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Tibialis Anterior Rupture Xray Rounds Aug 17 th 2010.

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Presentation on theme: "Tibialis Anterior Rupture Xray Rounds Aug 17 th 2010."— Presentation transcript:

1 Tibialis Anterior Rupture Xray Rounds Aug 17 th 2010

2 Background Originally described in 1905 (Bruning) Originally described in 1905 (Bruning) 104 published cases (2006 data) 104 published cases (2006 data) Third most common rupture LE Third most common rupture LE1)Achilles2)Patellar Male yrs Male yrs Strongest extensor Strongest extensor –80% dorsiflexion force

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

4 Mechanism Supination with abrupt plantarflexion Supination with abrupt plantarflexion –4 causes: 1) Open, direct trauma 2) Closed, indirect trauma 3) Inner trauma 4) Spontaneous rupture Likely from previous degenerative processLikely from previous degenerative process SLE, Hyperparathyroidism, chronic acidosis of lead nephropathy, steroid therapy, DM, RA, psoriasis, gout. SLE, Hyperparathyroidism, chronic acidosis of lead nephropathy, steroid therapy, DM, RA, psoriasis, gout.

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

6 Anagnostakos et al 2006 Treatment No clear guidelines No clear guidelines Nonsx for Nonsx for –Low functional demand pts –>3 months since injury 1. If possible primary repair or sliding tendon repair 2. Distal avulsions –Reattach transosseously 3. <4cm defects –Turn down TA repair to cover deficit 4. >4cm –Tendon graft or transfer EHL, Ext to 5 th toe, P Brevis/Tertius, and PT EHL, Ext to 5 th toe, P Brevis/Tertius, and PT May also need GSR to balance forces May also need GSR to balance forces

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

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

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