinska N, Tubbs RS, Paulsen F, Szewczyk B, Podgórski M, Borowski A, Olewnik Ł. Anatomical Variations of the Tibialis Anterior Tendon Insertion: An Updated and Comprehensive Review. J Clin Med 2021; 10:jcm10163684. [PMID: 34441980 PMCID: PMC8396864 DOI: 10.3390/jcm10163684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/26/2021] [Accepted: 08/07/2021] [Indexed: 01/01/2023] Open
Abstract
The tibialis anterior muscle originates on the lateral condyle of the tibia, on the upper two-thirds of the lateral surface of this bone, on the anterior surface of the interosseous membrane and on the deep surface of the fascia cruris. The distal attachment is typically at the medial cuneiform and first metatarsal. However, the tibialis anterior tendon can vary morphologically in both adults and fetuses. Different authors have created new classification systems for it. The main aim of this review is to present condensed information about the tibialis anterior tendon based on the available literature. Another aim is to compare classification systems and the results of previous studies.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-419 Lodz, Poland; (N.Z.); (B.S.)
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA 70112, USA;
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA 70112, USA
- Department of Anatomical Sciences, St. George’s University, 38-902, Grenada
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
- Department of Topographic Anatomy and Operative Surgery, Sechenov University, 119991 Moscow, Russia
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-419 Lodz, Poland; (N.Z.); (B.S.)
| | - Michał Podgórski
- Department of Diagnostic Imaging, Polish Mother’s Memorial Hospital—Research Institute, 90-419 Łódź, Poland;
| | - Andrzej Borowski
- Orthopaedics and Pediatric Orthopaedics Department, Medical University of Lodz, 90-419 Łódź, Poland;
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-419 Lodz, Poland; (N.Z.); (B.S.)
- Correspondence:
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Johansen JK, Jordan M, Thomas M, Walther M, Simatira AM, Waizy H. Surgical treatment of tibialis anterior tendon rupture. Foot Ankle Surg 2021; 27:515-520. [PMID: 32948441 DOI: 10.1016/j.fas.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/16/2020] [Accepted: 06/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ruptures of the anterior tibial tendon can be both acute and chronic. The acute lesion can be caused by a sharp cutting trauma or by blunt or hyperplantarflexion trauma. Spontaneous ruptures are rare, and most ruptures are due to degenerative changes mainly affecting the distal avascular 5-30 mm of the tendon. Surgical repair is the preferred treatment for physically active patients. Overall, the literature shows that operative repair results in a very good outcome in most patients. This study compares the clinical outcome in patients with anterior tibial tendon rupture, treated with different surgical techniques. METHODS This multicenter cohort study was conducted at four different Foot and Ankle specialized clinics. The study was approved by the local ethical committee. A total of 48 patients with surgically treated tibialis anterior rupture was included. The study protocol included the demographic and clinical data of each patient and the surgical treatment. The VAS-FA PROM was recorded pre- and postoperative in all patients. The mean follow-up were 30 (20.8-48.5) months. RESULTS A significant difference was found in age between patients who stated "good" versus "fair" (p = 0.002) and "very good" versus "fair", i.e. younger age for "fair" p = 0.036, thus showing that younger patients do worse than older patient after surgery when rating the results. However there was no significant difference for older versus younger age looking at the results "poor", "fair, good and very good". The group with chronic tendon ruptures had a significantly higher preoperative VAS-FA than the group sustaining non-traumatic rupture (p = 0.048). There was no significant linear relation between age, postoperative VAS-FA and VAS-FA improvement. Also, we did not find a significant linear relation between age and outcome. Please see Tables 2-4 for results. CONCLUSION The tibialis anterior tendon rupture can be both acute and chronic. We could not identify any significant differences in clinical outcome or PROM between acute and delayed suture of the tibialis anterior tendon rupture. LEVEL OF EVIDENCE Level II. Prospective controlled cohort study.
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Affiliation(s)
- Jens Kurt Johansen
- Foot and Ankle Department, Hvidovre Hospital, Denmark; Hvidovre Hospital, Kettegaards Allé 30, 2630 Hvidovre, Denmark.
| | - Martin Jordan
- Hessingpark-Clinic, Foot and Ankle Department, 86199 Augsburg, Germany
| | - Manfred Thomas
- Hessingpark-Clinic, Foot and Ankle Department, 86199 Augsburg, Germany
| | - Markus Walther
- Schön Klinik München Harlaching - FIFA Medical Centre, 81547 Munich, Germany
| | - Anna-Maria Simatira
- Schön Klinik München Harlaching - FIFA Medical Centre, 81547 Munich, Germany
| | - Hazibullah Waizy
- Klinik für Orthopädie, Unfallchirurgie und Wirbelsäulentherapie, Donau-Ries Kliniken, Neudegger Allee 6, 86609 Donauwörth, Germany
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11
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Lemmens L, van Beek N, Verfaillie S. Postoperative results of distal tibialis anterior tendinosis. Foot Ankle Surg 2020; 26:851-854. [PMID: 31870617 DOI: 10.1016/j.fas.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Although distal tibialis anterior tendinopathy is a common condition, it has rarely been described in literature. It is often a condition in overweight women around 50-70 years old with pain that worsens at night. The purpose of this retrospective study is to describe the specific clinical signs and postoperative results of distal tibialis anterior tendinopathy. MATERIAL AND METHODS Between 2013 and 2017 we operated 9 patients (10ft) who failed a conservative treatment of distal tibialis anterior tendinopathy. Surgery consisted of debridement of the diseased tendon and reinsertion with a bone anchor. There was a minimum follow-up of 12 months. All patients were clinically evaluated postoperative (range 14-57 months after surgery) with the use of the American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analog Scale (VAS) RESULTS: The mean AOFAS score postoperative was 99 (range 94-100). The mean VAS score postoperative was 1 (range 0-3). In all 10 cases the patient was completely satisfied with the result following surgery. There was no recurrence or rupture of tendon after debridement. CONCLUSION Distal tibialis anterior tendinopathy is mainly a clinical diagnosis where conservative treatment should always be the first choice. However, our results show that when conservative treatment fails, surgical treatment can lead to very good long term results with a high level of patient satisfaction.
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Affiliation(s)
- Laura Lemmens
- AZ Herentals, Nederrij 133, 2200, Herentals, Belgium.
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12
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Composite Cutaneous Anterolateral Thigh Flap with Rolled Fascia Lata for Tibialis Anterior Tendon Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2959. [PMID: 32802653 PMCID: PMC7413756 DOI: 10.1097/gox.0000000000002959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
Abstract
Rupture of the tibialis anterior tendon (TAT) is a rare phenomenon with limited therapeutic options derived from sparse case reports. Without proper anchoring of the tibialis anterior, dorsiflexion and inversion of the foot become impaired, disrupting patient's gait. Reported techniques for repair fall into nonoperative (ankle-foot orthosis) or operative (primary closure, tendon transfer, free gracilis) modalities, depending on patient factors, mechanism of injury, and extent of defect. In this report, we outline a novel method of tendon repair and soft tissue coverage for a large defect. Methods We present a unique case of traumatic TAT rupture with a failed primary closure yielding a large (>15 cm) defect. The patient presented with a defect spanning the entire anterior compartment of the leg, limiting options for coverage and functional restoration. Results The patient's large, chronic defect was successfully repaired via a composite cutaneous anterolateral thigh and a rolled fascia lata free flap. The patient had robust return to function and is able to dorsiflex and invert the foot and ambulate. Conclusions The use of this donor site offers a novel, advantageous option for TAT repair. It should be considered for patients with large defects that make other repair methods unfeasible.
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13
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Kopriva JM, Cheesborough J, Frick SL. Tendon Turndown to Bridge a Tibialis Anterior Gap and Restore Active Dorsiflexion After Degloving Foot Injury in a Child: A Case Report. JBJS Case Connect 2020; 10:e19.00445. [PMID: 32773712 DOI: 10.2106/jbjs.cc.19.00445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A child with a severe degloving injury to the dorsum of the foot and ankle had segmental loss of the tibialis anterior tendon and toe extensors. A tendon turndown procedure was used, and the repaired tendon was covered with a latissimus muscle free flap to restore active ankle dorsiflexion. Details of the procedure are described, and active dorsiflexion and functional ambulation were restored. CONCLUSIONS The tendon turndown method is a simple and effective way to overcome segmental tendon loss of tibialis anterior and allowed restoration of active dorsiflexion in this case without relying on tendon transfers or grafting.
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Affiliation(s)
| | - Jennifer Cheesborough
- Santa Clara Valley Medical Center, San Jose, California.,Department of Orthopaedic Surgery, Stanford University School of Medicine Stanford, California
| | - Steven L Frick
- Department of Orthopaedic Surgery, Stanford University School of Medicine Stanford, California
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14
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Vosoughi AR, Heyes G, Molloy AP, Mason LW, Hoveidaei AH. Management of tibialis anterior tendon rupture: Recommendations based on the literature review. Foot Ankle Surg 2020; 26:487-493. [PMID: 31501017 DOI: 10.1016/j.fas.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/05/2019] [Indexed: 02/04/2023]
Abstract
Tibialis anterior tendon (TAT) rupture is a rare injury that commonly diagnosed late due to mild clinical signs and symptoms. Management of TAT rupture is a topic without a clear consensus in the literature. This current concept review tries to shed some light on the data and treatment. Our extensive literature review identified 81 case reports and case series from 1905 to 2018. Several reported management techniques with their advantages and disadvantages were analyzed and our treatment recommendations are given based on current available evidences. LEVELS OF EVIDENCE: IV.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Gavin Heyes
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, United Kingdom.
| | - Andrew P Molloy
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, United Kingdom.
| | - Lyndon W Mason
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, United Kingdom.
| | - Amir Human Hoveidaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
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15
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Chronic Lower Leg Pain in Athletes: Overview of Presentation and Management. HSS J 2020; 16:86-100. [PMID: 32015745 PMCID: PMC6973789 DOI: 10.1007/s11420-019-09669-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Athletes with chronic lower leg pain present a diagnostic challenge for clinicians due to the differential diagnoses that must be considered. PURPOSE/QUESTIONS We aimed to review the literature for studies on the diagnosis and management of chronic lower leg pain in athletes. METHODS A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The PubMed, Scopus, and Cochrane library databases were searched, and articles that examined chronic lower leg pain in athletes were considered for review. Two independent reviewers conducted the search utilizing pertinent Boolean operations. RESULTS Following two independent database searches, 275 articles were considered for initial review. After the inclusion and exclusion criteria were applied, 88 were included in the final review. These studies show that the most common causes of lower leg pain in athletes include medial tibial stress syndrome, chronic exertional compartment syndrome, tibial stress fractures, nerve entrapments, lower leg tendinopathies, and popliteal artery entrapment syndrome. Less frequently encountered causes include saphenous nerve entrapment and tendinopathy of the popliteus. Conservative management is the mainstay of care for the majority of cases of chronic lower leg pain; however, surgical intervention may be necessary. CONCLUSIONS Multiple conditions may result in lower leg pain in athletes. A focused clinical history and physical examination supplemented with appropriate imaging studies can guide clinicians in diagnosis and management. We provide a table to aid in the differential diagnosis of chronic leg pain in the athlete.
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Siang DKT, Pitarini A, Koo K. Allograft Reconstruction of Spontaneous Tibialis Anterior Tendon Rupture in a Diabetic Patient. J Orthop Case Rep 2019; 9:57-60. [PMID: 31559229 PMCID: PMC6742874 DOI: 10.13107/jocr.2250-0685.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The tibialis anterior (TA) is a powerful dorsiflexor of the ankle. Ruptures of the TA can be a distressing condition that needed a surgical intervention. Fortunately, despite being the third most common lower limb tendon rupture (after Achilles and patellar tendon), ruptures of the TA remain a rare clinical entity. We present a case of spontaneous rupture of the TA in an elderly diabetic lady as well as our successful repair using a TA allograft to bridge the defect gap. Case Report: A 73-year-old known diabetic lady complains of a 6-month history of progressive right ankle pain and swelling over the dorsum of her foot. She did not recall any trauma or twisting injury. She had tenderness over the anterior ankle, an erythematous cystic soft tissue mass, and weakness in ankle dorsiflexion. In addition, she demonstrated notable prominent first metatarsophalangeal hyperextension on ankle dorsiflexion. Loss of contour of normal TA anatomy was noted over anterior aspect of ankle joint. Magnetic resonance imaging reported a complete rupture of the TA tendon with a 4.2 cm tendon gap. Surgical repair using a TA allograft whip stitched side to side to the proximal TA stump and the remaining allograft secured on the medial cuneiform with bio absorbable screw. Rehabilitation consisted of a structured program with protected weight bearing. At 3 months after surgical repair, the patient was able to return to daily activities. Conclusion: This case report highlights the successful use of a TA allograft in the repair of a chronic TA rupture in an elderly diabetic patient. This repair has demonstrated to be reliable at 12-month post-surgery and allows prompt return to daily activities.
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Affiliation(s)
- Don Koh Thong Siang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Building Level 4, 169856, Singapore
| | - Astuti Pitarini
- Department of Orthopedic and Traumatology Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Building Level 4, 169856, Singapore
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17
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Gossett L, Gossett PC, Roberts J, Anderson J. Gastrocnemius Recession for the Treatment of Tibialis Anterior Tendinopathy. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419852940. [PMID: 35097331 PMCID: PMC8500391 DOI: 10.1177/2473011419852940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Leland Gossett
- Spectrum Health–Michigan State University Orthopaedic Surgery Residency, Grand Rapids, MI, USA
| | - P. Cameron Gossett
- Spectrum Health–Michigan State University Orthopaedic Surgery Residency, Grand Rapids, MI, USA
| | - Justin Roberts
- Orthopaedic Associates of Michigan, Grand Rapids, MI, USA
| | - John Anderson
- Orthopaedic Associates of Michigan, Grand Rapids, MI, USA
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18
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Tibialis anterior tendinosis: Clinical characterization and surgical treatment. Foot (Edinb) 2019; 39:79-84. [PMID: 30978661 DOI: 10.1016/j.foot.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tibialis anterior (TA) tendinosis is rarely reported on in the literature. It is seen in patients older than 45 and causes weakness in dorsiflexion. This paper aims to describe surgical treatment and clinical outcomes. METHODS Between 2015 and 2018, nine patients (six females, three males) with severe TA tendinosis with no tear (2), partial (1), or complete (6) underwent operative treatment. Patients underwent debridement and direct repair without augmentation, direct repair with fiber tape augmentation, tibialis posterior tendon (PTT) transfer, or tibialis anterior tendon (TAT) augmentation with a tendon autograft (n=4). Autografts consisted of extensor digitalis longus (EDL) tendon, plantaris tendon, or both. RESULTS Mean postoperative follow-up was 21.3 (range 8-31) months. All patients had a concomitant gastrocnemius recession, and three had hindfoot arthrodesis. Preoperative dorsiflexion strength was 0/5 for all and improved to 5/5 postoperatively in seven. The only current smoker developed wound dehiscence 2 weeks postoperatively and healed by 4. One developed marginal skin necrosis 3 weeks postoperatively and was treated successfully with casting. CONCLUSION Surgery reestablished function in individuals with TA tendinosis and allowed high level of satisfaction. Direct repair is possible. If the tendon gap is too large an autograft of EDL and plantaris tendon can be utilized. LEVEL OF EVIDENCE Level III Retrospective Comparative Study.
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19
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Berger-Groch J, Rueger JM, Spiro AS. Rare Combination of a Cuboid-navicular Tarsal Coalition with a Closed Tibialis Anterior Tendon Rupture: A Case Report and Review of the Literature. J Orthop Case Rep 2019; 8:3-6. [PMID: 30740363 PMCID: PMC6367286 DOI: 10.13107/jocr.2250-0685.1182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Tibialis anterior tendon (TAT) rupture and cuboid-navicular coalition (CNC) are rare, to the best of our knowledge, only 238 cases of TAT rupture and 34 cases of CNC are described in the past century. Case Report A 47-year-old man came with a sudden onset of foot pain including drop foot to our department. We diagnosed a TAT rupture, which was fixed through suture. The pathologist testified degenerative changes in the tendon. In addition, a CNC was diagnosed. No extra treatment was necessary for the CNC. At the 6-year follow-up examination, the patient had no pain and went back to normal day activities (AOFAS 95/100 points). Conclusion We presume that, in our case, the long-term stress at the TAT through the foot deformity, caused by the CNC, may have supported the tendon rupture. CNC normally is symptom free. Therapy of a painful CNC should start with a conservative therapy. When this fails, an operation can be considered.
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Affiliation(s)
- Josephine Berger-Groch
- Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistreet 52, 20246 Hamburg, Germany
| | - Johannes M Rueger
- Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistreet 52, 20246 Hamburg, Germany
| | - Alexander S Spiro
- Department of Pediatric Orthopedics, Children's Hospital Altona, Bleickenallee 38, 22763 Hamburg, Germany
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