Reconstruction using an autograft with near complete preservation of the extensor retinaculum for chronic tibialis anterior tendon disruption

We present the case of a 42-year-old woman with chronic disruption of the tibialis anterior tendon who was treated by reconstructive surgery using autologous semitendinosus tendon grafting. Two incisional approaches, proximal and distal of the degenerative scar tissue between each ruptured stump, made it possible to preserve most of the extensor retinaculum, except for the inferior Y-shaped medial segment that was excised to prevent adhesion between the reconstructed tendon and the extensor retinaculum. Furthermore, by placing the proximal and distal suture knots far from the ends of the extensor retinaculum, impingement could be avoided between the knots using the Pulvertaft weave technique, and of the extensor retinaculum through movement of the ankle joint. Although some types of tendon transfer technique or interpositional autologous tendon grafting have been reported to show good outcomes for chronic tibialis anterior tendon disruption with a large defect, the recent trend has been toward reconstructive surgery using autografts. The surgical technique presented seems applicable for achieving minimum surgical complications in this rare condition.