Reconstruction of chronic tibialis anterior tendon rupture using a degradable synthetic matrix: A surgical technique

Tibialis anterior tendon (TAT) ruptures are uncommon and may occur acutely or present in a chronic, neglected form. Chronic ruptures, generally defined as those present for more than four weeks, are frequently associated with tendon retraction, degenerative stump tissue, and a segmental defect that precludes primary end-to-end repair. Established reconstructive options include tendon transfer, autograft interposition, and allograft interposition, each carrying trade-offs in donor site morbidity, tissue availability, and cost. We describe reconstruction of a chronic insertional TAT rupture in a 68-year-old male using a degradable synthetic polycaprolactone-based polyurethane urea matrix (FlexBand; Artelon, Inc., Marietta, GA, USA) secured to the medial cuneiform with two bone anchors and sutured to a debrided and lengthened proximal tendon stump. At final documented follow-up of 12 weeks, the patient ambulated without foot slap or compensatory gait deviation, with dorsiflexion and plantarflexion clinically symmetric to the contralateral limb and no restriction in activities of daily living. This report describes the technical feasibility of the approach.