Repair of Acute Extensor Hallucis Longus Tendon Injuries

Abstract

Primary repair or reconstruction of EHL tendon lacerations is a reliable procedure that restores hallux alignment and function in most patients as measured by the validated FAAM questionnaire. Deep tendon transfer from the extensor digitorum longus may be performed if EHL tendon edges are not opposable thus eliminating the need for allograft reconstruction.

Gracilis musculotendinous free flap for lower extremity reconstruction after surgical removal of malignant tumors: A report of five cases

“…Methods to reconstruct the tendons of the foot and ankle, similar to the cases presented here, have been published. One group described repairing damaged tendons in the foot according to a two‐step algorithm; primary repair is preferred, whereas large or otherwise complex tendinous defects require tendon transfer (Wong, Daniel, & Raikin, ). Another author explored the use of the extensor hallucis brevis tendon as a donor for defects in EHL (Berens, ).…”

Split Peroneus Longus Free Tendon Autograft Transplantation for the Treatment of Neglected Extensor Hallucis Longus Tendon Laceration: A Case Report

“…Despite more robust data describing acute EHL injuries, very few reports have addressed neglected EHL tendon ruptures with severe retraction. In cases in which tendon retraction persists after tendon mobilization, or in chronic conditions (≥6 weeks) in which the tendon ends cannot be reapproximated or the tendon ends have become severely degenerated, a tendon graft is the procedure of choice (5,7). Case studies have suggested the use of split EHL tendon lengthening (8), a fascia lata allograft (9), a gracilis autograft (13), and an extensor digitorum longus free tendon graft (16) for such repair.…”

“…Early recommendations for EHL tendon ruptures and lacerations suggested that these injuries could be treated without operative repair (2,3). However, more recent reports have described improved hallux function after EHL repair with tendon transfer, tendon lengthening, and tendon grafting (4)(5)(6)(7)(8)(9). In general, a trend has occurred toward primary surgical repair of acute tendon injuries or surgical reconstruction if tendon retraction prevents tension-free tendon opposition (1,4,9).…”

“…In general, a trend has occurred toward primary surgical repair of acute tendon injuries or surgical reconstruction if tendon retraction prevents tension-free tendon opposition (1,4,9). However, most of these reports described acute EHL lacerations or ruptures and not a laceration that had been neglected (1,(4)(5)(6)(7)(8)(9)(10)(11).…”

Extensor hallucis longus tendon and soft‐tissue reconstruction with palmaris longus tendon included in a radial forearm free flap: A case report

“…At latest follow-up, 12 months postoperatively, the patient showed an F I G U R E 1 After the excision of a myxoinflammatory fibroblastic sarcoma recurrence, the EHL tendon was sacrificed, leaving a 14 × 5 cm soft-tissue defect and 14-cm tendon gap. EHL, extensor hallucis longus F I G U R E 2 A 14 × 5 cm radial forearm flap with a 16-cm section of palmaris longus tendon including the investing deep fascia was harvested from the left forearm on a vascular pedicle It has been estimated that the EHL muscle contributes 15% of the dorsiflexion strength of the ankle, and injury or surgical excision of EHL tendon without reconstruction cause hallux dysfunction and results in a flexion deformity at interphalangeal joint (Bastías et al, 2019;Griffiths, 1965;Joseph & Barhorst, 2012;Kessler, 1973;Lipscomb & Kelly, 1955;Park et al, 2003;Pedreira et al, 2019;Robertson, Nutton, & Keating, 2006;Smith & Coughlin, 2008;Soucacos et al, 1992;Taylor & Townsend, 1979;Thordarson & Shean, 2005;Wong et al, 2014;Zielaskowski & Pontious, 2002). There is no consensus in the literature regarding the ideal reconstruction of EHL tendon after oncologic resection: most of the cases reported reconstructions of acute or chronic tendon rupture.…”