Rupture Of Tibialis Anterior Tendon Research Articles

Tibialis Anterior Tendon Reconstruction Utilizing Split Tendon Turn-down: A Case Report and Technique Guide.

Tibialis anterior tendon (TAT) ruptures are rare, equating to less than 1% of all musculotendinous injuries. These injuries can be acute or atraumatic, with the latter often associated with chronic degenerative tendinopathy. Surgical repair is indicated when conservative measures fail in meeting functional demands. Direct end-to-end repair is the preferred method for TAT ruptures but may not be feasible with a large tendon defect. Various surgical techniques have been described to address this pathology, including allograft tendon interposition or extensor hallucis longus (EHL) transfer. The authors present a unique technique utilizing a minimal incision TAT turn-down with dermal matrix allograft augmentation, and, in addition, a case implementing this technique in a patient with a large insertional defect. The patient's postoperative course and outcomes were favorable, with improvements in pain, satisfaction, functional scores, and strength. The surgical technique offers versatility and can be adapted to different tendon defect sizes. It also allows for minimal-incision exposure, beneficial for patients with comorbidities or compromised skin integrity. In conclusion, the authors present a case report and surgical technique for the management of large-deficit, chronic TAT ruptures using split TAT turn-down. This technique provides a potential solution for cases where direct end-to-end repair is not feasible.Level of Evidence: Level V.

Tibialis Anterior Tendon Rupture Surgical Treatments and Outcomes: A Systematic Review and Meta-Analysis

Tibialis anterior tendon ruptures are a rare condition with an often-delayed diagnosis due to transient pain and compensation of remaining anterior compartment tendons. Previous systematic reviews have limited their recommendations to surgical treatment over nonoperative cares given the relatively small sample size in the literature. This current systematic review and meta-analysis was performed to compare the outcomes amongst the various surgical techniques and define factors that may affect long term patients results. Twenty-six references (217 cases) were identified. Use of extensor tendon autograft (odds ratio [OR] 5.55; I2=46%), autograft repair through semitendinosus/gracilis/ plantaris/ Achilles tendon/ peroneus longus ([OR] 4.14; I2=71%), or direct repair ([OR] 3.59; I2=57%), provided the best postoperative outcomes, whereas allograft repair ([OR] .52; I2=77%),and ipsilateral split/ turn-down tibialis anterior tendon ([OR] .69; I2=71%), were associated with poorer outcomes. Ruptures fixed in the acute phase ([OR] 8.3; I2=26%), were associated with statistically significant better outcomes when compared to these ruptures fixed in the chronic phase ([OR] .52; I2=77%). Results of this systematic review and meta-analysis suggests that ruptures should be surgically repaired in the acute phase whenever possible and comparable outcomes can be achieved through extensor tendon autograft repair, autograft repair, and direct repair.

Minimally invasive dual-incision approach: An alternative technique to repair tibialis anterior tendon rupture surgical technique and case report

The authors present a minimally invasive surgical technique to repair tibialis anterior tendon rupture which can be used in mild and moderate retraction. Operative technique is illustrated with its different steps. Advantages and indications are specified according to the data reported in the literature.

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

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.

Primary tendon repair in a case of acute traumatic tibialis anterior with extensor hallucis longus tendon rupture in a young male-a case report

<p>Tibialis anterior tendon rupture is a rare entity which can be either traumatic and non-traumatic. It often presents late due to mild clinical symptoms and signs. Acute ruptures are traumatic occurring in young individuals while chronic ruptures are due to degenerative processes occurring in elderly individuals, commonly after 45 years of age. Tibia anterior along with extensor hallucis tendon is an even rarer entity, operative management of which becomes mandatory, more so in a young active individual for better outcome. We have a 31-year-old male patient, who presented to us with an acute post traumatic tibialis anterior tendon rupture of 3 days duration which was diagnosed following an initial clinical examination, an unremarkable X-ray picture, and Ultrasonography confirming the diagnosis. The patient was managed with primary repair of the tibialis anterior tendon along with Extensor hallucis tendon (which was found intra-operatively) with 2-0 ethibond sutures using a cross-linked Bunnell technique. The patient regained full ankle range of motion at 8 weeks post operative period with ankle dorsiflexion and great toe extension back to pre-injury state.As we have seen with this case, early primary repair in a case of acute rupture at tibialis anterior and extensor hallucis longus rupture with non-absorbable suture has significant improved post operative outcome in terms of return of the affected range of motion and can be practice safely in new hands with limited resources as material of suture and technique has not significant effect in post operative outcome. Acute tibialis anterior and extensor hallucis tendon rupture, non absorbable suture, ethibond, cross linked Bunnell technique.</p><p><strong> </strong></p>

Surgical Management of Tibialis Anterior Tendon Ruptures: A Systematic Review and Proposed Treatment Algorithm

Category: Sports; Other Introduction/Purpose: Although rare, Tibialis Anterior Tendon (TAT) tears or ruptures can have a detrimental effect on patients' quality of life. There is no current consensus as to the most appropriate surgical treatment for TAT rupture, in part because of the paucity of data surrounding this condition. Therefore, this study attempts to address this deficiency by performing a systematic review of the literature of the different surgical interventions for TAT rupture, analyzing the level of evidence (LoE) and quality of evidence (QoE) of the included studies, and recommending an algorithm approach to the surgical treatment of TAT injury. Methods: In September 2021, the MEDLINE and EMBASE databases were systematically reviewed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following search terms were used: (anterior) AND (tibialis OR tibial) AND (tendon) AND (tear OR rupture) NOT (acl OR cruciate OR meniscal OR patellar). ??Full-length peer-reviewed studies in English with a sample size of 5 participants that reported functional outcome scores were included. We excluded systematic reviews, meta-analyses, review articles, and case series/reports with less than five participants. The LoE and QoE of the included studies were evaluated using the Journal of Bone and Joint Surgery Criteria and the Modified Coleman Methodology Score, respectively. In some cases, tabulated data from studies were analyzed to obtain relevant statistics for our analysis, including deriving descriptive statistics such as mean and standard deviation values, as well calculating p-values with two- sample t-tests assuming either equal or unequal variance. Results: Twelve studies with 171 patients were included in this review, 11 with Level IV evidence and one with Level II evidence. Additionally, there were 17 different types of repair techniques used, where direct repair (including end-to-end repair and bone fixation) was performed on 33.5% of tendons, tendon transfers were performed on 20.8% of tendons, and grafts were performed on 45.7% of tendons. For the mean postoperative AOFAS Ankle-Hindfoot (AOFAS-AH) scores, both the direct repair and autograft cohorts had significantly higher mean scores than the allograft cohort (p=0.008 and p=0.002 respectively). The autograft cohort was also found to have significantly higher post-operative means AOFAS-AH than the tendon transfer cohort (p=0.047). We also found statistically significant improvements in dorsiflexion strength after surgical intervention in early intervention (<=6 weeks from injury to surgery) and delayed intervention cohorts. Conclusion: Surgical management of TAT ruptures produces good clinical outcomes in the intermediate follow-up. As there is no current consensus on the most appropriate surgical treatment, we have designed a treatment algorithm based upon the current literature citing statistical evidence determined in this systematic review.

Expedited Diagnosis and Surgical Repair of Isolated Acute Anterior Tibial Tendon Rupture: A Case Report

Isolated acute anterior tibial (AT) tendon rupture is rare and can be missed, resulting in significant functional deformity of the affected limb. Early surgical treatment can improve functional patient outcomes, familiarity with patient presentation, including a history of ankle pain and swelling after hyper-plantar flexion and signs of a palpable dell and weak dorsiflexory strength at the ankle, and prompt confirmation with MRI are crucial.

Outcomes of Tibialis Anterior Tendon Reconstruction with Autograft or Allograft.

In cases of tibialis anterior tendon (TAT) ruptures associated with significant tendon defect, an interposition graft is often needed for reconstruction. Both auto- and allograft reconstructions have been described in the literature. Our hypothesis was that both graft types would have a good integrity and provide comparable outcomes. Patients who underwent TAT reconstruction using either an auto- or allograft were identified. Patient-reported outcomes (PROs) were collected using the 12-Item Short Form Health Survey (SF-12) questionnaire, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the Foot Function Index (FFI), and the Karlsson-Peterson score. Functional outcome was assessed by isokinetic strength measurement. Outcomes were further assessed with magnetic resonance imaging (MRI) evaluation of graft integrity. All measurements were also performed for the contralateral foot. Twenty-one patients with an average follow-up of 82 months (20-262 months), comprising 12 allograft and 9 autograft TAT reconstructions, were recruited. There were no significant differences in patient-reported outcomes between allograft reconstructions and autografts: SF-12 (30.7 vs 31.1, P = .77); AOFAS (83 vs 91.2, P = .19); FFI (20.7% vs 9.5%, P = .22); and Karlsson-Peterson (78.9 vs 87.1, P = .23). All grafts (100%) were intact on MRI with a well-preserved integrity and no signs of new rupture. There were no major differences in range of motion and functional outcomes as measured by strength testing between the operative and nonoperative side. Reconstructions of TAT achieved good PROs, as well as functional and imaging results with a preserved graft integrity in all cases. There were no substantial differences between allograft and autograft reconstructions. Level IV, retrospective case series.

Closed Traumatic Rupture of Tibialis Anterior Tendon

Hui Chen*, Gang-Rui Jia, Xin-Qiang Wang and Xin-Qiang Wang Author Affiliations Department of Orthopaedics, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China Received: March 10, 2021 | Published: March 26, 2021 Corresponding author: Themistoklis Sertis, Cardiologist, Cardiology Department of Drama General Hospital, Drama, Greece DOI: 10.26717/BJSTR.2021.34.005607

Tibialis Anterior Tendon Partial Release and Plantar Implant Placement for Midfoot Arthrodesis: Technique Tip

Category:Midfoot/Forefoot; OtherIntroduction/Purpose:Midfoot arthrodesis is a reliable procedure for deformity correction and pain relief. First tarsometatarsal arthrodesis can be used for correction of hallux valgus deformity with large intermetatarsal angles or first-ray hypermobility. Midfoot arthrodesis is also integral in correction of pes planovalgus deformity with midfoot collapse. First tarsometatarsal arthrodesis has a nonunion rate of 2-15%. Arthrodesis is completed traditionally through a dorsal approach. Due to high nonunion rates, recent studies have investigated plater based plates. These have been shown to have superior strength by creating a tension band construct as the foot is loaded. Tibialis anterior footprint is at risk when accessing first tarsometatarsal joint for arthrodesis. We explore whether the tibialis insertional footprint can be released and repaired with no deleterious effects.Methods:Patients included were undergoing first tarsometatarsal joint or naviculocuneiform joint arthrodesis with a plantar based plate and screw construct for hallux valgus deformity with large intermetatarsal angle or first-ray hypermobility, and those with first TMT joint arthritis, pes planovalgus, Lisfranc injury, or Charcot neuroarthropathy. Medial based surgical approach is centered over the first tarsometatarsal joint. Saphenous neurovascular bundle is retracted dorsally. Release of the capsular structures allowed for complete visualization and distraction of the joint. The distal-most attachment of the tibialis anterior tendon onto the first metatarsal is release in line with the capsulotomy. Primary insertion on the medial cuneiform was preserved. A cuff of released insertional tissue is preserved and reflected distally for repair. Standard tarsometatarsal arthrodesis joint preparation was completed. Plantar plate then fixed and compressed. Deep fascial layers were then closed over the plated were previous tendon release was performed.Results:In 62 patients, none had tibialis anterior tendon rupture, weakness, or irritation, with average follow-up of 36.2 months. Nine wound complications were recognized during the study. Twelve percent of patients experiencing delayed incisional healing that went on to heal with local wound care. Smokers accounted for six of the seven patients (OR 24.62, p<.05), and one of seven patients had Charcot (OR 2.08, p<.05). Deep wound complications, which required return to the operating room for formal irrigation and debridement, were seen in 3% (2 of 62). Both patients were active smokers and had removal of hardware at the time of debridement. Both underwent definitive coverage with split-thickness skin grafts and went on to successful arthrodesis and wound healing.Conclusion:One advantage of applying a plate and screw construct plantarly for midfoot arthrodesis is biomechanical stability. Multiple studies have indicated this plantar construct may be superior. Another benefit may be less hardware prominence due to increased soft-tissue coverage. Subcutaneous positions of dorsal plates have been reported to contribute to incisional irritation and symptomatic hardware. Tibialis anterior tendon damage has been suggested as a limitation of the plantar approach for midfoot arthrodesis, and the tendon insertion must be released to prepare the joint adequately to apply implants. This series shows tendon release can be safely accomplished without any deleterious effects.

Surgical treatment of tibialis anterior tendon rupture

BackgroundRuptures of the anterior tibial tendon can be both acute and chronic. The acute lesion can be caused by a sharp cutting trauma or by blunt or hyperplantarflexion trauma.Spontaneous ruptures are rare, and most ruptures are due to degenerative changes mainly affecting the distal avascular 5−30 mm of the tendon. Surgical repair is the preferred treatment for physically active patients.Overall, the literature shows that operative repair results in a very good outcome in most patients.This study compares the clinical outcome in patients with anterior tibial tendon rupture, treated with different surgical techniques. MethodsThis multicenter cohort study was conducted at four different Foot and Ankle specialized clinics. The study was approved by the local ethical committee. A total of 48 patients with surgically treated tibialis anterior rupture was included. The study protocol included the demographic and clinical data of each patient and the surgical treatment. The VAS-FA PROM was recorded pre- and postoperative in all patients. The mean follow-up were 30 (20.8–48.5) months. ResultsA significant difference was found in age between patients who stated “good” versus “fair” (p = 0.002) and “very good” versus “fair”, i.e. younger age for “fair” p = 0.036, thus showing that younger patients do worse than older patient after surgery when rating the results. However there was no significant difference for older versus younger age looking at the results “poor”, “fair, good and very good”.The group with chronic tendon ruptures had a significantly higher preoperative VAS-FA than the group sustaining non-traumatic rupture (p = 0.048). There was no significant linear relation between age, postoperative VAS-FA and VAS-FA improvement. Also, we did not find a significant linear relation between age and outcome. Please see Tables 2–4 for results. ConclusionThe tibialis anterior tendon rupture can be both acute and chronic. We could not identify any significant differences in clinical outcome or PROM between acute and delayed suture of the tibialis anterior tendon rupture. Level of Evidence: Level II. Prospective controlled cohort study.

Noninsertional Tibialis Anterior Tendon Rupture Managed With Midsubstance SpeedBridge Repair

Tibialis anterior tendon rupture is uncommon but can lead to substantial functional impairment and persisting pain. Operative repair of the ruptured tendon is warranted in most cases, but little data exist on outcomes and surgical techniques for repair. To date, the literature contains only small retrospective review series and case reports on the management of this injury. We introduce a new technique for repair of lacerated tibialis anterior tendons using the Midsubstance SpeedBridge. This method is an adaptation of a previously described technique for treating Achilles tendon ruptures. The benefits of this construct are that it allows for direct tendon-bone fixation, it is knotless, and it can be preloaded to minimize postoperative repair elongation. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Composite Cutaneous Anterolateral Thigh Flap with Rolled Fascia Lata for Tibialis Anterior Tendon Reconstruction.

Background:Rupture of the tibialis anterior tendon (TAT) is a rare phenomenon with limited therapeutic options derived from sparse case reports. Without proper anchoring of the tibialis anterior, dorsiflexion and inversion of the foot become impaired, disrupting patient’s gait. Reported techniques for repair fall into nonoperative (ankle-foot orthosis) or operative (primary closure, tendon transfer, free gracilis) modalities, depending on patient factors, mechanism of injury, and extent of defect. In this report, we outline a novel method of tendon repair and soft tissue coverage for a large defect.Methods:We present a unique case of traumatic TAT rupture with a failed primary closure yielding a large (>15 cm) defect. The patient presented with a defect spanning the entire anterior compartment of the leg, limiting options for coverage and functional restoration.Results:The patient’s large, chronic defect was successfully repaired via a composite cutaneous anterolateral thigh and a rolled fascia lata free flap. The patient had robust return to function and is able to dorsiflex and invert the foot and ambulate.Conclusions:The use of this donor site offers a novel, advantageous option for TAT repair. It should be considered for patients with large defects that make other repair methods unfeasible.

Chronic tibialis anterior rupture: An underdiagnosed condition

Rupture of the tibialis anterior tendon is a rare condition and the diagnosis is frequently delayed, due to subtle changes in foot and ankle function. However, chronic deficits can be visible over time namely progressive gait dysfunction, with a limited dorsiflexion and foot slapping. The authors describe a case report of an isolated chronic anterior tibial tendon rupture, of a 16-year-old boy, treated with a free flap interposition with gracilis tendon. The gracilis tendon can safely be used as a free flap interposition in chronic anterior tibial tendon rupture with large tendon defects, with excellent clinical results. Large gaps can be successfully bridged with this technique, with the advantage of sparing the other local tendons and lower donor site morbility.

PO 18205 - Case report

Introduction: Anterior tibial tendon ruptures are quite rare. All studies found in the literature refer to the adult population, with no reports of this injury in the pediatric population. The literature on the treatment of this injury is scarce. Objective: To report the case of a child subjected to peroneus brevis tendon transfer for the sequela of a severe anterior tibial and extensor hallucis longus tendon injury. Methods: Male patient, 8 years of age, was run over by a car and sustained an exposed tibial fracture and major soft-tissue injury of the foot. Anterior tibial, posterior tibial and extensor hallucis longus tendon rupture were detected. Damage control, soft-tissue cover and conservative treatment of the anterior tibial and extensor hallucis longus tendons were initially performed; however, the conservative treatment failed, and valgus deformity and pronation developed. Subsequently, tenoplasty (posterior tibial tendon), the Strayer procedure (gastrocnemius recession of the Achilles tendon) and elongation of the peroneus longus and brevis tendons were also performed, but the patient experienced deformity recurrence. Subcutaneous peroneus brevis tendon transfer to the navicular was then chosen, with postoperative use of an ankle-foot orthosis (AFO) and physical therapy. Results: The deformity was improved. The patient progressed with satisfactory gait and strength. He currently walks without support using an AFO. Both the patient and his family were satisfied with the functional outcome of the tendon transfer. Conclusion: Reconstruction of anterior tibial and extensor hallucis longus tendon rupture through peroneus brevis tendon transfer is a viable and reliable treatment option. No complications such as adhesions or correction failure were observed, thus corroborating the viability of this method.

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.

Traumatic rupture of the anterior tibial tendon following closed ankle and foot fracture: A case report and literature review

A 22-year-old man presented with traumatic rupture of the anterior tibial tendon associated with a closed ankle fracture. The tendon rupture was not diagnosed before surgery but was recognized at the time of open reduction. The tendon was repaired and the fracture was internally fixed. Six months after the operation, the patient had nearly full range of pain-free ankle movement and normal gait. To our knowledge, such a case has not been reported previously. Although anterior tibial tendon rupture is rare, it should be suspected in cases of closed ankle fracture, irrespective of the mechanism of injury.

Tibialis Anterior Reconstruction With Hamstring Autograft Using a Minimally Invasive Approach.

Tibialis anterior tendon ruptures are rare and can cause significant dysfunction. Often, conservative measures are prescribed because of the morbidity of a tendon transfer as an operative solution. We present a novel reconstruction technique using hamstring autograft, which may obviate the need for local tendon transfer and long-term bracing. Patients who underwent tibialis anterior reconstruction with hamstring autograft between 2011 and 2015 were screened for inclusion. Eight were included. Functional outcomes were assessed pre-and-postoperatively using the Foot and Ankle Outcome Score (FAOS), Visual Analog Pain Scale (VAS), and Short-Form-12 (SF-12) general health questionnaire. Isokinetic testing using a dynamometer (Biodex System 4 Pro) was performed at 60 and 120 degrees/s, respectively, for inversion/eversion and plantarflexion/dorsiflexion on both ankles at a minimum of 6 months postoperatively to determine peak torque, average power, and total work. Range of motion (ROM) testing was also performed, using a goniometer, at a minimum of 6 months postoperatively. Average follow-up was 17.3 (6.0-40.0) months for strength testing and ROM testing, and 18.5 (12.0-26.0) months for functional outcome scores. Average postoperative functional scores improved for all tests. ROM was similar between the uninvolved and involved ankles for inversion/eversion and plantarflexion/dorsiflexion. Patients showed deficits in dorsiflexion strength in all measures tested and improvements in inversion strength. All patients were able to ambulate without a brace. Use of a hamstring autograft for tibialis anterior reconstruction resulted in good clinical outcomes. This procedure successfully restored ankle ROM postoperatively and tendon strength in inversion and dorsiflexion, with most patients showing little deficit when comparing their involved and uninvolved sides. Level IV, Case series.

Tibialis Anterior Tendon Reconstruction Using Augmented Half-Thickness Tendon Segment Transposition.

Therapeutic, Level IV.

Results of Augmented Half-Thickness Tibialis Anterior Tendon Segment Transposition, a Novel Technique for Tibialis Anterior Tendon Reconstruction

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