Split-tendon Docking Technique for Tibialis Anterior Allograft Reconstruction

Tibialis anterior ruptures present unique surgical challenges due to frequently delayed diagnosis, often necessitating tendon reconstruction. The Pulvertaft weave has been a mainstay for tendon coaptation in graft reconstruction, but the bulky nature of that construct is a disadvantage in areas with limited soft tissue, such as the foot and ankle. Here we introduce the “split-tendon docking” technique as an alternative, aiming to maintain the strength of the tendon coaptation while reducing its profile. Preoperative evaluation is discussed, including clinical and imaging assessments. The technique is described, including the approach, graft preparation, and docking technique. Complications and postoperative care are considered. While the technique requires further use and validation, it presents a promising, lower-profile alternative for foot and ankle tendon coaptation. Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.