J Korean Orthop Assoc.  2015 Oct;50(5):412-417. 10.4055/jkoa.2015.50.5.412.

Complete Rupture of the Tibialis Anterior Tendon Due to Intratendinous Ganglion Cyst

• Kweon SH
• Kang HJ
• Lee SI

• KMID: 2185105
• DOI: http://doi.org/10.4055/jkoa.2015.50.5.412

Abstract

Spontaneous rupture of the tibialis anterior tendon is rare among ordinary people. The tendon rupture usually occurs in patients iatrogenically after local steroid injection to the tendon or with pre-existing systemic disease such as diabetes mellitus, gout, and rheumatic disease. However, no case of complete rupture of the tibialis anterior tendon due to an intratendinous ganglion cyst has been reported. We report on a case of a 39-year-old female with spontaneous rupture of the tibialis anterior tendon due to intratendinous ganglion cyst and her clinical results.

Keyword

anterior tibial tendon; ganglion cyst; spontaneous rupture

MeSH Terms

Adult
Diabetes Mellitus
Female
Ganglion Cysts*
Gout
Humans
Rheumatic Diseases
Rupture*
Rupture, Spontaneous
Tendons*

Figure

• 

  Figure 1 Photograph showing mild erythematous skin color change and swelling just anterior of the tibialis anterior tendon.

• 

  Figure 2 Magnetic resonance imaging showing the cystic lesion located along the tibialis anterior tendon. Low signaled in T1-weighted image (A, B) and high signaled in T2-weighted image. (C, D) Continuity of tibialis anterior tendon near the cystic lesion was not seen, suggesting complete rupture.

• 

  Figure 3 Intraoperative photograph illustrating the deep purple, well demarcated 8×5-cm-sized soft tissue mass.

• 

  Figure 4 After incision of the cystic wall, we observed a completely ruptured tibialis anterior tendon. And severe delaminated and degenerative changes were observed on the proximal and distal end of the ruptured tendon.

• 

  Figure 5 The distal portion of the ruptured tibialis anterior tendon was sutured to the side of the intact extensor hallucis longus tendon.

• 

  Figure 6 Photomicrograph demonstrates hyalinized collagenous fibrous wall and a characteristic myxoid degeneration (H&E; A: ×40, B: ×100). These are specific findings of ganglion.

• 

  Figure 7 Active dorsal ankle flexion at 30 months.

Reference

1. Jerome JT, Varghese M, Sankaran B, Thomas S, Thirumagal SK. Tibialis anterior tendon rupture in gout--case report and literature review. Foot Ankle Surg. 2008; 14:166–169.

2. Sapkas GS, Tzoutzopoulos A, Tsoukas FC, Triantafillopoulos IK. Spontaneous tibialis anterior tendon rupture: delayed repair with free-sliding tibialis anterior tendon graft. Am J Orthop (Belle Mead NJ). 2008; 37:E213–E216.

3. Khoury NJ, el-Khoury GY, Saltzman CL, Brandser EA. Rupture of the anterior tibial tendon: diagnosis by MR imaging. AJR Am J Roentgenol. 1996; 167:351–354.

4. 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; 47:463–467.

5. Aydingöz U, Aydingöz O. Spontaneous rupture of the tibialis anterior tendon in a patient with psoriasis. Clin Imaging. 2002; 26:209–211.

6. Markarian GG, Kelikian AS, Brage M, Trainor T, Dias L. Anterior tibialis tendon ruptures: an outcome analysis of operative versus nonoperative treatment. Foot Ankle Int. 1998; 19:792–802.

7. Waldecker U. Unusual location of a posttraumatic ganglion and rupture of the peroneus brevis tendon: a case report. J Foot Ankle Surg. 2005; 44:163–165.

8. Petersen W, Stein V, Tillmann B. Blood supply of the tibialis anterior tendon. Arch Orthop Trauma Surg. 1999; 119:371–375.

9. Sammarco VJ, Sammarco GJ, Henning C, Chaim S. Surgical repair of acute and chronic tibialis anterior tendon ruptures. J Bone Joint Surg Am. 2009; 91:325–332.