Extensor hallucis longus-transfer for tibialis anterior tendon rupture repair.

OBJECTIVE

Restore the function of the tibialis anterior muscle, which is responsible for dorsiflexion and inversion of the foot.

INDICATIONS: Spontaneous or traumatic rupture of the tibialis anterior tendon.

CONTRAINDICATIONS: Patients with multimorbidity or lack of functional demands.

SURGICAL TECHNIQUE: Direct repair of the tibialis anterior tendon with fiber-wire suture and augmentation with extensor hallucis longus tendon, potentially in combination with reinsertion of the tibialis anterior tendon in the medial cuneiform.

POSTOPERATIVE MANAGEMENT: Six weeks of non-weight-bearing: 3 weeks of cast immobilization with ankle in 10° dorsiflexion, followed by 3 weeks of splint immobilization and passive mobilization. Then stepwise increase in weight-bearing over a period of 2-3 weeks.

RESULTS

In 8 patients postoperative results with a mean follow-up of 13.5 months were available. One patient showed a rerupture of the augmented tendon. The mean American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 81.0 (range 67-88). The median ankle dorsiflexion muscle strength was 67% (range 29.3-85.5%) compared to the nonoperated leg. All patients, except the one that experienced rerupture, were very satisfied or satisfied with the result.