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Tibialis Anterior Rupture

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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

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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: , 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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