TIBIALIS ANTERIOR TENDON RUPTURE - EVALUATION AND FOLLOW-UP BY ULTRASONOGRAPHY

Objective: The purpose of this study was to demonstrate the sonographic appearance of acute spontaneous anterior tibialis tendon (ATT) rupture, to describe the later sonographic appearance of ATT after 4-6-8 weeks of conservative treatment, and to describe the clinical outcome of these patients. Methods: This was a retrospective study of seven patients, physically active men, aged 40-75, who presented with clinical symptoms suggesting ATT rupture. All patients were treated conservatively by case immobilization and went through a follow-up ultrasound examination 4-6-8 weeks afterwards, until clinical recovery. Two patients had ultrasound examination one year after the injury. Results: All seven patients had a complete tear of the ATT with a visible gap between the torn tendon ends seen on sonography. The mean gap size at the time of initial examination was 2 cm. There was a disruption of the normal fibrillar pattern of the tendon, with non-clear fluid accumulated in the gap between the torn tendon ends. Using real-time dynamic ultrasound revealed paradoxical movement with retraction of the torn tendon ends and increasing the distance between the torn ends. All patients were treated conservatively. Sonographic follow-up examinations after 4, 6, 8 weeks revealed restoration of the tendon continuity with good active and passive movements. All seven patients demonstrated irregular and thickened tendon with echogenic scar. Clinically, at 6-8 weeks they had good range of motion (ROM) of the ankle enabling them to resume their normal daily activity.