Allograft Reconstruction of Spontaneous Tibialis Anterior Tendon Rupture in a Diabetic Patient.

Abstract

Introduction:The tibialis anterior (TA) is a powerful dorsiflexor of the ankle. Ruptures of the TA can be a distressing condition that needed a surgical intervention. Fortunately, despite being the third most common lower limb tendon rupture (after Achilles and patellar tendon), ruptures of the TA remain a rare clinical entity. We present a case of spontaneous rupture of the TA in an elderly diabetic lady as well as our successful repair using a TA allograft to bridge the defect gap.Case Report:A 73-year-old known diabetic lady complains of a 6-month history of progressive right ankle pain and swelling over the dorsum of her foot. She did not recall any trauma or twisting injury. She had tenderness over the anterior ankle, an erythematous cystic soft tissue mass, and weakness in ankle dorsiflexion. In addition, she demonstrated notable prominent first metatarsophalangeal hyperextension on ankle dorsiflexion. Loss of contour of normal TA anatomy was noted over anterior aspect of ankle joint. Magnetic resonance imaging reported a complete rupture of the TA tendon with a 4.2 cm tendon gap. Surgical repair using a TA allograft whip stitched side to side to the proximal TA stump and the remaining allograft secured on the medial cuneiform with bio absorbable screw. Rehabilitation consisted of a structured program with protected weight bearing. At 3 months after surgical repair, the patient was able to return to daily activities.Conclusion:This case report highlights the successful use of a TA allograft in the repair of a chronic TA rupture in an elderly diabetic patient. This repair has demonstrated to be reliable at 12-month post-surgery and allows prompt return to daily activities.