SLR - June 2010 - Peter Walimire
Reference:
Sammarco J, Sammarco J, Henning C, Chaim S. Surgical Repair of Acute and Chronic Tibialis Anterior Tendon Ruptures. Jour Bone Joint Surg Am. 2009;91:325-32.
Scientific Literature Review
Reviewer: Peter Walimire, DPM
Program: Florida Hospital East Orlando PM&S 36
Podiatric Relevance:
Tibialis anterior tendon ruptures are uncommon injuries, but can result in debilitating muscle imbalances and foot deformities if left untreated. Few prospective studies and no controlled studies have been performed regarding the efficacy of surgical repair, specifically regarding atraumatic ruptures and delays until treatment. Patient selection is vital in obtaining the best functional and physiologic outcomes in ruptures of the anterior tibial tendon.
Methods:
Nineteen tibialis anterior tendon ruptures were surgically repaired in eighteen patients. Ages ranged from twenty-one to seventy-eight years old. Early repair was defined as surgery between three days and six weeks after injury, and was performed for one traumatic and seven atraumatic ruptures. 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 delayed reconstructions. An interpositional autogenous tendon graft was used for four early repairs and eight delayed reconstructions. Patients were reassessed clinically and with the AOFAS hindfoot score at an average of 53.3 months after surgery.
Results:
The average AOFAS hindfoot score improved from 55.5 points preoperatively to 93.6 points postoperatively, and this was statistically significant. Patient age, sex, or medical comorbidity did not appear to affect surgical outcomes. Three patients sustained complications which required a second surgical procedure. 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:
Regardless of patient age, sex, medical comorbidity, or delay in diagnosis, surgical repair to restore the function of tibialis anterior can be beneficial. Early surgical intervention may be less complicated than delayed treatment, and additional procedures such as an intercalated free tendon graft or gastrocnemius recession may be necessary to achieve an appropriately tensioned and balanced repair.