Anterior tibial tendon avulsion with distal tibial fracture entrapment: case report

Mind the Anterior Tibial Tendon in Oblique Distal Third Tibial Fractures with Anterior Inferior Proximal Spike: A Case Report

CASE

An oblique fracture of the distal third of the tibia, treated nonoperatively in a 14-year-old adolescent boy, did not unite because of ensnarement of the anterior tibial tendon (ATT) around an anterior inferior bony spike from the proximal tibial fragment. Computed tomography scan with 3-dimensional volume rendering aided in preoperative diagnosis. Surgical extraction of the tendon from within the fracture site and internal fixation led to successful union and full painless function.

CONCLUSION

Beware of possible ATT entrapment as a cause of irreducibility of oblique distal third tibial fractures with an anterior inferior bony spike of the proximal fragment.

Injuries in Muscle-Tendon-Bone Units: A Systematic Review Considering the Role of Passive Tissue Fatigue

Background:

Low-cycle fatigue damage accumulating to the point of structural failure has been recently reported at the origin of the human anterior cruciate ligament under strenuous repetitive loading. If this can occur in a ligament, low-cycle fatigue damage may also occur in the connective tissue of muscle-tendon units. To this end, we reviewed what is known about how, when, and where injuries of muscle-tendon units occur throughout the body.

Purpose:

To systematically review injuries in the muscle-tendon-bone complex; assess the site of injury (muscle belly, musculotendinous junction [MTJ], tendon/aponeurosis, tendon/aponeurosis–bone junction, and tendon/aponeurosis avulsion), incidence, muscles and tendons involved, mechanism of injury, and main symptoms; and consider the hypothesis that injury may often be consistent with the accumulation of multiscale material fatigue damage during repetitive submaximal loading regimens.

Methods:

PubMed, Web of Science, Scopus, and ProQuest were searched on July 24, 2019. Quality assessment was undertaken using ARRIVE, STROBE, and CARE (Animal Research: Reporting In Vivo Experiments, Strengthening the Reporting of Observational Studies in Epidemiology, and the Case Report Statement and Checklist, respectively).

Results:

Overall, 131 studies met the inclusion criteria, including 799 specimens and 2,823 patients who sustained 3,246 injuries. Laboratory studies showed a preponderance of failures at the MTJ, a viscoelastic behavior of muscle-tendon units, and damage accumulation at the MTJ with repetitive loading. Observational studies showed that 35% of injuries occurred in the tendon midsubstance; 28%, at the MTJ; 18%, at the tendon-bone junction; 13%, within the muscle belly and that 6% were tendon avulsions including a bone fragment. The biceps femoris was the most injured muscle (25%), followed by the supraspinatus (12%) and the Achilles tendon (9%). The most common symptoms were hematoma and/or swelling, tenderness, edema and muscle/tendon retraction. The onset of injury was consistent with tissue fatigue at all injury sites except for tendon avulsions, where 63% of the injuries were caused by an evident trauma.

Conclusion:

Excluding traumatic tendon avulsions, most injuries were consistent with the hypothesis that material fatigue damage accumulated during repetitive submaximal loading regimens. If supported by data from better imaging modalities, this has implications for improving injury detection, prevention, and training regimens.

Management of tibialis anterior tendon rupture: Recommendations based on the literature review

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.

Tibialis anterior tendon traumatic rupture secondary to a closed talar neck fracture: A case report

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.

Zancolli Technique for Delayed Repair of Tibialis Anterior Tendon Rupture: A Case Report and Literature Review

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.

Presentation, Diagnosis, and Nonsurgical Treatment Options of the Anterior Tibial Tendon, Posterior Tibial Tendon, Peroneals, and Achilles

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.

Ipsilateral Rupture of Quadriceps Tendon with Distal Tibia Fracture: A Case Report and Review of the Literature

Traumatic rupture of the quadriceps tendon by itself is not an uncommon clinical condition. However, its association with concurrent ipsilateral closed distal tibia oblique fracture is exceedingly rare with only one previously reported case in English literature. The dual diagnosis of this atypical combination of injury may be masked by pain and immobilization of the more obvious fracture and may be missed, unless the treating physician maintains a high index of suspicion. Suprapatellar knee pain with or without a palpable gap in the quadriceps tendon and inability to straight leg raise in the setting of a distal tibia fracture should raise concern, but if initial treatment employs a long-leg splint the knee symptoms may be muted. In this report, we describe this unusual combination of injury in a 67-year-old male patient who sustained a trivial twisting injury to the leg. The aim of this report is to raise awareness and emphasize the importance of thorough and repeated clinical examinations in the presence of distracting injuries. Despite the complexity of the problem, standard techniques for quadriceps tendon repair using transpatellar bone tunnels following locked intramedullary rodding of the tibia fracture may lead to optimal outcomes.

Long-term outcomes following anterior tibialis tendon reconstruction with hamstring autograft in a series of 3 cases

Ruptures of the anterior tibialis tendon are uncommon, and there is a paucity of information regarding long-term ankle function following surgical reconstruction using hamstring autograft. In this case series, examinations were performed on 3 individuals who underwent anterior tibialis tendon reconstruction with hamstring autograft performed by the same surgeon. Two subjects were examined 8 years after reconstructive surgery, and 1 was examined at 5 years postoperative. Muscle strength and range of motion of subjects' ankles bilaterally were assessed using standard measures. The Tinetti Performance Oriented Mobility Assessment and the modified Gait Abnormality Rating Scale were used to assess gait and balance. The information gathered from these 3 cases indicates that tibialis anterior strength and ankle range of motion can be maintained or improved years after anterior tibialis reconstruction with hamstring autograft, and these individuals have a low risk of falling long after the repair has healed.

LEVEL OF CLINICAL EVIDENCE

4.