SLR - July 2016 - Anissa Hashemi-Awwal

Repair of Chronic Tibialis Anterior Tendon Ruptures

Reference: Funk SS, Gallagher B, Thomson AB. Repair of Chronic Tibialis Anterior Tendon Ruptures. Orthopedics. 2016 Mar 1; 39 (2): e386-e390.

Scientific Literature Review

Reviewed By: Anissa Hashemi-Awwal, DPM
Residency Program: Morristown Medical Center

Podiatric Relevance: This article discusses a modified approach in the surgical treatment of chronic anterior tendon tear by using EndoButton. The authors state that this technique is biomechanically superior in anatomic corollaries. The straightforward method often alleviates the need for tendon graft by using robust pseudo-tendon. This technique would also permit placement of the tendon insertion in the navicular if tendon length was inadequate.

Methods: Electronic medical records of all patients who had a tibialis anterior tendon rupture from 2006 to 2012 were evaluated. The clinical outcome used for this study was the Foot and Ankle Ability Measure (FAAM) score, which is a validated outcome measure for foot and ankle injury and disease. Seven patients were identified presenting 4 to 25 weeks after the injury. Statistical analysis was performed with univariate analysis with the Mann-Whitney U test.  

Operative Technique: Medial cuneiform is drilled with a 3.2-mm guide pin. Previously whip-stitched tendon is prepared, the medical implant is threaded and deployed and the distal tendon end is pulled into a bone tunnel. EndoButton deployment is confirmed on radiograph with anteroposterior and lateral views with intraoperative fluoroscopy. A Bio-Tenodesis screw is placed while holding tension to further tighten and augment repair. Final repair confirmed on intraoperative lateral radiograph.

Results: The FAAM was used preoperatively to evaluate patients' function. The average follow-up time was 2.1 years. The average FAAM score was 66.1 percent preoperatively and 87.1 percent postoperatively (P=.002).

Conclusions: The authors have presented a technique for tibialis anterior tendon repair using an EndoButton. This has demonstrated to be an effective treatment and is preferred at the authors' institution. The straightforward method often alleviates the need for tendon graft by using robust pseudo-tendon. This technique would also permit placement of the tendon insertion in the navicular if tendon length was inadequate. This study showed significant improvement in the FAAM. Limitations of the study included small sample size and lack of a control group. Because tibialis anterior tendon rupture is rare, studies have had small numbers of patients.

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