Three-Dimensional Anatomy of the Tibialis Anterior Tendon and its Clinical Implications for Tendon Rupture

Abstract

Abstract Purpose The present study aimed to evaluate the precise three-dimensional (3D) insertion site of the tibialis anterior tendon and to compare the classification systems to identify potential differences between populations. Methods Seventy lower limbs were dissected. The tibialis anterior tendon was dissected to verify the insertion site to the medial cuneiform and the base of the first metatarsal bone. The 3D territory of the tibialis anterior tendon insertion on the medial cuneiform and the first metatarsal bones was measured on a reconstructed 3D model. Results The insertion pattern of the tibialis anterior tendon was classified into three types, the most common being Type I: a single tibialis anterior tendon dividing into two equal-sized bands to the medial cuneiform and base of the first metatarsal bone (57.1%, 40/70 of cases). The 3D territory of the tibialis anterior tendon was larger in the plantar aspect than in the medial side of both the medial cuneiform and the base of the first metatarsal bone. The tendon width at the medial cuneiform was wider than at the first metatarsal bone. Conclusion The tibialis anterior tendon was more commonly attached to the plantar part than the medial part in both the medial cuneiform and the base of the first metatarsal bone. The morphology of the tendon insertion was similar to that in Caucasian data. This anatomic information will help surgeons to perform anatomical reconstruction of the tibialis anterior tendon and reduce further tendon damage in the first metatarsocuneiform joint area.