Isolated rupture of the tibialis anterior tendon associated with a fracture of the tibial shaft: a case report

Management of tibialis anterior tendon rupture: Recommendations based on the literature review

Tibialis anterior tendon (TAT) rupture is a rare injury that commonly diagnosed late due to mild clinical signs and symptoms. Management of TAT rupture is a topic without a clear consensus in the literature. This current concept review tries to shed some light on the data and treatment. Our extensive literature review identified 81 case reports and case series from 1905 to 2018. Several reported management techniques with their advantages and disadvantages were analyzed and our treatment recommendations are given based on current available evidences. LEVELS OF EVIDENCE: IV.

Management of Isolated Anterior Tibial Tendon Rupture: A Systematic Review and Meta-Analysis

Rupture of the tibialis anterior tendon is a rare condition reported to occur most often spontaneously in patients >45 years of age. Diagnosis is often delayed due to transient pain at the time of rupture and the ability of the long extensors to compensate for the lost action of the tibialis anterior. Treatment has been proposed to be based on the activity level of the individual; however, no consensus has been reached on the optimal treatment modality for this rare condition. A systematic review and meta-analysis were performed to determine outcomes obtained with conservative and surgical management. Twenty-four references (155 cases) were identified. Conservative management (21 cases, 13.55%) was associated with poorer outcomes (odds ratio [OR] 0.68; I² = 61%) because of pain and functional limitations related to ankle dorsiflexory weakness. Surgical intervention (134 cases, 86.45%) had a better chance for good outcome (OR 8.40; I² = 63%). Use of an ipsilateral split/turn-down ipsilateral tibialis anterior tendon graft (OR 32.15; I² = 0%) semitendinous autograft (OR 15.25; I² = 44%), or direct repair (OR 12.57; I² = 0%) provided the best postoperative outcomes, whereas extensor hallucis longus autograft was associated with the worst (OR 0.27, I² = 34%). The most common postoperative finding was objective mild dorsiflexory weakness (4/5 muscle strength), which did not translate to subjective functional limitation. Good functional results were found to occur regardless of patient age at the time of intervention. Results of this systematic review and meta-analysis suggests that surgical intervention provides better functional outcomes than conservative management. Use of an extensor hallucis longus autograft is not recommended if surgical intervention is performed.

Tibialis anterior tendon traumatic rupture secondary to a closed talar neck fracture: A case report

A case of a 22 year-old woman who sustained a closed Hawkins type II talar neck fracture after her left foot was caught in a rope while rock climbing outdoors is described. She presented to emergency department with a swollen and neurovascularly intact foot and a displaced talar neck fracture was identified. Intraoperatively a traumatic rupture of tibialis anterior tendon was found and was primarily repaired after the talar fixation. Revisiting the mechanism of injury it was evident that the jagged fracture ends ruptured the tibialis anterior tendon while she was hanging upside down on the strapping with the foot in forced equinus. This is the first case of such complication associated with a talar fracture and signifies the importance of tibialis anterior examination in such fractures.

Presentation, Diagnosis, and Nonsurgical Treatment Options of the Anterior Tibial Tendon, Posterior Tibial Tendon, Peroneals, and Achilles

Disorders of the anterior tibial tendon (ATT) are rare, and relatively few series have been described in the literature. Ruptures of the ATT are more common than tendinopathies of the ATT. For those patients with a tendinopathy, initial treatment may include activity and shoe-wear modifications.

Ipsilateral Rupture of Quadriceps Tendon with Distal Tibia Fracture: A Case Report and Review of the Literature

Traumatic rupture of the quadriceps tendon by itself is not an uncommon clinical condition. However, its association with concurrent ipsilateral closed distal tibia oblique fracture is exceedingly rare with only one previously reported case in English literature. The dual diagnosis of this atypical combination of injury may be masked by pain and immobilization of the more obvious fracture and may be missed, unless the treating physician maintains a high index of suspicion. Suprapatellar knee pain with or without a palpable gap in the quadriceps tendon and inability to straight leg raise in the setting of a distal tibia fracture should raise concern, but if initial treatment employs a long-leg splint the knee symptoms may be muted. In this report, we describe this unusual combination of injury in a 67-year-old male patient who sustained a trivial twisting injury to the leg. The aim of this report is to raise awareness and emphasize the importance of thorough and repeated clinical examinations in the presence of distracting injuries. Despite the complexity of the problem, standard techniques for quadriceps tendon repair using transpatellar bone tunnels following locked intramedullary rodding of the tibia fracture may lead to optimal outcomes.

Closed tibial fracture associated with laceration of tibialis anterior tendon

Traumatic laceration of the tibialis anterior tendon is a rare finding. To the best of our knowledge, 4 such cases have been reported in the surgical literature, and 3 of these were missed upon initial clinical examination. We present the case of a 26-year-old male motorcyclist who sustained an acute laceration of the tibialis anterior tendon in association with closed fractures of the tibia and fibula. The laceration was initially not included in the diagnosis, because weak ankle dorsiflexion was attributed to antalgic guarding. The primary aim of this report is to emphasize the possibility of tibialis anterior tendon laceration in association with closed fracture of the tibia, and to encourage surgeons to maintain a high index of suspicion for this particular defect. Furthermore, we encourage surgeons to undertake a meticulous physical examination and, if warranted, obtain ancillary diagnostic images, such as magnetic resonance images, in order to accurately diagnose and determine the optimal course of treatment.

Laceration of tibialis anterior tendon complicating a closed tibial fracture: a case report

Traumatic laceration of the tibialis anterior tendon complicating a closed tibial shaft fracture is a rare injury pattern. Only 3 such cases have been reported to date in the English literature and all were missed on initial examination. A case of a 17-year-old motorcyclist with an acute laceration of the tibialis anterior tendon resulting from a closed oblique tibial shaft fracture is presented. The tendon laceration was suspected preoperatively because of the patient's inability to actively dorsiflex his ankle joint and the existence of a palpable gap in the soft tissues over the anterolateral aspect of his tibia. Tibialis anterior tendon repair was performed simultaneously with fracture fixation. The role of careful physical examination is stressed so that this rare injury combination will not be missed.

Spontaneous rupture of the tibialis anterior tendon: a case report and literature review

Spontaneous rupture of the tibialis anterior tendon is uncommon. This article presents a case report in which spontaneous rupture of the tibialis anterior tendon occurred secondary to a gouty tophaceous deposit within the tendon. This report adds to the list of pathological conditions that should be considered in closed spontaneous rupture of the tibialis anterior tendon.

Ipsilateral peroneus brevis tendon grafting in a complicated case of traumatic rupture of tibialis anterior tendon

Ruptures of tibialis anterior tendon can be caused by open, closed, direct, or indirect trauma, as well as spontaneously. Sixty-three cases of tibialis anterior tendon ruptures have been reported in the international literature. The treatment of choice is the surgical end-to-end or side-to-side anastomosis after previous Z-lengthening. The case of a 28-year-old world-class female triathlete who sustained an open laceration of the tibialis anterior tendon from the bicycle chain guard is reported. The primarily applied tendon suture became infected and a wound revision with wide resection of the tendon stumps was necessary. This lead to an extensive defect of the tendon combined with a deep-seated keloidal scar reaction of the skin. The surgical closure was performed using free ipsilateral peroneus brevis tendon grafting. Four months after the operation the patient was completely rehabilitated. Eight months later she became the second European triathlon champion.