TIBIALIS ANTERIOR TENDON RUPTURE – EVALUATION AND FOLLOW-UP BY ULTRASONOGRAPHY

Abstract

Objective: The purpose of this study was to demonstrate the sonographic appearance of acute spontaneous anterior tibialis tendon (ATT) rupture, to describe the later sonographic appearance of ATT after 4–6–8 weeks of conservative treatment, and to describe the clinical outcome of these patients. Methods: This was a retrospective study of seven patients, physically active men, aged 40–75, who presented with clinical symptoms suggesting ATT rupture. All patients were treated conservatively by case immobilization and went through a follow-up ultrasound examination 4–6–8 weeks afterwards, until clinical recovery. Two patients had ultrasound examination one year after the injury. Results: All seven patients had a complete tear of the ATT with a visible gap between the torn tendon ends seen on sonography. The mean gap size at the time of initial examination was 2 cm. There was a disruption of the normal fibrillar pattern of the tendon, with non-clear fluid accumulated in the gap between the torn tendon ends. Using real-time dynamic ultrasound revealed paradoxical movement with retraction of the torn tendon ends and increasing the distance between the torn ends. All patients were treated conservatively. Sonographic follow-up examinations after 4, 6, 8 weeks revealed restoration of the tendon continuity with good active and passive movements. All seven patients demonstrated irregular and thickened tendon with echogenic scar. Clinically, at 6–8 weeks they had good range of motion (ROM) of the ankle enabling them to resume their normal daily activity.