J Korean Foot Ankle Soc.  2022 Dec;26(4):183-186. 10.14193/jkfas.2022.26.4.183.

Tenodesis after Tendon Lengthening for Irreparable Tibialis Anterior Tendon Avulsion Injury: A Case Report

• Chae SW
• Suh JS
• Choi JY

• KMID: 2536714
• DOI: http://doi.org/10.14193/jkfas.2022.26.4.183

Abstract

Anterior tibialis ruptures are a rare type of injury related to the foot and ankle. Specifically, chronic and non-traumatic ruptures are related to preexisting chronic tendinopathic conditions and anatomical factors. These ruptures may cause persistent pain and functional impairments if neglected. Chronic tibialis anterior ruptures are frequently diagnosed late because the symptoms are not distinct. In cases with chronic or non-traumatic tibialis anterior tendon ruptures, tendons often become irreparable. Hence, various surgical options have been introduced to address this issue. The current surgical treatment options are as follows: free sliding anterior tibialis graft, extensor hallucis longus tendon transfer, and reconstruction with an allograft tendon. To date, there have been few reports about the reconstruction technique using Z-plasty for irreparable tibialis anterior tendon ruptures. In this report, we present a rare case of the application of the tibialis anterior tendon reconstruction technique using Z-plasty and tenodesis for a middle-aged man with an irreparable avulsion injury rupture. We also present the management plan and prognostic outlook, as well as a subsequent review of the relevant literature.

Keyword

Ankle; Tibialis anterior tendon; Tendon avulsion injury; Suture anchors; Tendon lengthening

Figure

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  Figure 1 Preoperative magnetic resonance images. On T1 (A) and T2 (B), coronal and sagittal views, discontinuity of tibial anterior tendon was note with thickening of distal end (arrows).

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  Figure 2 Intraoperative findings. (A) During the operation, severe degeneration with inflammatory change of avulsed tibial anterior tendon was found. A 5-cm lengthening with Z-plasty was performed (B) and the lengthened tendon was fixed at medial cuneiform in a neutral position of the affected ankle (C).

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