Anterior tibial tendon rupture: results of operative treatment

Anterior tibial tendon ruptures are rare, and most studies have reported subjective outcome data, with little or no objective analysis. The purpose of this study was to review the results of the operative treatment of anterior tibial tendon ruptures using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and objective isokinetic testing.

We retrospectively reviewed the results of operatively treated anterior tibial tendon ruptures in 10 patients. The average age at the time of surgery was 57 (18 to 79) years. The etiology of rupture was traumatic in five and spontaneous in five patients. Evaluation consisted of preoperative and postoperative questionnaires, physical examination, and isokinetic strength testing. Average time between surgery and isokinetic testing was 27.9 months.

The average AOFAS score was 71.9 preoperatively and 89.8 postoperatively. Eight of 10 patients reported improvement in pain, and nine of 10 patients reported increased activity level postoperatively. All patients were satisfied with the overall function of their foot and would undergo the procedure again. The peak torque generated in the operative extremity during ankle dorsiflexion and hindfoot inversion was less than that of the uninvolved extremity. No statistically significant difference was noted between peak torque generation in ankles treated with direct anterior tibial tendon repair and ankles treated with anterior tibial tendon repair with augmentation.

Operative treatment of anterior tibial tendon rupture resulted in a high level of patient satisfaction; however, isokinetic testing demonstrated a decrease in dorsiflexion and inversion strength compared to the uninjured extremity. The clinical significance of this residual weakness was not apparent in most patients. Patients with anterior tibial tendon ruptures should be forewarned that normal strength may not be a realistic expectation after surgery.