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Tibialis Anterior Rupture

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Presentation on theme: "Tibialis Anterior Rupture"— Presentation transcript:

1 Tibialis Anterior Rupture
Xray Rounds Aug 17th 2010

2 Background Originally described in 1905 (Bruning)
104 published cases (2006 data) Third most common rupture LE 1)Achilles 2)Patellar Male yrs Strongest extensor 80% dorsiflexion force Bruning, F: Zwei seltene Falle von subkutaner Sehnenzerreissung. Munchen Med. Wchschr. 52: , 1905.

3 Symptoms Often mild Slapping foot Most young pts have laceration
Easily overlooked Slapping foot Most young pts have laceration Ultrasound vs MRI Confirm clinical dx Surgical planning

4 Mechanism Supination with abrupt plantarflexion 4 causes:
Open, direct trauma Closed, indirect trauma Inner trauma Spontaneous rupture Likely from previous degenerative process SLE, Hyperparathyroidism, chronic acidosis of lead nephropathy, steroid therapy, DM, RA, psoriasis, gout.

5 Anatomy Avascular zone
Middle part, anterior half (.5-3cm from insertion) 70% insert into medial side of med cuneiform and base of 1st met base 25% insert only into medial side of medial cuneiform 5% extra tendon b/n m cuneiform and 1st met base

6 Treatment No clear guidelines Nonsx for
Low functional demand pts >3 months since injury If possible primary repair or sliding tendon repair Distal avulsions Reattach transosseously <4cm defects Turn down TA repair to cover deficit >4cm Tendon graft or transfer EHL, Ext to 5th toe, P Brevis/Tertius, and PT May also need GSR to balance forces Anagnostakos et al 2006

7 Surgical Outcomes 19 TA repairs (largest report)
3 complications Improvement in MS in 18/19 AOFAS hindfoot score 55.593.6 Sammarco 2009

8 Case HPI PMH PSH Allergy: Morphine PE
73 yo male 6/10 pain Twisted ankle golfing Presented with MRI in hand 9 days post injury PMH Bladder Cancer PSH L Kidney removed, Bladder surgery, AAA Allergy: Morphine PE Pain along TA tendon, 0/5 dorsiflexory power, edema/erythema at dorsal midfoot Xrays (-) MRI Complete TA rupture Impression TA rupture Plan Scheduled for surgery 10 days post injury EHL transfer with interference screw








16 References Anagnostakos K, Bachelier F, Furst OA, Kelm J. Rupture of the Anterior Tibial Tendon: Three clinical cases, anatomical study, and literature review. FAI 27: , 2006. Ellington JK, McCormick J, Marion C, Cohen BE, Anderson RB, Davis WH, Jones CP. Surgical outcome following tibialis anterior tendon repair. FAI 31: Kopp FJ, Backus S, Deland JT, O’Malley MJ. Anterior Tibial Tendon Rupture: Results of Operative Treatment. FAI 28: , 2007. Sammarco VJ, Sammarco GJ, Henning C, Chaim S. Surgical repair of acute and chronic tibialis anterior tendon ruptures. JBJS 91: , 2009.

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