title: Repair of Chronic Tibialis Anterior Tendon Rupture With a Major Defect Using Gracilis Allograft.
abstract: BACKGROUND
  Tibialis anterior tendon (TAT) rupture is an uncommon injury, however, it can cause substantial deficit. Diagnosis is often delayed due to lack of initial symptoms; yet loss of function over time typically causes the patient to present for treatment. This delay usually ends up with major defects creating a great technical challenge for the operating surgeon. We present a novel technique and operative algorithm for the management of chronic TAT ruptures with a major gap after a delayed diagnosis not otherwise correctable with currently described techniques in the literature. This technique has been performed in 4 cases without any complications with fairly successful functional outcomes.
  
  
  METHODS
  For the reconstruction of chronic TAT rupture with an average delay of nine weeks after initial injury and gap of greater than 10 cm, a thorough operative algorithm was implemented in 4 patients using a double bundle gracilis allograft. Patients were then kept nonweightbearing for 6 weeks followed by weightbearing as tolerated. They began physical therapy with a focus on ankle exercises and gradual return to normal activity at 8 weeks, with resistance training exercises allowed at 12 weeks.
  
  
  RESULTS
  At a mean follow-up time of 24.5 months, all patients reported significant pain relief with normal gait pattern. There were no reported intra- or postoperative complications. The average Foot and Ankle Ability Measure score increased to 90 from 27.5 in the postoperative period. All patients were able to return their previous activity levels.
  
  
  CONCLUSIONS
  Gracilis allograft reconstruction as used in this study is a viable and reproducible alternative to primary repair with postoperative results being favorable without using complex tendon transfer techniques or autograft use necessitating the functional sacrifice of transferred or excised tendon. To the best of our knowledge, this is the first study demonstrating a successful technique and operative algorithm of gracilis allograft reconstruction of the TAT with a substantial deficit of greater than 10 cm with favorable results.
  
  
  METHODS
  Level IV: Operative algorithm with case series.
authors.affiliation: Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Alex
authors.initials: A
authors.lastname: Burton
authors.affiliation: Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania uaydogan@hmc.psu.edu.
authors.forename: Umur
authors.initials: U
authors.lastname: Aydogan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D064591:Allografts; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery*; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D012421:Rupture / Q000601:surgery*; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D061665:Time-to-Treatment
keywords: delayed diagnosis; gracilis allograft; reconstruction; rupture; tibialis anterior tendon