Evaluation of treatment options for tibialis anterior tendon ruptures

Tibialis anterior tendon (TAT) ruptures are rare injuries with limited literature. While operative intervention may improve function and reduce pain, the optimal timing and choice of surgical technique remain unclear.

To review the management of TAT ruptures across three institutions within the same academic health system and to evaluate surgical management patterns.

Patients greater than 18 years of age with TAT rupture or pathology treated between 2007 and 2024 by three board-certified foot and ankle surgeons were included. Minimum follow-up was three months. Patients without TAT pathology or inadequate follow-up were excluded. Data on demographics, treatment modality, rupture size, time to surgery, and complications were collected.

Twenty TAT ruptures in 19 patients were identified. Eleven cases were managed conservatively, and nine surgically (five EHL tendon transfers, four direct tendon repairs). Larger rupture deficits were associated with shorter time to operative intervention. No infections were reported, and one re-rupture occurred in the direct repair group. Postoperative recovery allowed return to full muscle strength in all surgical cases. Both surgical approaches demonstrated favorable functional outcomes, and conservative management was effective in low-demand patients with smaller deficits.

Both direct repair and EHL tendon transfer provide reliable restoration of strength and function with low complication rates in appropriately selected patients. Conservative management remains a reasonable alternative for small defects or low-demand individuals. This study contributes to the limited literature on TAT ruptures and supports further prospective research with standardized follow-up to refine indications, timing, and technique for surgical repair.