Tibialis anterior tendon rupture repair technique involving tendon transfer and tendon tenodesis; a case series to demonstrate preoperative work-up, surgical technique and postoperative protocol

Untreated tibialis anterior tendon ruptures can lead to gait abnormalities, flatfoot deformities, drop foot and chronic pain. Both traumatic and atraumatic ruptures of the tibialis anterior tendon can occur, though, atraumatic ruptures are often spontaneous and less common. For many patients, their symptoms are vague, which can result in a delay in diagnosis. Drop foot is typically the most noticeable symptom. Surgical treatment has been recommended for both traumatic and atraumatic ruptures to restore normal gait and function of tendon. Several surgical techniques have been published, however, there is no consensus on “gold standard” for optimal treatment. Here, a surgical technique is discussed which involves tenodesis of the extensor hallucis longus tendon to the ruptured tibialis anterior tendon with subsequent transfer into the medial cuneiform along with extensor hallux brevis to extensor hallux longus tenodesis distally over the first metatarsophalangeal joint. The authors find that this technique is reproducible in terms of allowing patients to regain dorsiflexory strength at the ankle joint and avoid postoperative ankle-foot orthoses. To date, all patients that have been treated with this technique have been able to return to normal ambulation without the use of a brace or subsequent gait disturbances.