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Klauser AS, Strobl S, Schwabl C, Kremser C, Klotz W, Vasilevska Nikodinovska V, Stofferin H, Scharll Y, Halpern E. Impact of Dual-Energy Computed Tomography (DECT) Postprocessing Protocols on Detection of Monosodium Urate (MSU) Deposits in Foot Tendons of Cadavers. Diagnostics (Basel) 2023; 13:2208. [PMID: 37443602 DOI: 10.3390/diagnostics13132208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To evaluate two different dual-energy computed tomography (DECT) post-processing protocols for the detection of MSU deposits in foot tendons of cadavers with verification by polarizing light microscopy as the gold standard. MATERIAL AND METHODS A total of 40 embalmed cadavers (15 male; 25 female; median age, 82 years; mean, 80 years; range, 52-99; SD ± 10.9) underwent DECT to assess MSU deposits in foot tendons. Two postprocessing DECT protocols with different Hounsfield unit (HU) thresholds, 150/500 (=established) versus 120/500 (=modified). HU were applied to dual source acquisition with 80 kV for tube A and 140 kV for tube B. Six fresh cadavers (4 male; 2 female; median age, 78; mean, 78.5; range 61-95) were examined by DECT. Tendon dissection of 2/6 fresh cadavers with positive DECT 120 and negative DECT 150 studies were used to verify MSU deposits by polarizing light microscopy. RESULTS The tibialis anterior tendon was found positive in 57.5%/100% (DECT 150/120), the peroneus tendon in 35%/100%, the achilles tendon in 25%/90%, the flexor halluces longus tendon in 10%/100%, and the tibialis posterior tendon in 12.5%/97.5%. DECT 120 resulted in increased tendon MSU deposit detection, when DECT 150 was negative, with an overall agreement between DECT 150 and DECT 120 of 80% (p = 0.013). Polarizing light microscope confirmed MSU deposits detected only by DECT 120 in the tibialis anterior, the achilles, the flexor halluces longus, and the peroneal tendons. CONCLUSION The DECT 120 protocol showed a higher sensitivity when compared to DECT 150.
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Affiliation(s)
| | - Sylvia Strobl
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christoph Schwabl
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christian Kremser
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Werner Klotz
- Department of Internal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Violeta Vasilevska Nikodinovska
- University Surgical Clinic "St. Naum Ohridski", Faculty of Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia
| | - Hannes Stofferin
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Yannick Scharll
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ethan Halpern
- Jefferson Prostate Diagnostic and Kimmel Cancer Center, Department of Radiology and Urology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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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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Management of Anterior Tibialis Tendon Ruptures. J Am Acad Orthop Surg 2021; 29:691-701. [PMID: 34197343 DOI: 10.5435/jaaos-d-20-00802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
Anterior tibialis tendon ruptures, while relatively infrequent ruptures, are commonly identified in delayed fashion, which can lead to significant impairments in patient gait and function. Surgical treatment is typically required to restore ankle dorsiflexion function and proper gait. Depending on various patient-specific factors, tendon quality and excursion, and chronicity, a range of treatment options are available to manage these patients, from nonsurgical care to surgical treatment. Surgical options include direct repair, local tendon transfer, autograft tendon reconstruction, and allograft tendon reconstruction. Additional procedures may need to be considered. Despite the variety of described surgical procedures, limited evidence-based guidelines are available to direct surgeons in the most optimal treatment for their patients. In addition to the relevant anatomy, biomechanics, and pathoanatomy, the reconstructive armamentarium is detailed and reviewed here, along with outcomes and potential complications, to guide surgeons in the most appropriate treatment for their patients.
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Han Z, Zhao X, Ma W, Li T, Zhang Y, Qi C, Yu T. [Analysis of the effect of asymptomatic hyperuricemia on the effectiveness after arthroscopic rotator cuff repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:667-672. [PMID: 34142490 DOI: 10.7507/1002-1892.202102004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effect of asymptomatic hyperuricemia on the effectiveness of arthroscopic rotator cuff repair. Methods The clinical data of 80 patients who underwent arthroscopic rotator cuff repair and met the selection criteria between March 2018 and December 2019 were retrospectively analyzed. According to the serum uric acid level, the patients were divided into hyperuric acid group (46 cases, the serum uric acid level was more than 417 μmol/L in males and was more than 357 μmol/L in females) and normal group (34 cases, serum uric acid level was lower than the above standard). There was no significant difference in gender, age, side, body mass index, blood glucose level, total cholesterol level, rotator cuff tear size, and preoperative shoulder motion, visual analogue scale (VAS) score, University of California-Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and other general data between the two groups ( P>0.05). The range of motion of abduction, forward flexion, and external rotation at 90° abduction were recorded and compared between the two groups before operation and at last follow-up; the improvement of shoulder pain was evaluated by VAS score; the improvement of shoulder function was evaluated by UCLA score, Constant score, and ASES score; and the shoulder joint MRI grade was evaluated according to Sugaya evaluation criteria. Results All patients were followed up 9-16 months, with an average of 11.9 months; there was no significant difference in the follow-up time between the two groups ( t=0.968, P=0.336). There were 2 cases of retear in the hyperuric acid group (including 1 case of severe tear) and 1 case of light retear in the normal group. The remaining patients in the two groups had no early-related complications. At last follow-up, the range of motion of the shoulder joints (abduction, forward flexion, external rotation at 90° abduction), VAS score, UCLA score, Constant score, and ASES score of the two groups were significantly improved when compared with preoperative ones ( P<0.05); the above indicators in the normal group were significantly better than those in the hyperuric acid group ( P<0.05). The MRI grade of the shoulder joint in the normal group was significantly better than that in the hyperuric acid group ( Z=-2.000, P=0.045). Conclusion Compared with patients with normal serum uric acid level, asymptomatic hyperuricemia can lead to worse recovery after arthroscopic rotator cuff repair in patients with rotator cuff tears.
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Affiliation(s)
- Zengshuai Han
- Department of Orthopedic Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266100, P.R.China
| | - Xia Zhao
- Department of Orthopedic Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266100, P.R.China
| | - Wenru Ma
- Department of Orthopedic Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266100, P.R.China
| | - Tianyu Li
- Department of Orthopedic Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266100, P.R.China
| | - Yi Zhang
- Department of Orthopedic Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266100, P.R.China
| | - Chao Qi
- Department of Orthopedic Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266100, P.R.China
| | - Tengbo Yu
- Department of Orthopedic Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266100, P.R.China
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5
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Abstract
BACKGROUND Though the tibialis anterior (TA) serves a vital role in ankle dorsiflexion, there is little information regarding risk factors and demographic information that might predispose one to tendinopathy or rupture. This study investigates the features of patients in a single institution who presented with either TA tendinopathy or rupture. The circumstances surrounding rupture were also noted. METHODS ICD-9/10 codes were used to find patients who presented with TA pathology to 2 foot and ankle surgeons at 1 academic medical center from 2011 to 2018. Patient characteristics were noted, including age, sex, body mass index, and the presence of a gastrocnemius equinus contracture. Characteristics of patients with traumatic and atraumatic ruptures were compared. RESULTS Ninety-four patients presented between 2011 and 2018 (79 cases of tendinopathy and 15 ruptures). The average patient age was 56 years, and the ratio of women to men was 74:20 (3.7:1). With regard to those who experienced rupture, there were 2 ruptures directly related to athletic activity (traumatic), whereas 13 ruptures were found on examination with no overt history of injury (atraumatic). The average age for patients with traumatic ruptures was 39 years compared with 73 years for those with atraumatic rupture (P < .05). CONCLUSION This study investigates the features of patients in a single institution who presented with TA pathology. With regard to tendon ruptures, traumatic ruptures tend to occur in younger patients, whereas older patients are more likely to suffer atraumatic ruptures. Nonoperative treatment often appears to be effective for TA pathology. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Matthew M Levitsky
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Christina E Freibott
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Justin K Greisberg
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - J Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.,Jacksonville Orthopaedic Institute, Jacksonville, FL, USA
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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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7
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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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8
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Towiwat P, Chhana A, Dalbeth N. The anatomical pathology of gout: a systematic literature review. BMC Musculoskelet Disord 2019; 20:140. [PMID: 30935368 PMCID: PMC6444644 DOI: 10.1186/s12891-019-2519-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/20/2019] [Indexed: 02/14/2023] Open
Abstract
Background The aim of this systematic literature review was to comprehensively describe the anatomical pathology of tissues affected by gout. Methods We searched PubMed, The Cochrane Library, Excerpta Medica Database (EMBASE), and Web of Science Core Collection for all English language articles published before March 2018. Articles were included if they described the microscopic or macroscopic appearances of gout in human tissue. Results Four hundred and seventeen articles met inclusion criteria and were included in the review. Articles describing the anatomical pathology of gout in musculoskeletal structures, including bone, tendon and ligaments, synovium and cartilage, were most common. Articles describing skin and kidney pathology in gout were also common, with pathology in other sites such as visceral organs less common. At all sites, monosodium urate crystal deposition was reported, and the tophus was also described within many different tissues. During a gout flare, diffuse acute neutrophilic synovial inflammation was evident. The tophus was described as an organised chronic giant cell granulomatous structure consisting of monosodium urate crystals, innate and adaptive immune cells, and fibrovascular tissue. Conclusions Consistent with the clinical presentation of gout, most studies describing the anatomical pathology of gout report involvement of musculoskeletal structures, with monosodium urate crystal deposition and tophus the most common lesions described. This review details the anatomical pathology features of gout at affected sites. Electronic supplementary material The online version of this article (10.1186/s12891-019-2519-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patapong Towiwat
- Department of Medicine, University of Auckland, Auckland, New Zealand. .,Department of Medicine, Naresuan University, Phitsanulok, 65000, Thailand.
| | - Ashika Chhana
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Tickner A, Thorng S, Martin M, Marmolejo V. Management of Isolated Anterior Tibial Tendon Rupture: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2019; 58:213-220. [PMID: 30554867 DOI: 10.1053/j.jfas.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Indexed: 02/03/2023]
Abstract
Rupture of the tibialis anterior tendon is a rare condition reported to occur most often spontaneously in patients >45 years of age. Diagnosis is often delayed due to transient pain at the time of rupture and the ability of the long extensors to compensate for the lost action of the tibialis anterior. Treatment has been proposed to be based on the activity level of the individual; however, no consensus has been reached on the optimal treatment modality for this rare condition. A systematic review and meta-analysis were performed to determine outcomes obtained with conservative and surgical management. Twenty-four references (155 cases) were identified. Conservative management (21 cases, 13.55%) was associated with poorer outcomes (odds ratio [OR] 0.68; I2 = 61%) because of pain and functional limitations related to ankle dorsiflexory weakness. Surgical intervention (134 cases, 86.45%) had a better chance for good outcome (OR 8.40; I2 = 63%). Use of an ipsilateral split/turn-down ipsilateral tibialis anterior tendon graft (OR 32.15; I2 = 0%) semitendinous autograft (OR 15.25; I2 = 44%), or direct repair (OR 12.57; I2 = 0%) provided the best postoperative outcomes, whereas extensor hallucis longus autograft was associated with the worst (OR 0.27, I2 = 34%). The most common postoperative finding was objective mild dorsiflexory weakness (4/5 muscle strength), which did not translate to subjective functional limitation. Good functional results were found to occur regardless of patient age at the time of intervention. Results of this systematic review and meta-analysis suggests that surgical intervention provides better functional outcomes than conservative management. Use of an extensor hallucis longus autograft is not recommended if surgical intervention is performed.
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Affiliation(s)
- Anthony Tickner
- Podiatric Surgical Attending, Saint Vincent Hospital/Worcester Medical Center PM&S 36 Surgical Residency Program, Worcester, MA.
| | - Seiha Thorng
- Staff Podiatrist, Sutter Gould Medical Group, Stockton, CA
| | - Mary Martin
- Resident, Saint Vincent Hospital/Worcester Medical Center PM&S 36 Surgical Residency Program, Worcester, MA
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Papachristos IV, Dalal RB. Tibialis anterior tendon traumatic rupture secondary to a closed talar neck fracture: A case report. Foot (Edinb) 2019; 38:76-80. [PMID: 30711780 DOI: 10.1016/j.foot.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/21/2019] [Indexed: 02/04/2023]
Abstract
A case of a 22 year-old woman who sustained a closed Hawkins type II talar neck fracture after her left foot was caught in a rope while rock climbing outdoors is described. She presented to emergency department with a swollen and neurovascularly intact foot and a displaced talar neck fracture was identified. Intraoperatively a traumatic rupture of tibialis anterior tendon was found and was primarily repaired after the talar fixation. Revisiting the mechanism of injury it was evident that the jagged fracture ends ruptured the tibialis anterior tendon while she was hanging upside down on the strapping with the foot in forced equinus. This is the first case of such complication associated with a talar fracture and signifies the importance of tibialis anterior examination in such fractures.
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Affiliation(s)
- Ioannis V Papachristos
- Stepping Hill Hospital, Stockport NHS Foundation Trust, Poplar Grove, Stockport SK2 7JE, United Kingdom.
| | - Rakesh B Dalal
- Stepping Hill Hospital, Stockport NHS Foundation Trust, Poplar Grove, Stockport SK2 7JE, United Kingdom.
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Vrettakos A, Vampertzis T, Vavilis T, Chaftikis N, Antonoglou G, Papastergiou S. Closed Rupture of Anterior Tibialis Tendon after Minor Injury without Medical History: A Surgical Repair. J Orthop Case Rep 2019; 9:67-70. [PMID: 32405492 PMCID: PMC7210906 DOI: 10.13107/jocr.2019.v09.i04.1484] [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 Closed rupture of the anterior tibial tendon is uncommon, with only a few cases being documented in literature. It usually happens in the forceful plantar flexion of the foot while in eversion and the simultaneous contraction of the anterior tibialis muscle. Care Report We present the case of a 65-year-old man with closed rupture of the tibialis anterior tendon after injury who was treated by primary surgical repair. The surgical technique as well as the rehabilitation protocol are described in detail. Conclusion Primary surgical reconstruction repair is indicated in younger, active individuals. It appears that early diagnosis and treatment provides the best clinical results, while delayed treatment usually requires the use of a tendon graft in combination with tendon transfers, giving inferior results compared to primary tendon repair.
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Affiliation(s)
- Aristeidis Vrettakos
- Department of Orthopaedic Surgery and Traumatology, Unit for Sports Medicine, Agios Pavlos General Hospital of Thessaloniki, Greece
| | - Themistoklis Vampertzis
- Department of Orthopaedic Surgery and Traumatology, Unit for Sports Medicine, Agios Pavlos General Hospital of Thessaloniki, Greece
| | - Theofanis Vavilis
- Laboratory of Medical Biology-Genetics, Medical School, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Chaftikis
- Department of Orthopaedic Surgery and Traumatology, St. Luke's Hospital, Panorama,55236, Thessaloniki, Greece
| | - Georgios Antonoglou
- Department of Orthopaedic Surgery and Traumatology, Unit for Sports Medicine, Agios Pavlos General Hospital of Thessaloniki, Greece
| | - Stergios Papastergiou
- Department of Orthopaedic Surgery and Traumatology, Unit for Sports Medicine, Agios Pavlos General Hospital of Thessaloniki, Greece
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12
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Laing AJ, Carr C. Decompressive Medial Cuneiform Exostectomy for Resistant Tibialis Anterior Insertional Tendinopathy. J Foot Ankle Surg 2018; 57:531-536. [PMID: 29685565 DOI: 10.1053/j.jfas.2017.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Indexed: 02/03/2023]
Abstract
Distal tibialis anterior tendinopathy, as a clinical entity, has only recently been documented in foot and ankle studies. We report our experience with medial cuneiform decompressive exostectomy and superficial tendon debridement in 14 cases of recalcitrant tibilalis anterior insertional pain. We reviewed 13 patients (14 feet; 12 females, 1 male; mean age 67.9 ± 7.5; range 55 to 80 years) in whom conservative treatment had failed who had undergone debridement of the insertional tibialis anterior tendon and decompressive exostectomy of the medial cuneiform. Pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale and visual analog scale (VAS) pain scores, local clinical findings, and dorsiflexion power at an average follow-up period of 28 ± 17.9 (range 6 to 55) months were assessed. All patients had experienced burning, nocturnal, medial midfoot pain and disability. The symptom longevity preoperatively was 8.5 ± 3.1 (range 6 to 17) months. Peritendinous or intrasubstance signal changes were noted on magnetic resonance imaging in 10 feet (71%). The mean preoperative VAS pain score was 8.7 ± 1.3 (range 5 to10), whereas postoperative it was 0.4 ± 0.5 (range 0 to1) (p = .001). The mean preoperative and postoperative AOFAS midfoot scale score was 54 ± 14.5 (range 20 to 70) and 91 ± 6.8 (range 79 to 100), respectively (p = .001). Postoperative ankle dorsiflexion power was normal and local tenderness had resolved in all patients. One patient (7.1%) stumbled at 2 weeks, resulting in avulsion of the tibialis anterior tendon, requiring transosseous fixation and gastrocnemius recession. All patients reported satisfaction with the surgical outcome and willingness to undergo the surgery again if necessary. A combination of medial cuneiform mechanical decompression and insertional tendon debridement can offer successful outcomes in resistant insertional tibialis anterior tendinopathy.
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Affiliation(s)
- Alan J Laing
- Foot and Ankle Surgeon, Orthopedic Department, Beacon Hospital, Dublin, Ireland.
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13
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Valisena S, Petri GJ, Ferrero A. Zancolli Technique for Delayed Repair of Tibialis Anterior Tendon Rupture: A Case Report and Literature Review. Foot Ankle Spec 2018; 11:372-377. [PMID: 29307230 DOI: 10.1177/1938640017751539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several techniques for repair of tibialis anterior tendon ruptures (TATRs) are reported, although it is a rare lesion. We describe a case of TATR, discuss our treatment, and review the criteria for the choice of treatment. METHODS In November 2015, a 61-year-old woman presented to our department 13 days after an injury to her left ankle, with avulsion of TAT. Because of the stump retraction, we performed a Zancolli-like plasty, anchoring the tendon to the navicular bone. Evidence about the timing and type of surgery has been reviewed. RESULTS The patient was followed up for 16 months before being discharged. The American Orthopaedic Foot and Ankle Society score improved from an initial value of 32 to a final score of 90. CONCLUSIONS The choice of treatment depends on several factors. Patients' physical demands and the type of rupture guide the choice of surgical technique. LEVELS OF EVIDENCE Therapeutic, Level IV: Retrospective.
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Affiliation(s)
- Silvia Valisena
- Service of Traumatology, Regional Hospital of Bellinzona, Via Ospedale, Bellinzona, Switzerland (SV).,Clinica Luganese Moncucco, Lugano, Switzerland (GJP, AF)
| | - Gianfranco John Petri
- Service of Traumatology, Regional Hospital of Bellinzona, Via Ospedale, Bellinzona, Switzerland (SV).,Clinica Luganese Moncucco, Lugano, Switzerland (GJP, AF)
| | - Andrea Ferrero
- Service of Traumatology, Regional Hospital of Bellinzona, Via Ospedale, Bellinzona, Switzerland (SV).,Clinica Luganese Moncucco, Lugano, Switzerland (GJP, AF)
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14
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Patel R, Fallat L. Surgical Techniques for Repair of Atraumatic Tibialis Anterior Tendon Ruptures: A Report of Two Cases. J Foot Ankle Surg 2018; 56:1343-1349. [PMID: 29079244 DOI: 10.1053/j.jfas.2017.06.024] [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: 06/22/2016] [Indexed: 02/03/2023]
Abstract
Tendon ruptures of the foot and ankle are overwhelmingly due to direct or blunt force trauma; however, spontaneous tendon ruptures have been less commonly documented in the published data. Surgical techniques for the repair of atraumatic ruptures differ from those for acute traumatic ruptures owing to the delayed patient presentation. Spontaneous tendon ruptures usually result from predisposing factors that have compromised the structural integrity of the tendon before the rupture occurs. We present 2 cases of atraumatic rupture of the tibialis anterior tendon, each repaired using a different surgical technique. A unique surgical procedure was selected after preoperative planning and individual patient considerations. Each patient had a minimum follow-up period of 12 months after surgery. Both patients returned to their previous functional status with no long-term sequela.
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Affiliation(s)
- Romy Patel
- Second-Year Resident, Podiatric Surgical Residency, Beaumont Hospital Wayne, Podiatric Surgery, Wayne, MI
| | - Lawrence Fallat
- Director, Podiatric Surgical Residency, Beaumont Hospital Wayne, Podiatric Surgery, Wayne, MI.
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15
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Presentation, Diagnosis, and Nonsurgical Treatment Options of the Anterior Tibial Tendon, Posterior Tibial Tendon, Peroneals, and Achilles. Foot Ankle Clin 2017; 22:677-687. [PMID: 29078822 DOI: 10.1016/j.fcl.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Disorders of the anterior tibial tendon (ATT) are rare, and relatively few series have been described in the literature. Ruptures of the ATT are more common than tendinopathies of the ATT. For those patients with a tendinopathy, initial treatment may include activity and shoe-wear modifications.
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16
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Harkin E, Pinzur M, Schiff A. Treatment of Acute and Chronic Tibialis Anterior Tendon Rupture and Tendinopathy. Foot Ankle Clin 2017; 22:819-831. [PMID: 29078830 DOI: 10.1016/j.fcl.2017.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tibialis anterior (TA) tendon rupture is a rare injury that has been described and studied in orthopedic literature through case reports and low-volume case studies. This article reviews the current literature on TA tendinosis and acute and chronic ruptures. It discusses the patient presentation, physical examination, nonoperative management, surgical treatment options, and outcomes.
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Affiliation(s)
- Elizabeth Harkin
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Maguire Suite 1700, Maywood, IL 60153, USA.
| | - Michael Pinzur
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Maguire Suite 1700, Maywood, IL 60153, USA
| | - Adam Schiff
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Maguire Suite 1700, Maywood, IL 60153, USA
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17
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Samaila EM, Luiso F, Trivellin G, Brunelli M, Magnan B. A pseudotumoral lesion diagnosed for a hypertrofic fibrosis at the proximal stump in anterior tibialis tendon missed rupture: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:120-124. [PMID: 29083363 PMCID: PMC6357660 DOI: 10.23750/abm.v88i4 -s.6803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
The Anterior Tibialis is the most important muscle in ankle dorsiflexion. The anterior tibialis tendon (ATT)'s rupture is an infrequent condition which can be both traumatic and spontaneous. Clinic is poor and it is necessary to confirm the suspect by US or MRI. The reported case refers to a 40 years old man who had a direct trauma at ankle and midfoot which was originally conservatively treated for an ankle sprain. Three months later he returned with pain, swelling and paresthesia. MRI was performed showing a neoformation in the contest of ATT's rupture. The patient underwent open excisional biopsy which was diagnostic for hypertrofic fibrosis. After two weeks, the symptoms were completely decreased and patient didn't want to undergo surgery for tendon reconstruction because he had no limitation in daily activity life.
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18
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Huang SW, Wu CW, Lin LF, Liou TH, Lin HW. Gout Can Increase the Risk of Receiving Rotator Cuff Tear Repair Surgery. Am J Sports Med 2017; 45:2355-2363. [PMID: 28486089 DOI: 10.1177/0363546517704843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gout commonly involves joint inflammation, and clinical epidemiological studies on involved tendons are scant. Rotator cuff tears are the most common cause of shoulder disability, and surgery is one of the choices often adopted to regain previous function. PURPOSE To investigate the risk of receiving rotator cuff repair surgery among patients with gout and to analyze possible risk factors to design an effective prevention strategy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors studied a 7-year longitudinal follow-up of patients from the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005). This included a cohort of patients who received a diagnosis of gout during 2004-2008 (gout cohort) and a cohort matched by propensity scores (control cohort). A 2-stage approach that used the National Health Interview Survey 2005 was used to obtain missing confounding variables from the LHID2005. The crude hazard ratio (HR) and adjusted HR were estimated between the gout and control cohorts. RESULTS The gout and control cohorts comprised 32,723 patients with gout and 65,446 people matched at a ratio of 1:2. The incidence of rotator cuff repair was 31 and 18 per 100,000 person-years in the gout and control cohorts, respectively. The crude HR for rotator cuff repair in the gout cohort was 1.73 (95% confidence interval [CI], 1.23-2.44; P < .01) during the 7-year follow-up period. After adjustment for covariates by use of the 2-stage approach, the propensity score calibration-adjusted HR was 1.60 (95% CI, 1.12-2.29; P < .01) in the gout cohort. Further analysis revealed that the adjusted HR was 1.73 (95% CI, 1.20-2.50; P < .001) among patients with gout who did not take hypouricemic medication and 2.70 (95% CI, 1.31-5.59; P < .01) for patients with gout aged 50 years or younger. CONCLUSION Patients with gout, particularly those aged 50 years or younger and without hypouricemic medication control, are at a relatively higher risk of receiving rotator cuff repair surgery. Strict control of uric acid levels with hypouricemic medication may effectively reduce the risk of rotator cuff repair.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Chin-Wen Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan.,Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Abstract
MR imaging has an important role in the evaluation of the postoperative foot and ankle. In this article, a variety of operative techniques and postoperative findings in the foot and ankle are described, including tendon and ligament reconstruction, as well as the treatment of tarsal coalition and Morton neuroma. The role of MR imaging in the assessment of complications of foot and ankle surgery is also detailed.
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Affiliation(s)
- Samuel D Madoff
- Department of Radiology, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA.
| | - Jeffrey Kaye
- Department of Radiology, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA
| | - Joel S Newman
- Department of Radiology, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA
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20
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Reb CW, Stenson JF, Daniel JN. Tibialis Anterior Tendon Reconstruction Using Augmented Half-Thickness Tendon Segment Transposition. Foot Ankle Spec 2017; 10:144-148. [PMID: 28068842 DOI: 10.1177/1938640016685825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Tibialis anterior tendon rupture causes substantial morbidity. The present study describes the outcomes of augmented, half-thickness tibialis anterior tendon segment transposition, a novel reconstruction technique. This was an institutional review board-approved retrospective review of 3 patients with surgically treated attritional distal rupture with 1-year follow-up. The postdebridement tendon defect prohibited primary repair and was managed by distal transposition of a half-thickness healthy segment. This repair was augmented with human acellular dermal matrix allograft (Graftjacket, Wright Medical Technology, Memphis, TN). The mean age was 68 years (range, 59-73 years). Mean interval between injury and surgery was 59.3 days (range, 15-146 days). All patients regained symmetrical range of motion, motor power, and the ability to heel walk. Mean pain scores improved from 4.6 (range, 2.5-8.5) preoperatively to 0.7 (range, 0-2) postoperatively. Mean Foot and Ankle Ability Measure scores increased from 30.6 (range, 23.8-43.8) preoperatively to 78.7 (range, 72.6-97.6) postoperatively. No postoperative complications occurred. One patient was satisfied and 2 were very satisfied with their outcome. Although limited, the present findings appear to indicate that this technique produces short-term clinical results comparable to those described for other techniques for tibialis anterior tendon reconstruction. LEVELS OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Christopher W Reb
- Foot and Ankle Surgery, Orthopedic Foot and Ankle Center, Westerville, Ohio (CWR).,Rowan University School of Osteopathic Medicine, Stratford, New Jersey (JFS).,Jefferson Medical College, Foot and Ankle Services, Rothman Institute, Philadelphia, Pennsylvania (JND)
| | - James F Stenson
- Foot and Ankle Surgery, Orthopedic Foot and Ankle Center, Westerville, Ohio (CWR).,Rowan University School of Osteopathic Medicine, Stratford, New Jersey (JFS).,Jefferson Medical College, Foot and Ankle Services, Rothman Institute, Philadelphia, Pennsylvania (JND)
| | - Joseph N Daniel
- Foot and Ankle Surgery, Orthopedic Foot and Ankle Center, Westerville, Ohio (CWR).,Rowan University School of Osteopathic Medicine, Stratford, New Jersey (JFS).,Jefferson Medical College, Foot and Ankle Services, Rothman Institute, Philadelphia, Pennsylvania (JND)
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21
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Funk SS, Gallagher B, Thomson AB. Repair of Chronic Tibialis Anterior Tendon Ruptures. Orthopedics 2016; 39:e386-90. [PMID: 26966943 DOI: 10.3928/01477447-20160307-05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/13/2015] [Indexed: 02/03/2023]
Abstract
This article presents a novel technique for repair of chronic tibialis anterior tendon ruptures. All chronic tibialis anterior tendon ruptures reviewed were treated with this technique. Patients with chronic tibialis anterior tendon ruptures presenting to the authors' institution from 2006 to 2012 had preoperative and postoperative Foot and Ankle Ability Measure scores. The average follow-up time was 2.1 years. The average Foot and Ankle Ability Measure score was 66.1% preoperatively and 87.1% postoperatively (P=.002). This technique offers theoretical improved strength and may help avoid the need for tendon graft often required by other techniques.
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22
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Peroneal nerve palsy after ankle sprain: an update. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:53-60. [DOI: 10.1007/s00590-016-1845-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
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23
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Die geheilte Sehne. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Lui TH. Endoscopic Resection of Avulsed Fragment of Tibial Tuberosity and Endoscopic-Assisted Repair of Patellar Tendon. Arthrosc Tech 2015; 4:e851-4. [PMID: 27284523 PMCID: PMC4887428 DOI: 10.1016/j.eats.2015.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 08/11/2015] [Indexed: 02/03/2023] Open
Abstract
An avulsion fracture of part of the tibial tuberosity can occur as a result of a tophaceous tuberosity or Osgood-Schlatter disease. We describe an endoscopic technique of debridement, bone fragment resection, and tendon repair. This technique has the potential advantage of fewer wound complications. It is performed through proximal and distal portals on the sides of the patellar tendon. The working space is deep to the tendon. After debridement of the tendon and resection of the bone fragment, the tendon gap is assessed. Endoscopic-assisted side-by-side repair is performed to close the gap if the gap is less than 30% of the width of the tendon. If the gap is more than 30% of the width of the tendon, the proximal stump of the avulsed tendon can be retrieved through the proximal portal. Krackow suture with stay stitches is applied to the proximal stump. The stump is put back and sutured to the tibial insertion through a bone tunnel or suture anchor. This is augmented by side-by-side suturing of the avulsed tendon with the adjacent normal tendon.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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25
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Huh J, Boyette DM, Parekh SG, Nunley JA. Allograft Reconstruction of Chronic Tibialis Anterior Tendon Ruptures. Foot Ankle Int 2015; 36:1180-9. [PMID: 26041544 DOI: 10.1177/1071100715589006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic ruptures of the tibialis anterior tendon are often associated with tendon retraction and poor-quality tissue, resulting in large segmental defects that make end-to-end repair impossible. Interpositional allograft reconstruction has previously been described as an operative option in these cases; however, there are no reports of the clinical outcomes of this technique in the literature. METHODS Eleven patients with chronic tibialis anterior tendon ruptures underwent intercalary allograft recon-struction between 2006 and 2013. Patient demographics, injury presentation, and details of surgery were reviewed. Postoperative outcomes at a mean follow-up of 43.8 (range, 6-105) months included the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, Short Form-12 (SF-12) physical health score, Lower Extremity Functional Score (LEFS), visual analog scale (VAS) pain rating, dorsiflexion strength, gait analysis, and complications. RESULTS The average postoperative dorsiflexion strength, as categorized by the Medical Council grading scale, was 4.8 ± 0.45. The average postoperative VAS score was 0.8 ± 1.1. The average LEFS was 66.9 ± 17.2, SF-12 physical health score was 40.1 ± 14.4, and AOFAS score was 84.3 ± 7.7. One complication occurred, consisting of transient neuritic pain in the superficial peroneal nerve distribution. There were no postoperative infections, tendon reruptures, reoperations, or allograft-associated complications. CONCLUSION Allograft reconstruction of chronic irreparable tibialis anterior tendon ruptures yielded satisfactory strength, pain, and patient-reported functional outcomes. This technique offers a safe and reliable alternative, without the donor site morbidity associated with tendon transfer or autograft harvest. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jeannie Huh
- Duke University Medical Center, Department of Orthopaedic Surgery, Durham, NC, USA
| | | | - Selene G Parekh
- Duke University Medical Center, Department of Orthopaedic Surgery, Durham, NC, USA
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26
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Jain K, Asad M, Joshi Y, Syed A. Tibialis anterior tendon rupture as a complication of first tarsometatarsal joint steroid injection: A case report and review of literature. Foot (Edinb) 2015. [PMID: 26205997 DOI: 10.1016/j.foot.2015.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
First tarsometatarsal joint steroid injection is a commonly performed procedure in foot and ankle practice. The joint is in close proximity to tibialis anterior tendon insertion. We describe a rare complication of the procedure which had to be treated surgically. We have also listed available treatment options based on literature review.
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Affiliation(s)
- Kowshik Jain
- Wrightington Hospital, Wigan WN6 9EP, United Kingdom.
| | - Mehek Asad
- University of Manchester, United Kingdom.
| | - Yogesh Joshi
- Wrexham Maelor Hospital, Wrexham LL13 7TX, United Kingdom.
| | - Asad Syed
- Wrexham Maelor Hospital, Wrexham LL13 7TX, United Kingdom.
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27
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Lui TH. Endoscopic Resection of Gouty Tophus of the Patellar Tendon. Arthrosc Tech 2015; 4:e379-82. [PMID: 26759781 PMCID: PMC4680920 DOI: 10.1016/j.eats.2015.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 03/11/2015] [Indexed: 02/03/2023] Open
Abstract
Tophaceous deposition of tendon can result in spontaneous patellar tendon rupture. Surgical therapy may be needed to control symptoms and prevent tendon rupture. Open debridement of the lesion requires a lengthy incision over the lesion; this may result in symptomatic scar adhesion of the patellar tendon or an unhealed wound with persistent tophaceous discharge. Moreover, the other part of the patellar tendon cannot be examined through the incision. We describe a technique for endoscopic resection of a gouty tophus of the patellar tendon. It has the advantage of small incisions away from the lesion and tendon and minimizes wound problems. The whole patellar tendon can be examined endoscopically.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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28
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Rajeev A, McDonald M, Newby M, Patterson P. Traumatic avulsion of tibialis anterior following an industrial accident: A case report. Int J Surg Case Rep 2015; 14:125-8. [PMID: 26263452 PMCID: PMC4573416 DOI: 10.1016/j.ijscr.2015.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/22/2015] [Accepted: 06/27/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Rupture of the tibialis anterior tendon is uncommon and can occur spontaneously or following trauma. If suspected, it should be diagnosed promptly, enabling early surgical management and good restoration of function. PRESENTATION OF CASE A 48 year old male sustained a crush injury to his right foot when it became stuck in a vertical industrial fan at work. He attended A & E complaining of swelling of the dorsum of foot. On examination, there was tenderness at the base of the first metatarsal. X-ray revealed an avulsion fracture of the first metatarsal, and MRI showed rupture of tibialis anterior. The patient underwent surgical repair 10 days later, with post-operative management in a non-weight bearing, then weight bearing cast. X-ray at 8 weeks showed that the fracture had healed. The patient had a course of physiotherapy and was followed up at 6 months to assess pain and function. DISCUSSION Tibialis anterior rupture should be considered if the history is suggestive, and can be diagnosed clinically based on the triad of a 'pseudotumour' of the ruptured tendon, loss of tendon contour, and reduced dorsiflexion of the ankle. In our case, the avulsion fracture prompted further imaging to confirm the diagnosis and plan surgery. There are various operative technique described in the literature. We used a whip stitch with anchors to reattach the tendon to the base of first metatarsal. CONCLUSION A prompt and early diagnosis of surgical repair of tibialis anterior tendon avulsion is important to ensure that the patients return to work as an industrial worker.
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Affiliation(s)
- Aysha Rajeev
- Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK.
| | - Mhiari McDonald
- Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Mike Newby
- Department of Radiology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Paul Patterson
- Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
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30
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Palmanovich E, Brin YS, Laver L, Ben David D, Massrawe S, Nyska M, Hetsroni I. Chronic tibialis anterior tendon tear treated with an Achilles tendon allograft technique. Orthopedics 2013; 36:850-3. [PMID: 24200427 DOI: 10.3928/01477447-20131021-04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tibialis anterior tendon tear is an uncommon injury. Nontraumatic or degenerative tears are usually seen in the avascular zone of the tendon. Treatment can be conservative or surgical. Conservative treatment is adequate for low-demand older patients. For active patients, surgical treatment can be challenging for the surgeon because after debridement of degenerative tissue, a gap may be formed that can make side-to-side suture impossible. The authors present allograft Achilles tendon insertion for reconstruction of chronic degenerative tears. Using Achilles tendon allograft has the advantage of bone-to-bone fixation, allowing rapid incorporation and earlier full weight bearing.
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31
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Simultaneous surgical repair of a tibialis anterior tendon rupture and diabetic charcot neuroarthropathy of the midfoot: a case report. Clin Podiatr Med Surg 2013; 30:599-604. [PMID: 24075138 DOI: 10.1016/j.cpm.2013.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The combination of simultaneous rupture of a tibialis anterior tendon and Charcot neuroarthropathy of the midfoot in a diabetic patient is a rare and challenging condition that can lead to major complications if not addressed appropriately. This article discusses a tibialis anterior tendon rupture that may have developed before or after the incidence of the diabetic Charcot neuroarthropathy midfoot deformity and raises awareness to potential spontaneous tendon ruptures that may be associated with the diabetic Charcot foot.
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33
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Radice F, Monckeberg JE, Carcuro G. Longitudinal tears of peroneus longus and brevis tendons: a gouty infiltration. J Foot Ankle Surg 2011; 50:751-3. [PMID: 21816636 DOI: 10.1053/j.jfas.2011.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Indexed: 02/03/2023]
Abstract
The natural history of recurrent uric acid deposition includes joint destruction, as well as tendon weakening and rupture. Simultaneous rupture of the peroneus longus and brevis tendons secondary to tophaceous gout is very rare. In the present report, we describe the case of a 37-year-old man who had a history of recurrent ankle pain and 4 previous episodes of acute gout localized to his ipsilateral first metatarsophalangeal joint. The physical examination revealed the ankle pain to actually be localized to the peroneal tendons immediately distal to the fibular malleolar groove. Magnetic resonance imaging showed longitudinal tears in the peroneus longus and brevis. Surgical exploration and repair of the ruptured tendons revealed the presence of monosodium urate deposition within the substance of the tendons at the rupture sites. The tendons were debrided and repaired using longus to brevis tenodesis. The postoperative course was unremarkable and entailed referral to a rheumatologist for metabolic management. After more than a 1-year period of follow-up, the patient was ambulating without difficulties wearing regular shoe gear.
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Lefebvre B, Beldame J, Bertiaux S, Biga N. Open and subcutaneous recent tibialis anterior tendon ruptures: does postoperative immobilization method influence outcome? Orthop Traumatol Surg Res 2011; 97:211-6. [PMID: 21273155 DOI: 10.1016/j.otsr.2010.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/31/2010] [Accepted: 09/20/2010] [Indexed: 02/02/2023]
Abstract
UNLABELLED We report on seven traumatic lesions of the tibialis anterior tendon (one subcutaneous rupture and six open tears) in seven injured patients of mean age 45 years [17-79] all managed by direct suture and immobilization either using a cast boot (four cases) or a lower leg external fixator (three cases). After a mean follow-up of 31 months (6-50), external fixation achieved favourable clinical results with no specific complication. External fixation improves the conditions for suture efficiency, provides full immobilization and facilitates wound care in patients at a high risk of developing cutaneous complications. In accordance with data published in the literature, immobilization by means of a windowed cast boot achieved satisfactory results in patients with no risk factors. This method compatible with early mobilization avoids placement of a posterior splint which could induce slackening and weakening of tendon repair. LEVEL OF EVIDENCE Retrospective study (Level IV).
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Affiliation(s)
- B Lefebvre
- Department of Orthopaedics and Traumatology, Rouen University, Rouen University Hospital Center, 1, rue de Germont, 76031 Rouen cedex, France
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Aderinto J, Gross A. Delayed repair of tibialis anterior tendon rupture with Achilles tendon allograft. J Foot Ankle Surg 2011; 50:340-2. [PMID: 21435914 DOI: 10.1053/j.jfas.2011.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Indexed: 02/03/2023]
Abstract
Few cases of spontaneous rupture of the tibialis anterior tendon have been reported in the literature. We report a case of a 66-year-old male with a spontaneous rupture of his left tibialis anterior tendon, with a delayed presentation of approximately 3 months. At the time of reconstruction there was marked retraction of the proximal portion of the tibialis anterior tendon, which precluded an end-to-end repair; therefore, we used an Achilles tendon allograft.
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Affiliation(s)
- Joseph Aderinto
- Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada
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Ellington JK, McCormick J, Marion C, Cohen BE, Anderson RB, Davis WH, Jones CP. Surgical outcome following tibialis anterior tendon repair. Foot Ankle Int 2010; 31:412-7. [PMID: 20460068 DOI: 10.3113/fai.2010.0412] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibialis anterior tendon rupture is an uncommon injury that can cause significant functional deficit. Recent series have supported surgical reconstruction in younger, more active patients. We investigated our clinical outcomes of patients having undergone surgical management of tibialis anterior tendon ruptures. MATERIALS AND METHODS Fifteen tibialis anterior tendon ruptures in 14 patients were retrospectively reviewed after surgical management. Five had primary repair, while 10 had tendon transfers. Average age at time of surgery was 70.6 years with an average followup of 27.2 months. Patients were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) and SF-36 clinical outcome scores. Strength measurements utilizing a dynamometer and range of motion (ROM) were documented on the operative and non-operative ankles. Patient satisfaction surveys were performed. RESULTS Average postoperative AOFAS hindfoot score was 88.8 and SF-36 score was 76.4. There was a statistically significant difference in average dorsiflexion strength of 21.8 lbs/in(2) on the operative side and 28.8 lbs/in(2) on the non-operative limb, and in dorsiflexion ROM of patients that received a gastrocnemius recession. There was no statistically significant difference between primary tendon repair versus tendon transfer groups nor plantarflexion strength or ROM among any group. Patient surveys revealed that seven patients were completely satisfied, six had minor reservations, and one had major reservations. There were no complications. CONCLUSION This study supports the surgical repair or reconstruction of the tibialis anterior tendon ruptures to restore functional strength and ROM.
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Affiliation(s)
- J Kent Ellington
- OrthoCarolina, Foot and Ankle Institute, Charlotte, NC 28203, USA.
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De Carvalho Junior AE, Bittar CK, Salomão O, Miranda JB, Ninomiya A, Silva DB. TENDINOPATHY OF THE ANTERIOR COMPARTMENT OF THE ANKLE. Rev Bras Ortop 2010; 45:141-7. [PMID: 27022532 PMCID: PMC4799075 DOI: 10.1016/s2255-4971(15)30283-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To carry out a retrospective analysis on the etiopathogenesis, diagnosis and therapeutic options in cases of tendinopathy of the anterior compartment of the ankle. METHOD 13 patients underwent surgery between September 1998 and February 2009; ten men and three women. The right side was involved in twelve patients and the left in one. The mean age was 35 years (range 15-67). The etiology was traumatic in eight patients and degenerative (non-traumatic) in five. The mean time elapsed between diagnosis and treatment was 19 months (range 1 - 60) and the mean length of follow-up was 34 months (range 4 - 127). The diagnosis was made through anamnesis and clinical examination. Magnetic resonance imaging was performed on nine patients, for staging and planning. The surgical treatment was personalized in each case (synovectomy, resection of the muscle belly, consolidation with the adjacent tendon, and free grafting of the semitendinosus tendon). The following scales were used to evaluate the results: 1) subjective satisfaction scale, 2) AOFAS and 3) Maryland. RESULTS In relation to the subjective satisfaction scale, 12 patients were satisfied and one was dissatisfied. The mean AOFAS score was 80 points, and the mean Maryland scale was 86 points. CONCLUSION Surgical treatment is effective for restoring function. The surgical techniques need to be personalized. The option of free grafting of the semitendinosus tendon is effective for gaps larger than five centimeters.
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Affiliation(s)
- Antonio Egydio De Carvalho Junior
- Professor of the Department of Orthopedics and Traumatology and Head of the Foot Surgery Group, State University of Campinas (Unicamp), Campinas, SP; Attending Physician at the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of Sao Paulo (USP) Sao Paulo, SP, Brazil
| | - Cíntia Kelly Bittar
- Attending Physician in the Foot Surgery Group, State University of Campinas (Unicamp), Campinas, SP; Attending Physician in the Foot and Ankle Group, Orthopedics Service of the Celso Pierrô Hospital and Maternity Hospital, Catholic Pontificate University of Campinas (PUC), Campinas, SP, Brazil
| | - Osny Salomão
- Emeritus Professor of the Department of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - João Batista Miranda
- Head of the Department of Orthopedics and Traumatology, State University of Campinas (Unicamp), Campinas, SP; Professor in the Department of Orthopedics and Traumatology and Head of the Knee Surgery Group, State University of Campinas (Unicamp), Campinas, SP, Brazil
| | - André Ninomiya
- Trainee Physician in the Foot Surgery Group, State University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Daniel Bento Silva
- Trainee Physician in the Foot Surgery Group, State University of Campinas (Unicamp), Campinas, SP, Brazil
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Ebrahimi FV, Tofighi M, Khatibi H. Closed tibial fracture associated with laceration of tibialis anterior tendon. J Foot Ankle Surg 2009; 49:86.e19-22. [PMID: 19906544 DOI: 10.1053/j.jfas.2009.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Indexed: 02/03/2023]
Abstract
Traumatic laceration of the tibialis anterior tendon is a rare finding. To the best of our knowledge, 4 such cases have been reported in the surgical literature, and 3 of these were missed upon initial clinical examination. We present the case of a 26-year-old male motorcyclist who sustained an acute laceration of the tibialis anterior tendon in association with closed fractures of the tibia and fibula. The laceration was initially not included in the diagnosis, because weak ankle dorsiflexion was attributed to antalgic guarding. The primary aim of this report is to emphasize the possibility of tibialis anterior tendon laceration in association with closed fracture of the tibia, and to encourage surgeons to maintain a high index of suspicion for this particular defect. Furthermore, we encourage surgeons to undertake a meticulous physical examination and, if warranted, obtain ancillary diagnostic images, such as magnetic resonance images, in order to accurately diagnose and determine the optimal course of treatment.
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Beischer AD, Beamond BM, Jowett AJL, O'Sullivan R, O'Sullivan R. Distal tendinosis of the tibialis anterior tendon. Foot Ankle Int 2009; 30:1053-9. [PMID: 19912714 DOI: 10.3113/fai.2009.1053] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Disorders of the tibialis anterior (TA) tendon have infrequently been reported but spontaneous rupture of this tendon is well recognized. The clinical presentation of tendinosis without rupture of the distal TA has not previously been reported and is the basis of this paper. MATERIALS AND METHODS A study of 29 patients diagnosed with distal TA tendinosis was undertaken. Data collected included, patient demographics, weight, height, pain profile and examination findings. All patients underwent MRI of the symptomatic foot. Operative findings of those patients undergoing surgery for this condition were collected. RESULTS Twenty-nine patients (32 feet) were included in the study group. Their mean age was 62 years and 27 patients were female. Twenty-one patients were overweight. The usual presenting symptom was burning medial midfoot pain that was often reported to be worst at night. Swelling over the TA tendon was frequently observed. On MRI the TA was thickened in all patients. Longitudinal split tears were observed in 19 feet. Chondral thinning and/or osteophyte formation at the first tarsometatarsal or medial naviculocuneiform joints was observed in 11 feet. Eleven feet underwent surgery. Universally the TA tendon was macroscopically thickened and had lost its normal fibrillary appearance. Longitudinal split tears were observed in eight tendons. Pathology was typical of a degenerative tendinosis. CONCLUSION Distal TA tendinosis is a condition that seems to predominantly affect overweight elderly women. It often presents with nocturnal burning medial midfoot pain.
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Affiliation(s)
- Andrew D Beischer
- Victorian Orthopaedic Foot & Ankle Clinic, Richmond, Melbourne, Victoria, Australia.
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Abstract
BACKGROUND Closed tibialis anterior tendon rupture is an uncommon condition typically occurring in the middle aged to elderly patient. Diagnosis may be delayed due to unfamiliarity with the problem by the treating physician. MATERIALS AND METHODS We treated seven patients (4 males aged 54 to 80; 3 females aged 43 to 82) with this problem. Four patients had a history of systemic corticosteroid use and one had had a local steroid injection. Four of the seven patients were managed with direct operative repair and one with a non-anatomical repair to the talar neck. Two patients were managed non-operatively of whom one subsequently required late surgical reconstruction. Patients were reviewed clinically and completed a Foot and Ankle Outcome Score (FAOS). Followup ranged from 12 months to 12 years. RESULTS In the operative group four patients had no functional limitations from the injury and one had mild ankle weakness. One in the nonoperative group required salvage surgery four years after rupture. At followup the mean FAOS was 85 (range, 64 to 98) in the operative group and 52 (range, 28 to 75) in the nonoperative group. CONCLUSION A ruptured tibialis anterior tendon is a rare condition. There is an association with systemic steroid use as well as local steroid injection. Early diagnosis allows operative repair by various techniques leading to predictably good results. Our experience supports operative repair even in the elderly patient.
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Affiliation(s)
- David Gwynne-Jones
- Department of Orthopaedic Surgery, Dunedin Hospital, Great King Street, Dunedin 9024, New Zealand.
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George AT, Babu A, Davis J. Traumatic rupture of the tibialis anterior tendon associated with chronic tibialis posterior dysfunction. Foot Ankle Surg 2009; 15:46-52. [PMID: 19218066 DOI: 10.1016/j.fas.2008.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 03/17/2008] [Accepted: 04/28/2008] [Indexed: 02/04/2023]
Abstract
Isolated rupture of the tibialis anterior and tibialis posterior tendon is uncommon with approximately 25 cases reported in the English literature. Rupture of the tibialis anterior in the presence of chronic tibialis posterior dysfunction has not been reported to date. We present a patient with a closed traumatic rupture of the tibialis anterior tendon which occurred on a background of a pre-existing tibialis posterior dysfunction which was being treated non-operatively and discuss the successful operative management that was performed to reconstruct both tendons.
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Affiliation(s)
- A T George
- Department of Orthopaedic Surgery, Torbay Hospital, Devon, United Kingdom.
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Neumayer F, Djembi YR, Gerin A, Masquelet AC. Closed rupture of the tibialis anterior tendon: a report of 2 cases. J Foot Ankle Surg 2009; 48:457-61. [PMID: 19577722 DOI: 10.1053/j.jfas.2009.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 03/16/2009] [Indexed: 02/03/2023]
Abstract
UNLABELLED Closed rupture of the tibialis anterior tendon is a rare injury, and it usually affects individuals older than 50 years of age. This rare injury tends to occur spontaneously, and this often delays diagnosis and adequate treatment. Although direct surgical repair of the ruptured tibialis anterior tendon is generally considered the treatment of choice, nonanatomic repair, tendon lengthening, or tendon transfer might be necessary in cases where shortening of the muscle-tendon unit has taken place. In this report, we describe 2 cases that involved the surgical repair of closed ruptures of the tibialis anterior tendon. In the first case, direct repair was undertaken at approximately 6 months after the onset of symptoms, and in the second case repair of the tibialis anterior tendon required augmentation tenodesis with the extensor retinaculum. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- Felix Neumayer
- Department of Orthopaedics and Trauma, University Hospital Lausanne (CHUV), Lausanne, Switzerland.
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Jerome JTJ, Varghese M, Sankaran B, Thomas S, Thirumagal SK. Tibialis anterior tendon rupture in gout--case report and literature review. Foot Ankle Surg 2009; 14:166-9. [PMID: 19083637 DOI: 10.1016/j.fas.2007.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 12/17/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND A case report in which spontaneous rupture of the tibialis anterior tendon occurred secondary to a gouty tophaceous deposit within the tendon. The injury occurs in middle-aged and elderly patients after displacement of the foot in plantar flexion and eversion. The treatment of the rupture is discussed. METHOD An appropriate clinical examination, including an exact history taking, leads to the right diagnosis of tibialis anterior tendon rupture in gout. The rupture can occur through abnormal tendons or may occur in any portion of the tendon, but causes little disability if diagnosed promptly. RESULTS Repair of the tibialis anterior tendon was done by non-absorbable suture. The leg was immobilized in a plaster cast, and daily active assisted exercises were started at the end of 3 weeks. Patient retained full function, power, and range of motion in foot and ankle at the end of 6 months. CONCLUSIONS Closed rupture of the anterior tibial tendon is uncommon in gout, with few cases being reported previously. This report adds to the list of pathological conditions that should be considered in closed spontaneous rupture of the tibialis anterior tendon. Early repair does improve the likelihood of a good result. The problem of the contributory effect of atresia, degenerative changes, or both, has not yet been solved. Primary operative suture, preferably with non-absorbable suture is the treatment of choice for acute ruptures and for patients with high activity levels. Recovery is prompt with little, if any, measurable permanent disability.
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Sammarco VJ, Sammarco GJ, Henning C, Chaim S. Surgical repair of acute and chronic tibialis anterior tendon ruptures. J Bone Joint Surg Am 2009; 91:325-32. [PMID: 19181976 DOI: 10.2106/jbjs.g.01386] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- V James Sammarco
- Cincinnati SportsMedicine and Orthopaedic Center, 10663 Montgomery Road, Cincinnati, OH 45242, USA.
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Crystal Deposition Disease Masquerading as Proliferative Tenosynovitis and Its Associated Sequelae. Ann Plast Surg 2009; 62:128-33. [DOI: 10.1097/sap.0b013e3181788e98] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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DiDomenico LA, Williams K, Petrolla AF. Spontaneous rupture of the anterior tibial tendon in a diabetic patient: results of operative treatment. J Foot Ankle Surg 2008; 47:463-7. [PMID: 18725129 DOI: 10.1053/j.jfas.2008.05.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Indexed: 02/03/2023]
Abstract
UNLABELLED Spontaneous rupture of the tibialis anterior tendon is infrequently seen as a clinical entity. In this report, we describe the case of a diabetic neuropathic patient that underwent successful surgical repair of a spontaneously ruptured tibialis anterior tendon with no other factors that would render the tendon susceptible to injury or rupture. LEVEL OF CLINICAL EVIDENCE 4.
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Stavrou P, Symeonidis PD. Gracilis tendon graft for tibialis anterior tendon reconstruction: a report of two cases. Foot Ankle Int 2008; 29:742-5. [PMID: 18785428 DOI: 10.3113/fai.2008.0742] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Rupture of the tibialis anterior tendon is an unusual injury. Most ruptures occur in elderly men with a history of minor trauma. The sudden occurrence of a "foot drop" is often the presenting symptom. The diagnosis is frequently delayed. The acute rupture is best treated by direct repair. Treatment of the chronic rupture is tailored to the patient. In relatively inactive patients, either a polypropylene ankle-foot orthosis or no treatment at all is indicated. In the more active patient, a reconstruction using extensor hallucis longus helps restore dorsiflexion function.
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Affiliation(s)
- John P Negrine
- Orthosports, 160 Belmore Road, Randwick, Sydney, NSW 2031, Australia.
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Yamazaki S, Majima T, Yasui K, Kikumoto T, Minami A. Reconstruction of chronic anterior tibial tendon defect using hamstring tendon graft: a case report. Foot Ankle Int 2007; 28:1190-3. [PMID: 18021590 DOI: 10.3113/fai.2007.1190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Shuji Yamazaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Sapporo, Hokkaido 060-8638, Japan.
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Kopp FJ, Backus S, Deland JT, O'Malley MJ. Anterior tibial tendon rupture: results of operative treatment. Foot Ankle Int 2007; 28:1045-7. [PMID: 17923052 DOI: 10.3113/fai.2007.1045] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior tibial tendon ruptures are rare, and most studies have reported subjective outcome data, with little or no objective analysis. The purpose of this study was to review the results of the operative treatment of anterior tibial tendon ruptures using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and objective isokinetic testing. METHODS We retrospectively reviewed the results of operatively treated anterior tibial tendon ruptures in 10 patients. The average age at the time of surgery was 57 (18 to 79) years. The etiology of rupture was traumatic in five and spontaneous in five patients. Evaluation consisted of preoperative and postoperative questionnaires, physical examination, and isokinetic strength testing. Average time between surgery and isokinetic testing was 27.9 months. RESULTS The average AOFAS score was 71.9 preoperatively and 89.8 postoperatively. Eight of 10 patients reported improvement in pain, and nine of 10 patients reported increased activity level postoperatively. All patients were satisfied with the overall function of their foot and would undergo the procedure again. The peak torque generated in the operative extremity during ankle dorsiflexion and hindfoot inversion was less than that of the uninvolved extremity. No statistically significant difference was noted between peak torque generation in ankles treated with direct anterior tibial tendon repair and ankles treated with anterior tibial tendon repair with augmentation. CONCLUSIONS Operative treatment of anterior tibial tendon rupture resulted in a high level of patient satisfaction; however, isokinetic testing demonstrated a decrease in dorsiflexion and inversion strength compared to the uninjured extremity. The clinical significance of this residual weakness was not apparent in most patients. Patients with anterior tibial tendon ruptures should be forewarned that normal strength may not be a realistic expectation after surgery.
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Affiliation(s)
- Franz J Kopp
- San Diego Orthopaedic Associates, San Diego, CA 92103-2181, USA.
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