Reconstruction of chronic tibialis anterior tendon ruptures using a free anterior half of a peroneus longus tendon autograft: A technical note

Abstract

Purpose: Chronic rupture of the tibialis anterior (TA) tendon is rare. Several reconstruction techniques have been introduced. However, to the best of our knowledge, the use of a free anterior half of a peroneus longus tendon (AHPLT) autograft has not been reported for reconstruction of TA tendon rupture. This study aimed to describe the surgical technique and present the clinical outcomes of reconstruction of the chronic TA tendon ruptures using an AHPLT autograft. Methods: Between September 2013 and April 2019, five patients with chronic TA tendon rupture were surgically treated by reconstruction using an AHPLT autograft. The AHPLT could be easily harvested percutaneously with a tendon stripper from the ipsilateral lower leg around the reconstruction site. The study included four men and one woman, with a mean age of 43.8 (range: 23–65) years. Results: At a mean follow-up period of 42.8 (range; 12–70) months, the mean Foot Function Index value significantly improved from 53.6 ± 19.8 preoperatively to 25.8 ± 20.8 postoperatively ( p = .04). None of the patients had morbidities (such as nerve injury, delayed tendon ruptures, or tenosynovitis) around the AHPLT donor site. Three patients were very satisfied, two patients were satisfied, and one patient was fair with the results. Conclusions: Reconstruction of chronic TA tendon ruptures using a free AHPLT autograft could be successfully performed with satisfactory clinical outcomes and minimal donor site morbidities. Future studies with a larger population size and a comparative group are warranted to confirm these findings.

Peroneus Longus Split Versus Semitendinosus Tendon Autograft Size: A Cross-sectional Study

“…69 In 1945, Hambly 19 published a simple technique for harvesting a split PLT autograft for lateral ankle ligament reconstruction, which has been modified for minimally invasive harvesting proximal to the tip of the lateral malleolus. 30 Although the AHPLT was found to be a suitable graft for various ligament reconstructions around the knee, 7,8,64,66,67,69 ankle, [30][31][32]43,61 and shoulder, 70 data on graft size are scarce.…”

Reconstruction of the Anterior Tibialis Tendon Using In-phase Tendon Transfers

“…[3][4][5] Data on ATT rupture are limited and mainly consist of case series reports with differing approaches to treatment. 7,8 Studies have shown higher complication rates as high as 23.5% from nonoperative management. 9 Complications include neuroma formation, claw, and hammer toes due to EDL dorsiflexion compensation, flatfoot, dorsiflexion weakness, heel cord contractures, and pain from the pseudotumor on the mid-ankle joint.…”

“…8 However, avascular tendon grafts may not adequately heal, especially in the setting of chronic tears, and harvesting autografts may result in donor site morbidity. 8 Any avascular tendon graft also has the risk of losing tension and "stretching out" over time. There is a small, albeit significant, infection rate with human tendinous allografts.…”

“…This can accomplished by isolated muscle testing or electromyography 3–5 . Data on ATT rupture are limited and mainly consist of case series reports with differing approaches to treatment 7,8 . Studies have shown higher complication rates as high as 23.5% from nonoperative management 9 .…”

“…Reconstruction with tendon graft most commonly utilizes semitendinosus, plantaris, or extensor digitorum with one author reporting the use of partial peroneus longus tendon 8 . However, avascular tendon grafts may not adequately heal, especially in the setting of chronic tears, and harvesting autografts may result in donor site morbidity 8 . Any avascular tendon graft also has the risk of losing tension and “stretching out” over time.…”