Chronic extensor hallucis longus tendon rupture treated with double-bundle autograft of extensor hallucis capsularis: A case report

Abstract

The extensor hallucis capsularis is an accessory extensor tendon with varied occurrence. Here, we present the case of a 40-year-old man with chronic extensor hallucis longus tendon rupture treated using extensor hallucis capsularis tendon as a double-bundle autograft. He had dropped a knife proximal to the right hallux metatarsophalangeal joint 4 months ago. Computed tomography revealed the presence of extensor hallucis capsularis, with its width and thickness, and the point of divergence from the extensor hallucis longus tendon. Because direct suturing was considered difficult and the extensor hallucis capsularis tendon was sufficiently wide and long, double-bundle autograft transplantation of extensor hallucis capsularis was performed. At 1-year follow-up examination, the patient retained almost full function of his hallux. To the best of our knowledge, this is the first case to use this technique. Using the extensor hallucis capsularis tendon for grafting should be carefully considered because the variable width and length may limit the graft strength. Level of evidence: IV

Reconstruction of chronic extensor hallucis longus tendon rupture using plantaris tendon graft

“…For late reconstruction of the EHL tendon requiring lengthening, techniques have been described using EDL (1) , semitendinosus, gracilis, peroneal longus, plantaris tendon, and accessory extensor of the EHL tendon (4) , in addition to the possibility of using an allograft from a tissue bank.…”

Unknown variant of the accessory subscapularis muscle?

“…We hypothesize that it can be used as a source of material during an autograft, as in the case of an additional extensor hallucis longus (EHL). Kurishige ( 2019 ) used the extensor hallucis capsularis (a type of additional EHL) in treating EHL rupture. The effectiveness was assessed 1 year after the operation.…”

“…The effectiveness was assessed 1 year after the operation. Significant improvements in strength of the EHL, its activity, and foot stabilization were noted (Kurashige 2019 ). Of course, other muscles could have been used in such a case.…”

Ultrasound Examination and Navigation for Repeat/Delayed Reconstruction of the Ankle Extensor Tendons

“…Similar to the TA, EHL tendon lacerations need to be repaired in the first three months of injury [3]. Kurashige et al [10] reported a case of chronic EHL tendon rupture diagnosed with magnetic resonance imaging. In their work, the authors described successful grafting with the use of an accessory extensor hallucis capsularis tendon.…”