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Extensor hallucis longus-transfer for tibialis anterior tendon rupture repair

Musculus-extensor-hallucis-longus-Sehnentransfer zur Behandlung von Rupturen der M.-tibialis-anterior-Sehne

  • Surgical Techniques
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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Abstract

Objective

Restore the function of the tibialis anterior muscle, which is responsible for dorsiflexion and inversion of the foot.

Indications

Spontaneous or traumatic rupture of the tibialis anterior tendon.

Contraindications

Patients with multimorbidity or lack of functional demands.

Surgical technique

Direct repair of the tibialis anterior tendon with fiber-wire suture and augmentation with extensor hallucis longus tendon, potentially in combination with reinsertion of the tibialis anterior tendon in the medial cuneiform.

Postoperative management

Six weeks of non-weight-bearing: 3 weeks of cast immobilization with ankle in 10° dorsiflexion, followed by 3 weeks of splint immobilization and passive mobilization. Then stepwise increase in weight-bearing over a period of 2–3 weeks.

Results

In 8 patients postoperative results with a mean follow-up of 13.5 months were available. One patient showed a rerupture of the augmented tendon. The mean American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 81.0 (range 67–88). The median ankle dorsiflexion muscle strength was 67% (range 29.3–85.5%) compared to the nonoperated leg. All patients, except the one that experienced rerupture, were very satisfied or satisfied with the result.

Zusammenfassung

Operationsziel

Wiederherstellung der Funktion der Sehne des M. tibialis anterior mit Dorsalflexion und Inversion.

Indikationen

Sowohl spontane als auch traumatische Rupturen der Sehne des M. tibialis anterior.

Kontraindikationen

Multimorbidität sowie fehlende funktionelle Einschränkungen.

Operationstechnik

Direkte Naht der Sehne des M. tibialis anterior mit Fiber-Wire-Naht und Augmentation mit Extensor-hallucis-longus-Sehnentransfer sowie ggf. Reinsertion der Tibialis-anterior-Sehne im Os cuneiforme mediale.

Weiterbehandlung

Sechs Wochen Entlastung der betroffenen Extremität, 3 Wochen in einem Unterschenkel-Baycast in 10°-Dorsalextension, danach Wechsel auf eine Baycast-Schiene, aus welcher für weitere 3 Wochen eine passive Beübung zur Vermeidung von Sehnenverklebungen erfolgt. Dann sukzessiver Übergang zur Vollbelastung über weitere 2–3 Wochen.

Ergebnisse

Nach einem mittleren Follow-up von 13,5 Monaten konnten 8 Patienten untersucht werden. Ein Patient zeigte eine Reruptur der augmentierten Sehne. Der durchschnittliche Ankle-Hindfoot-Score der American Orthopaedic Foot and Ankle Society (AOFAS) betrug 81,0 (Spanne 67–88). Die wiederhergestellte Kraft der Dorsalflexion im Sprunggelenk betrug im Median 67 % (Spanne 29,3–85,5 %) im Vergleich zur kontralateralen, gesunden Seite. Alle, ausgenommen des Patienten mit der rerupturierten Sehne, waren mit dem Operationsergebnis sehr zufrieden oder zufrieden.

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Authors and Affiliations

  1. Klinik Diakonissen Schladming, Salzburger Straße 777, 8970, Schladming, Austria

    L. Fraissler

  2. Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Germany

    K. Horas, S. Bölch, P. Raab & M. Rudert

  3. Orthopädie Chirurgie Würzburg, Oeggstraße 3, 97070, Würzburg, Germany

    M. Walcher

Authors
  1. L. Fraissler
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  2. K. Horas
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  3. S. Bölch
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  4. P. Raab
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  5. M. Rudert
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Corresponding author

Correspondence to L. Fraissler.

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Conflict of interest

L. Fraissler, K. Horas, S. Bölch, P. Raab, M. Rudert and M. Walcher declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Editor

T. Mittlmeier, Rostock

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R. Himmelhan, Mannheim

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Fraissler, L., Horas, K., Bölch, S. et al. Extensor hallucis longus-transfer for tibialis anterior tendon rupture repair. Oper Orthop Traumatol 31, 143–148 (2019). https://doi.org/10.1007/s00064-018-0571-7

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  • DOI: https://doi.org/10.1007/s00064-018-0571-7

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