Abstract
Category:
Ankle
Introduction/Purpose:
Tibialis anterior tendon (TAT) rupture causes substantial morbidity. Nearly 200 surgical cases have been reported in the literature since 1905 wherein primary repair was not achieved approximately 40% of the time due to post- debridement tendon defect size. The present study describes the clinical outcomes of augmented, half-thickness TAT segment transposition, a novel reconstruction technique for managing post-debridement TAT defect. The purpose was to assess this technique as an alternative to tendon transfer and allograft tendon interposition.
Methods:
IRB-approved, retrospective electronic medical record review of patients with attritional distal TAT rupture. In all cases, the post-debridement tendon defect prohibited primary repair or reinsertion and was managed by distal transposition of a half-thickness TAT segment to span the defect. This graft was secured with a six core suture end-to-end anastomosis. Then, this repair was augmented with human acellular dermal matrix allograft (Graftjacket®, Wright Medical Technology, Memphis, TN). A total of five patients were treated with this technique. One patient died of unrelated causes remote from surgery and one was lost to follow up. Three patients with a minimum one year follow up were included. Outcomes were assessed via observed range of motion, clinical motor power assessment, ability to heel walk 15 feet, visual analog scale pain score, Foot and Ankle Ability Measure score, postoperative complications, and patient satisfaction at one year. Outcomes data were analyzed using descriptive statistics.
Results:
The mean age was 68 years (range, 59 to 73 years). Two patients were female. Mean interval between injury and surgery was 59.3 days (range, 15 to 146 days). All patients regained symmetrical range of motion, medical research council grade 5 motor power and the ability to heel walk. Mean pain scores improved from 4.6 (range, 2.5 to 8.5) preoperatively to 0.7 (range, 0 to 2) postoperatively. Mean FAAM scores increased from 30.6 (range, 23.8 to 43.8) preoperatively to 78.7 (range, 72.6 to 97.6) postoperatively. No postoperative complications occurred. At one year, one patient was satisfied and two were very satisfied with their outcome.
Conclusion:
Although constrained by a small sample size, the present findings appear to indicate that this technique produces short term clinical results comparable to those described for other techniques for TAT reconstruction. Future work should assess if these results are reproducible and long lasting. Additionally, the relative value of saving donor site morbidity or the cost of allograft tendon in comparison to the added cost of the Graftjacket should be determined