Fractures of ossified tibialis anterior tendon have been successfully managed by the excision of the ossified tendon and transfer of the extensor hallucis longus tendon. A 64-year-old man sustained an injury during mountain hiking 2 weeks prior to presentation, falling down on his heels with his ankle fully plantarflexed. Two tender and bony hard masses were palpable along the course of the tibialis anterior tendon, one at the anteromedial aspect of the ankle and another at the dorsum of the talonavicular joint. Radiographs of the ankle demonstrated an approximately 2×1-cm ovoid-shaped bony mass at the anterior aspect of the ankle joint and another bony mass of similar size and shape at the dorsal aspect of the talonavicular joint. He underwent operative exploration, and complete rupture of the tendon through a bony mass was observed. The gap between the torn ends of the tendon after excision of the mass was too long to be repaired directly. Extensor hallucis longus tendon was retrieved 1 cm proximal to the metatarsophalangeal joint and was passed through the insertion of the anterior tibial tendon and pulled proximally and sutured to itself with the ankle in neutral. At 1 year after surgery, plain radiographs and ultrasonography showed no recurrence of calcification or ossification in the tendon and good mobility of the tibialis anterior muscle was observed.
Posterior root tear of the medial meniscus which is frequently unrecognized is a common injury of meniscus that often results in serious consequences in a knee joint. After medial meniscus posterior root tear (MMPR), there is a significant increase in tibio-femoral contact pressure concomitant with altered knee joint kinematics. This injury frequently leads to meniscal extrusion, and thus the transmission of circumferential hoop stresses would be impaired, which condition is biomechanically similar to that of total meniscectomy. For these reasons, several methods (conservative treatment, meniscectomy, repair, or unicompartmental knee arthroplasty) have been developed for treatment of MMPR, many of which have shown good clinical results. However, the methods of MMPR treatment are still debatable. This article presents a review of the current strategies for treatment of common injuries to these MMPR and clinical results of high tibia osteotomy for MMPR after failed conservative treatment.
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