Tibialis Anterior Reconstruction with Hamstring Autograft Using a Minimally Invasive Approach

Abstract

Category: Sports Introduction/Purpose: Anterior tibial tendon ruptures are rare orthopedic injuries but can cause significant dysfunction and may need surgery to correct. Often conservative measures have been prescribed due to the morbidity of a tendon transfer as a surgical solution. The aim of this report is to present a novel reconstruction technique using hamstring autograft and provide an outcome analysis using subjective and objective criteria in order to demonstrate the safety and efficacy of this novel procedure which may obviate the need for tendon transfer or long term bracing. Methods: Patients who underwent tibialis anterior reconstruction with hamstring autograft between 2011 and 2015 by a fellowship-trained orthopedic surgeon were screened for inclusion. 10 patients were enrolled in the study, and 1 was later excluded due to concomitant conditions in her foot and ankle. Retrospective chart review was performed and functional outcomes were assessed pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire. Postoperative isokinetic testing and range of motion (ROM) using a dynamometer (Biodex System 4 Pro) was performed for inversion/eversion and plantarflexion/dorsiflexion on the involved and uninvolved ankles at a minimum of 6 months post operatively. Testing was performed at two different speeds, 60 degrees/sec and 120 degrees/sec, to determine postoperative strength and endurance of the repaired tendon, respectively. Peak torque, Max rep total work, average power, and total work were measured. Results: The average follow-up was 17.3 (range 6.0-40.0) months. Average postoperative scores improved for the VAS, SF-12 and all subscales of the FAOS. Range of motion was similar between the uninvolved and involved ankles for inversion/eversion and plantarflexion/dorsiflexion with slightly decreased measures for both inversion and dorsiflexion. Strength and endurance testing was categorized by the percent difference between the operative and non-operative side. Patients showed only small deficits in inversion strength and endurance in all measures tested. Patients showed more deficits in dorsiflexion strength and endurance, with the majority of patients showing less than 50% deficits in average power and torque for both strength and endurance (Table). All patients were able to ambulate without a brace or noticeable limp. There were no infections. Conclusion: Use of hamstring autograft for tibialis anterior reconstruction resulted in improved functional outcomes and few postoperative complications. Our results show that this procedure successfully restores ankle range of motion postoperatively. In addition, the procedure successfully restores tendon strength in inversion, with most repaired ankles showing little deficit in the involved side as compared to the uninvolved side. This is a reproducible technique with minimal morbidty and excellent clinical outcomes.