2 Background Originally described in 1905 (Bruning) 104 published cases (2006 data)Third most common rupture LE1)Achilles2)PatellarMale yrsStrongest extensor80% dorsiflexion forceBruning, F: Zwei seltene Falle von subkutaner Sehnenzerreissung. Munchen Med. Wchschr. 52: , 1905.
3 Symptoms Often mild Slapping foot Most young pts have laceration Easily overlookedSlapping footMost young pts have lacerationUltrasound vs MRIConfirm clinical dxSurgical planning
4 Mechanism Supination with abrupt plantarflexion 4 causes: Open, direct traumaClosed, indirect traumaInner traumaSpontaneous ruptureLikely from previous degenerative processSLE, 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 base25% insert only into medial side of medial cuneiform5% extra tendon b/n m cuneiform and 1st met base
6 Treatment No clear guidelines Nonsx for Low functional demand pts>3 months since injuryIf possible primary repair or sliding tendon repairDistal avulsionsReattach transosseously<4cm defectsTurn down TA repair to cover deficit>4cmTendon graft or transferEHL, Ext to 5th toe, P Brevis/Tertius, and PTMay also need GSR to balance forcesAnagnostakos et al 2006
7 Surgical Outcomes 19 TA repairs (largest report) 3 complicationsImprovement in MS in 18/19AOFAS hindfoot score 55.593.6Sammarco 2009
8 Case HPI PMH PSH Allergy: Morphine PE 73 yo male6/10 painTwisted ankle golfingPresented with MRI in hand 9 days post injuryPMHBladder CancerPSHL Kidney removed, Bladder surgery, AAAAllergy: MorphinePEPain along TA tendon, 0/5 dorsiflexory power, edema/erythema at dorsal midfootXrays (-) MRI Complete TA ruptureImpressionTA rupturePlanScheduled for surgery 10 days post injuryEHL transfer with interference screw
16 ReferencesAnagnostakos 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.