Split Peroneus Longus Free Tendon Autograft Transplantation for the Treatment of Neglected Extensor Hallucis Longus Tendon Laceration: A Case Report

Abstract

A neglected laceration of the extensor hallucis longus (EHL) tendon is rare. Retraction of the tendon ends often occurs when a laceration is neglected, leading to a substantial tendon deficit. A paucity of case reports is available describing the treatment of EHL laceration with a large area of gap secondary to retraction. Therefore, the treatment recommendations are limited. We present the case of a neglected EHL tendon laceration with a 10.5-cm gap in a healthy 22-year-old female. The EHL tendon laceration was repaired using a split peroneus longus tendon autograft that, to the best of our knowledge, has not been previously reported. At the 3-year follow-up evaluation, the patient retained full function of her hallux and was free of symptoms.

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

“…Previous studies have reported that the extension power of the great toe after tendon graft or tendon transfer was from slightly decreased to full strength. 1,4–6,12 In the current case, although both MTP and IP joints had flexion contractures, the extension power on the affected side was normal. These results were consistent with those of previous reports, despite the patient exhibiting poor compliance to rehabilitation exercises of the tendon function postoperatively.…”

“…In previous reports, ROM after tendon graft or tendon transfer was from −22° to approximately the same compared with the healthy side in the MTP joint. 1,4–6,12 Although few reports on ROM in the IP joints are available, Matsuda et al 12 have reported it as −5° compared with the healthy side postoperatively. In the current case, at the 1-year follow-up examination, active extension measured between metatarsal and proximal phalanx was 35° and 45° on the affected and healthy sides, respectively, and that measured in the IP joints was 0° and 5° on the affected and healthy sides.…”

“…EDL tendon, semitendinosus, gracilis, split peroneus longus or split EHL have been used for tendon autograft and EDL to the second toe for tendon transfer. 1–6 Although very few reports have been published regarding the reconstructing of chronic EHL tendon ruptures, almost all have demonstrated fair to good outcomes. 1,4–6,12 However, the use of autograft could be associated with donor site morbidity that results in pain and dysfunction.…”

“…Typically, the extensor digitorum longus (EDL) tendon, semitendinosus, gracilis or peroneus longus have been used for tendon autografts, and the EDL tendon to the second toe is used for tendon transfer. 1–6 However, these procedures are invasive because the original function is sacrificed.…”

Unknown variant of the accessory subscapularis muscle?

“…The EDL tendon, the gracilis, fibularis longus muscle, and the semitendinosus could also help. However, the procedure would be invasive and the original function of the muscle could be sacrificed (Olewnik 2019 ; Olewnik et al 2019 ; So et al 2018 ).…”