Hello, today I will be presenting on the surgical management of tibialis anterior tendon ruptures, a systematic review, and proposed treatment algorithm. Here are the relevant disclosures. So, although rare, tibialis anterior tendon tears or ruptures can have a detrimental effect on patients' quality of life. At the moment, there is no current consensus as to the most appropriate surgical treatment for a TAT rupture, in part because of the paucity of data surrounding this condition. This study attempts to address this deficiency by performing a systematic review of the literature of different surgical interventions for a TAT rupture, analyzing the level of evidence and quality of evidence of the included studies, and recommending an algorithm approach to surgical treatment of TAT injury. In September 2021, the MEDLINE and NBASE databases were systematically reviewed based on the PRISMA guidelines with the search terms listed there. Full-length peer-reviewed studies in English with a sample size of 5 participants that reported functional outcome scores were included. We excluded systematic reviews, meta-analyses, review articles, and case series and reports with less than 5 participants. The level and quality of evidence of the included studies were evaluated using the Journal of Bone and Joint Surgery criteria and the Modified Coleman Methodology score respectively. In some cases, calculated data from the studies were analyzed to obtain relevant statistics for our analysis, including deriving descriptive statistics such as mean and standard deviation values, as well as calculating p-values with two sample t-tests assuming either equal or unequal variance. Twelve studies with 171 patients were included in this review, 11 with level 4 evidence and one with level 2 evidence. Additionally, there were 17 different types of repair techniques used, where direct repair including end-to-end repair and bone fixation was performed on 33.5% of tendons, tendon transfers performed on 20.8% of tendons, and grafts performed on 45.7% of tendons. For the mean postoperative AOFAS ankle-hindfoot AOFAS-AH scores, both the direct repair and autograft cohorts had significantly higher mean scores than the allograft cohorts. The autograft cohort was also found to have significantly higher postoperative mean AOFAS than the tendon transfer cohort. We also found statistically significant improvements in dorsiflexion strength after surgical intervention in early intervention, which is less than or equal to six weeks from injury to surgery, and delayed intervention cohorts as well. Here is the treatment algorithm. So when the time from injury to surgery is less than six weeks, the length of the tendon gap is considered. With a length of tendon gap less than two centimeters, direct repair is suggested. Between two and five centimeter gap, EHL tendon transfer is suggested. With a tendon gap greater or equal to five centimeters, semitendinosus tendon autograft is suggested. And when the time from injury to surgery is greater than or equal to six weeks, a semitendinosus tendon autograft is also suggested. So we conclude by saying the surgical management of TAT ruptures produces good clinical outcomes in the intermediate follow-up. As there is no current consensus on the most appropriate surgical treatment, we've designed a treatment algorithm based upon the current literature citing statistical evidence determined in this systematic review. Thank you.

surgical management

tibialis anterior tendon ruptures

quality of life

surgical treatment

systematic review