Tibialis Anterior Tendinopathy
Sydney C. Karnovsky
Mark C. Drakos
Sterile Instruments/Equipment
Tourniquet
#2 orthocord
3-0 Vicryl, 0 Vicryl, 3-0 nylon sutures
Drill
Bio-Tenodesis screw
Positioning
Place the patient in a supine position.
Place a nonsterile tourniquet on the operative thigh. Prep and drape the lower extremity in a sterile manner.
Exsanguinate the lower extremity and inflate the tourniquet 250 mm Hg.
Surgical Approach
Identify the tibialis anterior tendon (Figure 16-1).
Figure 16-1. The incision sites are labeled. A, The hamstrings. B, The proximal native tibialis anterior stump. C, The tibialis anterior insertion at the medial cuneiform.
In all chronic cases, use a hamstring autograft to augment and reconstruct the tendon (see Chapter 11 for hamstring harvest techniques).
Locate the area of the tibialis anterior rupture and make a 2- to 3-cm incision.
Remove the damaged area of the tendon (Figure 16-2).
Figure 16-2. An incision is made over the area of the damaged tendon.
Resect the tibialis anterior stump back to normal-looking tendon (Figures 16-3, 16-4, 16-5, 16-6, 16-7).
Note: Cheat high during this portion of the operation.
Make a 2-cm incision over the medial cuneiform (Figure 16-8).Related posts:
Management of Metatarsalgia and Equinus Contracture: Gastrocnemius Recession, Percutaneous Tendoachilles Lengthening, and Diaphyseal Metatarsal Shortening Osteotomy
Management of Lesser Toe Deformity: PIP Arthroplasty and Extensor Lengthening
Medial Malleolar Stress Fractures
Talus Fractures
Achilles Tendinopathy
Arthroscopic Management of Osteochondral Lesions of the Talus
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