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Tibialis Anterior tendon rupture

Discussion in 'Biomechanics, Sports and Foot orthoses' started by hazelnoakes, Jul 18, 2007.

  1. hazelnoakes

    hazelnoakes Active Member


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    I'm after some info regarding Tibialis Anterior tendon rupture. A client presented 8 days after feeling something "snap" when rushing to the car. Initial x-rays taken by the hospital showed no problem. I referred back to his GP with recommendation of further scans which apparently showed the Tib Ant tendon has torn off the bone.

    What is the likelyhood of surgical intervention and if so, what is the chance of a full recovery?

    His GP has referred to a surgeon and his appointment is one month after initial injury - is there an urgent need to bring this appt forward?

    Thea Lawson
    via Hazel!
     
  2. Kevin Kirby

    Kevin Kirby Well-Known Member

    If it were my anterior tibial tendon that had just ruptured, I would be seeing my friendly orthopedic surgeon the same day for surgical repair. If the patient waits a month, then the tendon will be retracted into the leg and will be more difficult to reattach without a more complicated grafting procedure. Get the referral NOW!
     
  3. hazelnoakes

    hazelnoakes Active Member

    Will put in a few calls and see what I can wrangle! Given that it is almost 2 weeks post injury, would the tendon have already retracted fully into the leg?
     
  4. hazelnoakes

    hazelnoakes Active Member

    Thanks Kevin. Thea is contacting our local orthopaedic surgeon as I type this email.
    Hazel
     
  5. Kevin Kirby

    Kevin Kirby Well-Known Member

    The tendon will be more difficult to be pulled back into anatomical position the longer the time that has elapsed from the date of rupture due to accommodative shortening of the muscle fibers/connective tissue elements of the muscle/tendon unit. Muscle-tendon units tends to shorten when not stretched regularly. Time is of the essence in this condition to allow normal restoration of anterior tibial function by surgical repair.
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Surgical repair of acute and chronic tibialis anterior tendon ruptures.
    Sammarco VJ, Sammarco GJ, Henning C, Chaim S.
    J Bone Joint Surg Am. 2009 Feb;91(2):325-32.
     
  7. bob

    bob Well-Known Member

    Eh? "Orthopedic surgeon"? What's wrong with YOUR hands Kevin? Do you not work with podiatric colleagues familiar with this surgery if you don't want to do it? I'm not having a go at you, or our orthopaedic friends, but I was just wondering why you specified an orthopaedic surgeon? ;)
     
  8. Kevin Kirby

    Kevin Kirby Well-Known Member

    I have worked in a group practice with orthopedic surgeons for the past 24 years. They do excellent tendon surgery and do a lot of it. And by the way, I don't think I would want to do my OWN surgery on my own ruptured anterior tibial tendon, if I was unfortunate enough to develop this pathology.
     
  9. bob

    bob Well-Known Member

    Ha haa! Yes, obviously you're not going to do your own surgery, but you know what I meant. I'm sure you realised that what I was really saying is - why specify an ortho and not a pod (especially when you are a pod)? And you answered this to a point - you work in a group practice and they do most of the tendon surgery. Fair enough. :D
     
  10. Jeff S

    Jeff S Active Member

    Over the last 9 months, I have repaired 2 acute and one old Tib Ant. rupture. In all cases the tendon had retracted under the superior extensor retinaculum. I all cases, I lengthened the tendon at the myotendinous junction from 4-12 cm. The tendon was re-attached under physiologic tension to its insertion. NWB 6 weeks, PT at 3 weeks and FWB in a AFO by 8 weeks. The AFO was DC'd after 3 months. All patients had 4+/5 strength returned, no pain and no tendon graft was used.
     
  11. Mareesha

    Mareesha New Member

    Jeff: My orthopedic surgeon says he may have to do a graft to repair my severed ATT; would you be willing to comment on how you repaired your ruptured ATTs without grafts? thanks...
     
  12. Jeff S

    Jeff S Active Member

    Sure: as part of the repair, the edges of the torn tendon need to be removed/debrided to a fresh, healthy surface. If the amount of damaged tendon removed is excessive in length (>2 cm), something needs to be done to make up the missing length. I prefer to lengthen the tendon rather than sacrifice a normal tendon or use cadaver graft (dead tendon) to accomplish this task. I lengthen the anterior tibial tendon in the front of the leg near the shin bone. It is right under the skin and very easy to get at. Best of luck!!!
     
  13. Jeff S

    Jeff S Active Member

    I trained in the Bay area and know many of the guys there. Tom Chang is in the San Rafel area and Steve Paladino is in East Bay. Dee, every surgeon has their preference for surgical repair of a particular problem; so I can't guarantee that they would use this method. I know they are both highly compentent and very well trained and respected. So if either one recommended a graft, it will be done perfectly! Otherwise, you may be making a trip to Philly...lol...Best of Luck.

    Jeff Siegel, DPM, FACFAS
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    The Operative Treatment of the Degenerative Rupture of the Anterior Tibialis Tendon.
    Schneppendahl J, Gehrmann SV, Stosberg U, Regenbrecht B, Windolf J, Wild M.
    Z Orthop Unfall. 2009 Nov 12. [Epub ahead of print]
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Surgical outcome following tibialis anterior tendon repair.
    Ellington JK, McCormick J, Marion C, Cohen BE, Anderson RB, Davis WH, Jones CP.
    Foot Ankle Int. 2010 May;31(5):412-7.
     
  16. NewsBot

    NewsBot The Admin that posts the news.

    The operative treatment of the degenerative rupture of the anterior tibialis tendon
    Schneppendahl J, Gehrmann SV, Stosberg U, Regenbrecht B, Windolf J, Wild M.
    Z Orthop Unfall. 2010 May;148(3):343-7.
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Repair of Lacerated Anterior Tibial Tendon with Acellular Tissue Graft Augmentation
    Lawrence A. DiDomenico, Gregory A. Blasko, Laurence Cane, Davina J. Cross
    Journal of Foot and Ankle Surgery (in press)
     
  18. NewsBot

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    Gait Analysis after Tibialis Anterior Tendon Rupture Repair Using Z-Plasty
    Jürgen Goetz, MD, Johannes Beckmann, MD, PhD, Franz Koeck, MD, PhD, Joachim Grifka, MD, PhD, Silvia Dullien, Guido Heers, MD, PhD
    Journal of Foot and Ankle Surgery; Article in Press
     
  19. NewsBot

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    Traumatic tibialis anterior tendon rupture: treatment with a two-stage silicone tube and an interposition hamstring tendons graft protocol
    Vasileios Kontogeorgakos, et al
    Knee Surgery, Sports Traumatology, Arthroscopy; June 2013
     
  20. NewsBot

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    Reconstruction using an autograft with near complete preservation of the extensor retinaculum for chronic tibialis anterior tendon disruption
    Youichi Yasui, Masato Takao, Wataru Miyamoto, Takashi Matsu****a
    Archives of Orthopaedic and Trauma Surgery; September 2013
     
  21. NewsBot

    NewsBot The Admin that posts the news.

    Chronic Tibialis Anterior Tendon Tear Treated With an Achilles Tendon Allograft Technique
    Ezequiel Palmanovich, MD; Yaron S. Brin, MD; Lior Laver, MD; Dror Ben David, MD; Sabri Massrawe, MD; Meir Nyska, MD; Iftach Hetsroni, MD
    Orthopedics; November 2013 - Volume 36 · Issue 11: 850-853
     
  22. NewsBot

    NewsBot The Admin that posts the news.

    Minimally Invasive Repair of the Tibialis Anterior Tendon Using a Semitendinosus Autograft.
    Michels F, Van Der Bauwhede J, Oosterlinck D, Thomas S, Guillo S.
    Foot Ankle Int. 2013 Dec 20
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Tibialis anterior tendon rupture as a complication of first tarsometatarsal joint steroid injection: A case report and review of literature
    Kowshik Jainc, Mehek Asad, Yogesh Joshi, Asad Syed
    The Foot: June 11, 2015
     
  24. NewsBot

    NewsBot The Admin that posts the news.

    Soft tissue repair for tibialis anterior tendon ruptures using plate and screw fixation technique in combination with anterolateral thigh flaps transplantation.
    Mao H, Xu G
    J Orthop Surg Res. 2015 Sep 17;10(1):143.
     
  25. NewsBot

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    Complete Rupture of the Tibialis Anterior Tendon Due to Intratendinous Ganglion Cyst
    Seok Hyun Kweon, M.D., Ph.D., Hong Je Kang, M.D., Ph.D., and Seoung In Lee, M.D.
    J Korean Orthop Assoc. 2015 Oct;50(5):412-417
     
  26. NewsBot

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    Repair of Chronic Tibialis Anterior Tendon Rupture With a Major Defect Using Gracilis Allograft
    Alex Burton, Umur Aydogan
    Foot Ankle Spec January 7, 2016
     
  27. NewsBot

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    Repair of Chronic Tibialis Anterior Tendon Ruptures.
    Funk SS, Gallagher B, Thomson AB.
    Orthopedics. 2016 Mar 9:1-5
     
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