Reconstruction of the Anterior Tibialis Tendon Using In-phase Tendon Transfers

Abstract

Anterior tibialis tendon ruptures or lacerations are rare conditions that do not have a universally accepted treatment. Previously reported methods have described end-to-end repair, transfer of the extensor hallucis longus, and allograft interposition graft. The purpose of this paper is to describe a technique for reconstruction of the anterior tibialis tendon with a transfer of the medial 2 tendons of the extensor digitorum longus (EDL) to span any gaps or diseased tendon. In addition, the lateral 2 tendons of the EDL are transferred to the peroneus tertius to balance dorsiflexion and prevent overpull on the fourth and fifth toes if the EDL tendons are left in place. Using the EDL to reconstruct the anterior tibialis provides an in-phase tendon transfer resulting in symmetric dorsiflexion at the ankle. In addition, the EDL is a normal muscle with the capacity for hypertrophy, which supplements the muscle power of the injured anterior tibialis which often atrophies in the interim between injury and repair. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.