De Cock Laurens, Van Eynde Elke, Vandeputte Geoffroy
Orthopaedic Surgeon, Department of Orthopaedic Surgery, AZ Sint-Blasius, Kroonveldlaan 50, 9200 Dendermonde, Belgium.
Orthopaedic Surgeon, Department of Orthopaedic Surgery, GZA hospital, Sint-Vincentiusstraat 20, 2018 Anwerp, Belgium.
Foot Ankle Surg. 2021 Oct;27(7):827-831. doi: 10.1016/j.fas.2020.10.012. Epub 2020 Nov 5.
Distal tibialis anterior tendinopathy (DTAT) is condition which is infrequently described in literature and is usually treated with conservative means. If resistant to a rehabilitation protocol and unloading, a surgical treatment could be proposed. The aim of this research is to report on the history and clinical image of DTAT and present the clinical results of a simple surgical decompression of the tendon with local debridement and release of the distal extensor retinaculum.
Seventeen patients diagnosed with DTAT in 18 feet underwent surgery between 2008 and 2018. Upon initial presentation, all patients reported a persistent history of pain over the tibialis anterior (TA) insertion. Ultrasound was routinely performed to confirm the diagnosis. In patients with confirmed diagnosis of DTAT, persistent despite conservative treatment, we proceeded with surgical intervention during which we released the tendon by opening the distal extensor retinaculum. Retrospective chart review was performed, and functional outcomes were assessed using the AOFAS midfoot score. AOFAS score results were collected postoperatively with at least one-year follow-up.
All patients experienced pain on palpation of the distal aspect of the TA tendon. Most patients experienced pain at night and were frequent hikers. Our study population consisted of mostly female and overweight patients. All patients reported pain relief with a significant improvement of VAS for pain from 6.7 ± 1.1 preoperatively to 1.1 ± 1.2 postoperatively (p < 0.05). The postoperative AOFAS midfoot score was 97 ± 3.7. Fifteen patients were completely satisfied, two satisfied with minor reservations.
Simple distal TA tendon release by division of a consistently present constricting distal extensor retinaculum represents a surgical alternative in the treatment of chronic DTAT. Our study shows good clinical outcomes with low complications.
Level IV - retrospective case series.
胫骨前肌腱远端病变（DTAT）在文献中鲜有描述，通常采用保守治疗。若对康复方案和减负治疗无效，可考虑手术治疗。本研究旨在报告DTAT的病史和临床影像，并展示单纯手术减压肌腱、局部清创及松解远端伸肌支持带的临床效果。
2008年至2018年间，17例（18足）诊断为DTAT的患者接受了手术。初诊时，所有患者均报告胫骨前肌（TA）止点处持续疼痛。常规进行超声检查以确诊。对于确诊为DTAT且保守治疗无效的患者，我们进行了手术干预，术中通过切开远端伸肌支持带来松解肌腱。进行回顾性病历审查，并使用美国足踝外科协会（AOFAS）中足评分评估功能结果。术后至少随访一年收集AOFAS评分结果。
所有患者在触诊TA肌腱远端时均有疼痛。大多数患者夜间疼痛，且经常徒步。我们的研究对象主要为女性和超重患者。所有患者均报告疼痛缓解，视觉模拟评分法（VAS）疼痛评分从术前的6.7±1.1显著改善至术后的1.1±1.2（p<0.05）。术后AOFAS中足评分为97±3.7。15例患者完全满意，2例基本满意。
通过切开始终存在的狭窄远端伸肌支持带来单纯松解远端TA肌腱是治疗慢性DTAT的一种手术选择。我们的研究显示临床效果良好，并发症少。
IV级——回顾性病例系列。
