CME OnDemand: 2022 AOFAS Annual Meeting-Surgical Management of Tibialis Anterior Tendon Ruptures: A Systematic Review and Proposed Treatment Algorithm

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Tibialis Anterior Tendon (TAT) tears or ruptures can have a negative impact on patients' quality of life, but there is no consensus on the best surgical treatment for this condition due to limited data. To address this deficiency, a systematic review of the literature was conducted to analyze the different surgical interventions for TAT rupture and propose a treatment algorithm. The review included 12 studies with a total of 171 patients, and various repair techniques were used, including direct repair, tendon transfers, and grafts. The results showed that both direct repair and autograft cohorts had significantly higher functional outcome scores compared to the allograft cohort. The autograft cohort also had higher scores than the tendon transfer cohort. Additionally, surgical intervention led to statistically significant improvements in dorsiflexion strength in both early and delayed intervention cohorts. <br /><br />Based on the findings, the study proposes a treatment algorithm for TAT ruptures. The algorithm considers the time from injury to surgery and the length of the tendon gap. For injuries within 6 weeks, semitendinosus tendon autograft is recommended regardless of the tendon gap length. For injuries after 6 weeks, if the tendon gap is less than 2 cm, direct repair is recommended. If the tendon gap is between 2-5 cm, EHL tendon transfer is recommended. For a tendon gap of 5 cm or more, semitendinosus tendon autograft is recommended. The algorithm is based on the available literature and statistical evidence from the systematic review.<br /><br />In conclusion, surgical management of TAT ruptures yields good clinical outcomes in the intermediate follow-up. The proposed treatment algorithm provides guidance for surgical intervention based on the time from injury to surgery and the length of the tendon gap. However, further research and larger studies are needed to validate and refine the algorithm.

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Matthew B. Weiss, BS, Mohammad T. Azam, BS, Hugo A. Ubillus, MD, Arianna L. Gianakos, DO, Noah Kirschner, Raymond J. Walls, MD, FRCS, John G. Kennedy, MD, FRCS(Orth)

Keywords

Tibialis Anterior Tendon

TAT tears

TAT ruptures

surgical treatment

systematic review

literature analysis

repair techniques

direct repair

tendon transfers

grafts