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Bassil GF, Nader F, Lajmi A, Missaoui Z. Closed Rupture of the Extensor Hallucis Longus (EHL) Tendon Due to Forced Traumatic Hyperflexion of the Hallux: A Case Report. Cureus 2024; 16:e55137. [PMID: 38558707 PMCID: PMC10979719 DOI: 10.7759/cureus.55137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
A closed spontaneous rupture of the extensor hallucis longus (EHL) tendon is an infrequent yet challenging clinical occurrence, typically associated with systemic conditions (diabetes mellitus or rheumatoid arthritis). A closed EHL rupture, however, exists but is only reported as scattered cases in the literature. This article presents a unique case of a traumatic EHL tendon rupture in a patient without underlying predisposing factors. A 66-year-old woman, previously healthy, presented with an inability to dorsiflex her big toe following trauma, showcasing the clinical triad of pain, edema, and deficit in big toe extension. Magnetic resonance imaging confirmed a 5.9 cm EHL tendon gap that was treated by primary end-to-end repair of the ruptured tendon. The aim of this case report is to provide an overview of the literature available concerning the classification and treatment of EHL rupture and to assist in the early diagnosis and treatment of this rare condition.
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Affiliation(s)
- Georges F Bassil
- Orthopedic Surgery, Lebanese University Faculty of Medicine, Beirut, LBN
| | - Fadi Nader
- Orthopedics and Trauma, Université Paris Cité, Paris, FRA
- Orthopedic Surgery, Lebanese University Faculty of Medicine, Beirut, LBN
| | - Achraf Lajmi
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
| | - Zied Missaoui
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
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Chu T, Xiao J, Zhou X, Lin K, Tao Z. Free Chimeric Superficial Circumflex Iliac Artery Perforator Flap in Reconstructing the Distal Complex Extensor Tendon Injury. Plast Reconstr Surg 2024; 153:442e-447e. [PMID: 37104497 DOI: 10.1097/prs.0000000000010599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
SUMMARY The distal complex extensor tendon injury, presenting as traumatic skin, zones 1 and 2 of extensor pollicis longus and extensor hallucis longus, and bony insertion loss, represents a challenging issue and requires a well-vascularized skin paddle, tendinous graft, and insertional reconstruction. Guided by the all-in-one-step reconstruction rule, the chimeric superficial circumflex iliac artery perforator (SCIAP) flap, generally considered as a promising multiple-type tissue provider (eg, vascularized skin paddle, fascia, iliac flap), can fulfill the reconstructive demands and has an edge over the two-stage countermeasure. The authors adopted tripartite SCIAP flaps to reconstruct distal complex thumb or toe injuries in eight cases (six thumbs and two halluces), all of which were reattached with vascularized fascia lata-iliac crest conjunctions using a pull-out technique. All SCIAP flaps survived uneventfully without donor-site complications. The remodeled interphalangeal joints regained nearly normal radiologic manifestation. The chimeric SCIAP flap may be a promising technique for distal complex extensor tendon injury; providing vascularized skin paddle and fascia lata-iliac crest graft, it also qualifies for the all-in-one-stage reconstruction concept. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Tinggang Chu
- From the Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University
| | - Jian Xiao
- Department of Optometry and Ophthalmology, Wenzhou Medical University
| | - Xijie Zhou
- From the Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University
| | - Kang Lin
- From the Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University
| | - Zhenyu Tao
- From the Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University
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Hege AR, Choubisa C, Chitale N, Phansopkar P. Physiotherapy Management Post-operative to Total Extensor Hallucis Longus Rupture: A Case Report. Cureus 2023; 15:e50434. [PMID: 38222234 PMCID: PMC10784757 DOI: 10.7759/cureus.50434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Due to the contracture or degeneration of the ruptured tendon, using primary suturing to treat chronic extensor hallucis longus (EHL) tendon ruptures is challenging. The most common cause of EHL rupture is a laceration when a sharp object drops over the dorsum of the foot. EHL injuries are rare cases. In this report, we present a case of a 23-year-old female who was operated on for EHL rupture; she visited the Physiotherapy department with complaints of pain swelling over the left dorsum of the foot and was unable to perform great toe movements for six weeks. After three weeks of patient-tailored rehabilitation protocol that included interventions like faradic stimulation, strengthening exercises, gripping exercises, proprioception training, etc., we assessed the patient's primary outcomes like pain intensity, muscle strength, and range of motion and functional outcome measures that included lower extremity functional scale score at the end. Improvement in all the outcomes was seen. Our case report concludes that physiotherapy intervention has improved the primary and secondary outcomes and has helped patients to perform functional activities efficiently, such as maintaining balance while standing, walking, and bearing equal weight. This case report portrays that early physiotherapy treatment post-operatively in EHL rupture cases proves to be very beneficial.
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Affiliation(s)
- Akanksha R Hege
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chitrakshi Choubisa
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha Chitale
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Chronic Pectoralis Major Rupture Reconstruction With Interpositional Acellular Dermal Allograft. Ochsner J 2021; 21:217-223. [PMID: 34239387 PMCID: PMC8238110 DOI: 10.31486/toj.20.0003] [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] [Indexed: 11/25/2022] Open
Abstract
Background: Pectoralis major tendon (PMT) rupture commonly occurs in males 20 to 39 years of age. PMT rupture is most often associated with gym-based exercise, with attempted bench press being the most common causative event, but it is also associated with contact or impact sports. Delayed presentation, misdiagnoses, and chronic PMT rupture can result in a therapeutic dilemma. Case Series: We present 2 cases of chronic PMT rupture that were operatively managed using acellular dermal allograft as an interposition graft. Patients’ final follow-ups were at 20 and 30 months, respectively. Strength in their pectoralis major muscle was well preserved on the contralateral side: 88% for patient 1 and 110% for patient 2. Conclusion: Our reported technique using an interpositional acellular dermal allograft is a good option to treat chronic PMT rupture.
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Nasser E, Clark W, Gibboney M. A Novel Technique for Soft-Tissue Defect Repair After Traumatic Rupture of the Extensor Hallucis Longus Tendon. J Am Podiatr Med Assoc 2021; 111:466713. [PMID: 34144589 DOI: 10.7547/18-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgical repair of extensor hallucis longus (EHL) tendon rupture with a concomitant capsular defect has not been reported in the literature. This case presents a novel approach to EHL tendon rupture repair along with repair of a first metatarsophalangeal joint capsule defect. METHODS A case study is presented of a 61-year-old man with a traumatic EHL tendon rupture and capsular defect treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons with autograft flap reconstruction of the first metatarsophalangeal joint capsule. DISCUSSION A 61-year-old man presented with an acute traumatic EHL tendon rupture and first metatarsophalangeal joint capsule compromise after a chainsaw injury. He subsequently lost dorsiflexion of his hallux, and magnetic resonance imaging confirmed a 2.2-cm gap in the EHL tendon. He was treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons to reestablish dorsiflexion to the hallux. The injury was noted to infiltrate the first metatarsophalangeal joint capsule and was treated with an autograft of the first metatarsophalangeal joint capsule for a capsular defect. At 1-year follow-up the patient has regained dorsiflexion of the hallux and is back to activities such as snow skiing without pain. CONCLUSIONS Ruptures of the EHL tendon with first metatarsophalangeal joint capsule defects have not been reported in the literature. Herein, a novel approach was used to reestablish physiologic function to the EHL tendon and provide sufficient coverage of the first metatarsophalangeal joint.
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Duarte M, Fradinho N. A Combined Surgical Approach for Extensor Hallucis Longus Reconstruction: Two Case Reports. Indian J Plast Surg 2020; 54:225-228. [PMID: 34239251 PMCID: PMC8257318 DOI: 10.1055/s-0040-1721525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The surgical management of foot tendon injuries is not well-represented in literature. To achieve excellent functional recovery of the extensor hallucis longus (EHL) tendon, we aimed at developing a reliable and feasible reconstructive technique. A surgical technique for delayed reconstruction of the EHL tendon, combining an elongation procedure with second toe extensor tendon transfer, is described in this article. The results of this combined approach for EHL tendon reconstruction were remarkable, since the patients of the two clinical cases reported regained active extension of the hallux after 6 months without any associated complication. This study represents a step forward in foot surgery, since it describes an alternative technique to manage EHL tendon lesions.
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Affiliation(s)
- Marta Duarte
- Department of Plastic Reconstructive and Aesthetic Surgery, Central Lisbon Hospital Centre, Lisbon, Portugal
| | - Nuno Fradinho
- Department of Plastic Reconstructive and Aesthetic Surgery, Central Lisbon Hospital Centre, Lisbon, Portugal
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Jaffe D. Restoration of Extension of the Great Toe After an Untreated, Retracted Extensor Hallucis Longus Rupture: A Case Report. JBJS Case Connect 2019; 9:e0348. [PMID: 31609752 DOI: 10.2106/jbjs.cc.18.00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 66-year-old woman presented 10 days after dropping a knife onto her right foot. She was diagnosed with a complete, retracted extensor hallucis longus (EHL) rupture. A recommendation for acute repair was made, but she opted against surgery and was treated with observation and supportive care. At 1 year, the patient regained active extension of her big toe and had no gait disturbances or functional impairment. CONCLUSIONS There is no literature on the natural history of a retracted EHL rupture. Surgery is typically advised to prevent symptomatic drop toe and theoretical subsequent deformity. This case illustrates the potential for restoration of extension of the hallux without surgical repair.
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Affiliation(s)
- David Jaffe
- OrthoArizona, Arizona Bone and Joint Specialists, Scottsdale, Arizona
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Lucattelli E, Bastoni S, Bartoli MS, Menichini G, Innocenti M, Daolio PA. Extensor hallucis longus tendon and soft-tissue reconstruction with palmaris longus tendon included in a radial forearm free flap: A case report. Microsurgery 2019; 40:391-394. [PMID: 31605499 DOI: 10.1002/micr.30523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/23/2019] [Accepted: 10/01/2019] [Indexed: 11/08/2022]
Abstract
Reconstruction of foot structures is challenging because of the need to restore both anatomy and function. Extensor hallucis longus (EHL) excision without reconstruction could result in a flexion deformity of the toe at the interphalangeal joint. In this report, we present a case of the use of a palmaris longus tendon included in a fasciocutaneous radial forearm free flap to reconstruct EHL tendon and soft tissues of the distal foot dorsum. A 41-year-old woman presented with a recurrence of myxoinflammatory fibroblastic sarcoma on the medial part of the left foot dorsum. The EHL tendon was sacrificed, leaving a soft-tissue defect of 14 × 5 cm and 14-cm tendon gap. A 14 × 5 cm radial forearm flap with a 16-cm section of palmaris longus tendon was harvested from the left forearm. Radial artery and its comitant vein were anastomosed with dorsalis pedis artery and vein. EHL tendon repair was performed from the composite mass to the proximal and distal stumps. No complication in the postoperative period occurred. At latest follow-up, 12 months postoperatively, the patient showed a normal joint function and was satisfied with the treatment. Palmaris longus tendon included in a radial forearm free flap could be recommended for combined soft tissue and tendon defects, particularly on the foot dorsum.
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Affiliation(s)
- Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Stefano Bastoni
- C.O.O., Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
| | - Maria S Bartoli
- C.O.O., Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
| | - Giulio Menichini
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Marco Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Primo A Daolio
- C.O.O., Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
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Bastías GF, Cuchacovich N, Schiff A, Carcuro G, Pellegrini MJ. Technique tip: EDL-to-EHL double loop transfer for extensor hallucis longus reconstruction. Foot Ankle Surg 2019; 25:272-277. [PMID: 29409181 DOI: 10.1016/j.fas.2017.11.005] [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: 06/13/2017] [Revised: 10/03/2017] [Accepted: 11/26/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extensor hallucis longus (EHL) tendon injuries often occur in the setting of lacerations to the dorsum of the foot. End-to-end repair is advocated in acute lacerations, or in chronic cases when the tendon edges are suitable for tension free repair. Reconstruction with allograft or autograft is advocated for cases not amenable to a primary direct repair. This is often seen in cases with tendon retraction and more commonly in the chronic setting. In many countries the use of allograft is very limited or unavailable making reconstruction with autograft and tendon transfers the primary choice of treatment. Tendon diameter mismatch and diminished resistance are common issues in other previously described tendon transfers. METHODS We present the results of a new technique for reconstruction of non-reparable EHL lacerations in three patients using a dynamic double loop transfer of the extensor digitorum longus (EDL) of the second toe that addresses these issues. RESULTS At one-year follow up, all patients recovered active/passive hallux extension with good functional (AOFAS Score) and satisfaction results. No reruptures or other complications were reported in this group of patients. No second toe deformities or dysfunction were reported. CONCLUSIONS Second EDL-to-EHL Double Loop Transfer for Extensor Hallucis Longus reconstruction is a safe, reproducible and low-cost technique to address EHL ruptures when primary repair is not possible. LEVEL OF EVIDENCE IV (Case Series).
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Affiliation(s)
- Gonzalo F Bastías
- Foot and Ankle Unit, Instituto Traumatológico, Santiago, Chile; Department of Orthopedic Surgery, Clínica Indisa, Santiago, Chile; Department of Orthopedic Surgery, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Natalio Cuchacovich
- Foot and Ankle Unit, Hospital Clínico Universidad de Chile, Santiago, Chile; Department of Orthopedic Surgery, Clínica Las Condes, Santiago, Chile; Department of Orthopedic Surgery, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Adam Schiff
- Department of Orthopedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Giovanni Carcuro
- Foot and Ankle Unit, Hospital Clínico Universidad de Chile, Santiago, Chile; Department of Orthopedic Surgery, Clínica Las Condes, Santiago, Chile; Department of Orthopedic Surgery, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Manuel J Pellegrini
- Foot and Ankle Unit, Hospital Clínico Universidad de Chile, Santiago, Chile; Department of Orthopedic Surgery, Clínica Las Condes, Santiago, Chile; Department of Orthopedic Surgery, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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Kurashige T. Chronic extensor hallucis longus tendon rupture treated with double-bundle autograft of extensor hallucis capsularis: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19841962. [PMID: 31007922 PMCID: PMC6457017 DOI: 10.1177/2050313x19841962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/14/2019] [Indexed: 12/25/2022] Open
Abstract
The extensor hallucis capsularis is an accessory extensor tendon with varied
occurrence. Here, we present the case of a 40-year-old man with chronic extensor
hallucis longus tendon rupture treated using extensor hallucis capsularis tendon
as a double-bundle autograft. He had dropped a knife proximal to the right
hallux metatarsophalangeal joint 4 months ago. Computed tomography revealed the
presence of extensor hallucis capsularis, with its width and thickness, and the
point of divergence from the extensor hallucis longus tendon. Because direct
suturing was considered difficult and the extensor hallucis capsularis tendon
was sufficiently wide and long, double-bundle autograft transplantation of
extensor hallucis capsularis was performed. At 1-year follow-up examination, the
patient retained almost full function of his hallux. To the best of our
knowledge, this is the first case to use this technique. Using the extensor
hallucis capsularis tendon for grafting should be carefully considered because
the variable width and length may limit the graft strength. Level of evidence: IV
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Affiliation(s)
- Toshinori Kurashige
- Department of Orthopaedic Surgery, Chiba Aiyukai Memorial Hospital, Nagareyama, Japan
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So E, Black TE, Mehl B. Split Peroneus Longus Free Tendon Autograft Transplantation for the Treatment of Neglected Extensor Hallucis Longus Tendon Laceration: A Case Report. J Foot Ankle Surg 2018; 57:210-214. [PMID: 29268901 DOI: 10.1053/j.jfas.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 02/03/2023]
Abstract
A neglected laceration of the extensor hallucis longus (EHL) tendon is rare. Retraction of the tendon ends often occurs when a laceration is neglected, leading to a substantial tendon deficit. A paucity of case reports is available describing the treatment of EHL laceration with a large area of gap secondary to retraction. Therefore, the treatment recommendations are limited. We present the case of a neglected EHL tendon laceration with a 10.5-cm gap in a healthy 22-year-old female. The EHL tendon laceration was repaired using a split peroneus longus tendon autograft that, to the best of our knowledge, has not been previously reported. At the 3-year follow-up evaluation, the patient retained full function of her hallux and was free of symptoms.
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Affiliation(s)
- Eric So
- Resident, Grant Medical Center, Columbus, OH.
| | - Trevor E Black
- Fellow, Southeast Permanente Foot and Ankle Trauma & Reconstructive Fellowship, Atlanta, GA
| | - Bradley Mehl
- Attending Faculty, Private Practice, Columbus, OH
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Endoscopic-assisted Repair of Neglected Rupture or Rerupture After Primary Repair of Extensor Hallucis Longus Tendon. Sports Med Arthrosc Rev 2016; 24:34-7. [PMID: 26752777 DOI: 10.1097/jsa.0000000000000087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rerupture of the extensor hallucis longus tendon after primary repair and neglected rupture of the tendon poses surgical challenges to orthopedic surgeons. Open exploration and repair of the tendon ends usually requires large incision and extensive dissection. This may induce scarring and adhesion around the repaired tendon. Endoscopic-assisted repair has the advantage of minimally invasive surgery including less soft tissue trauma and scar formation and better cosmetic result. The use of Krackow locking suture and preservation of the extensor retinacula allow early mobilization of the great toe.
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Wong JC, Daniel JN, Raikin SM. Repair of acute extensor hallucis longus tendon injuries: a retrospective review. Foot Ankle Spec 2014; 7:45-51. [PMID: 24334369 DOI: 10.1177/1938640013514271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extensor hallucis longus (EHL) tendon injuries may occur with lacerations sustained over the dorsum of the foot and lead to hallux dysfunction. Primary repair is performed when tendon edges are opposable; however, if a gap exists between tendon edges, then reconstruction with tendon graft or tendon transfer may be necessary to restore hallux alignment and dorsiflexion. We describe the surgical technique and report the results on a large series of patients having undergone primary repair or reconstruction of EHL tendon lacerations. METHODS We retrospectively reviewed all patients undergoing EHL tendon repair or reconstruction between January 2005 and May 2012. Information on patient demographics, mechanism of injury, time to surgery, intraoperative findings, surgical repair or reconstruction technique, and postoperative function were collected. Patients were contacted by telephone for administration of the Foot and Ankle Ability Measure (FAAM) and American Orthopaedic Foot and Ankle Society Hallux questionnaires. RESULTS Twenty of 23 patients undergoing EHL tendon repair or reconstruction were available for review at an average clinical follow-up of 12 months (range 3-89 months) and an average telephone follow-up of 5.1 years (range 1-10.4 years). Primary EHL repair was performed in 80% of cases, with the remaining patients undergoing reconstruction with deep tendon transfer of the extensor digitorum longus tendon from the second toe. At final follow-up, 19 of 20 patients had active hallux dorsiflexion. The average FAAM Activities of Daily Living score was 94.2% (range 58.3% to 100%) and the average FAAM Sports score was 94.2% (range 65.6% to 100%). CONCLUSION Primary repair or reconstruction of EHL tendon lacerations is a reliable procedure that restores hallux alignment and function in most patients as measured by the validated FAAM questionnaire. Deep tendon transfer from the extensor digitorum longus may be performed if EHL tendon edges are not opposable thus eliminating the need for allograft reconstruction.
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Affiliation(s)
- Justin C Wong
- Department of Orthopaedic Surgery (JCW), Thomas Jefferson University, Philadelphia, Pennsylvania
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Cerovac S, Miranda B. Tendon ‘turnover lengthening’ technique. J Plast Reconstr Aesthet Surg 2013; 66:1587-90. [DOI: 10.1016/j.bjps.2013.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/06/2013] [Accepted: 06/03/2013] [Indexed: 11/29/2022]
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Ballard DH, Campbell KJ, Hedgepeth KB, Hollister AM, Simoncini AA, Pahilan ME, Youssef AM. Anatomic guide and sonography for surgical repair of leg muscle lacerations. J Surg Res 2013; 184:178-82. [PMID: 23566441 DOI: 10.1016/j.jss.2013.03.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 02/27/2013] [Accepted: 03/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND There were over 110,000 leg laceration cases reported in the United States in 2011. Currently, muscle laceration is repaired by suturing epimysium to epimysium. Tendon-to-tendon repair is stronger, restores the muscle's resting length, and leads to a better functional recovery. Tendons retract into the muscle belly following laceration and surgeons have a difficult time finding them. Many surgeons are unfamiliar with leg muscle anatomy and the fact that the leg muscles have long intramuscular tendons that are not visible in situ. A surgical anatomic guide exists to help surgeons locate forearm tendons; no such guide exists for tendons in the leg. MATERIALS AND METHODS The leg tendon ends of 11 cadavers were dissected, measured, and recorded as percentages of leg length. High-frequency ultrasound was used to locate tendon ends in three additional cadavers. These locations were compared with the actual tendon ends located via dissection. RESULTS There was little variation in tendon end position within the cadaver group, between men and women or right and left legs. The data are presented as an anatomic guide to inform surgeons of the tendon ends' likely locations in the leg. CONCLUSION The location of leg intramuscular tendon ends is predictable and the anatomic guide will help surgeons locate tendon ends and perform tendon-to-tendon repairs. Ultrasound is a potentially effective tool for detection of accurate location of repairable tendon ends in leg muscle lacerations.
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Affiliation(s)
- David H Ballard
- Louisiana State University Health, Shreveport, Louisiana 71103, USA
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Affiliation(s)
- Joseph Jeremy Chang
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China
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