Surgical treatment of tibialis anterior tendon rupture

BACKGROUND: Ruptures 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.

METHODS: This 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.

RESULTS: A 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.

CONCLUSION: The 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.