Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review

Injury of the extensor hallucis longus (EHL) tendon is relatively rare, but surgical repair is necessary to prevent deformity and gait disturbance. Primary suturing is possible if the condition is acute, but not when it is chronic. The scar tissue between the ruptured ends is a proliferative tissue...

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Autores principales:	Woo-Jong Kim, Ki-Jin Jung, Hyein Ahn, Eui-Dong Yeo, Hong-Seop Lee, Sung-Hun Won, Dhong-Won Lee, Jae-Young Ji, Sung-Joon Yoon, Yong-Cheol Hong
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	foot extensor hallucis longus reconstruction scar tissue Medicine R
Acceso en línea:	https://doaj.org/article/b7b83c6ad6db4824964d45ec08d3940d
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spelling	oai:doaj.org-article:b7b83c6ad6db4824964d45ec08d3940d2021-11-25T17:51:39ZReconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review10.3390/ijerph1822121571660-46011661-7827https://doaj.org/article/b7b83c6ad6db4824964d45ec08d3940d2021-11-01T00:00:00Zhttps://www.mdpi.com/1660-4601/18/22/12157https://doaj.org/toc/1661-7827https://doaj.org/toc/1660-4601Injury of the extensor hallucis longus (EHL) tendon is relatively rare, but surgical repair is necessary to prevent deformity and gait disturbance. Primary suturing is possible if the condition is acute, but not when it is chronic. The scar tissue between the ruptured ends is a proliferative tissue composed of fibroblasts and collagen fibers. Given the histological similarity to normal tendons, several studies have reported tendon reconstruction using scar tissue. Here, we report a reconstruction of a neglected EHL rupture using interposed scar tissue. A 54-year-old female visited our clinic with a weak extension of a big toe. She had dropped a knife on her foot a month prior, but did not go to hospital. The wound had healed, but she noted dysfunctional extension of the toe and increasing pain. Magnetic resonance imaging (MRI) revealed that EHL continuity was lost and that the proximal tendon stump was displaced toward the midfoot. Scar tissue running in the direction of the original ligament was observed between the ruptured ends. In the surgical field, the scar tissue formed a shape similar to the extensor tendon. Therefore, we performed tendon reconstruction using the interposed scar tissue. For the first 2 postoperative weeks, the ankle and foot were immobilized to protect the repair. Six weeks after surgery, the patient commenced full weight-bearing. At the 3-month follow-up, active extension of the hallux was possible, with a full range of motion. The patient did not feel any discomfort during daily life. Postoperative MRI performed at 1 year revealed that the reconstructed EHL exhibited homogeneously low signal intensity, and was continuous. The AOFAS Hallux Metatarsophalangeal-Interphalangeal scale improved from 57 to 90 points and the FAAM scores improved from 74% to 95% (the Activities of Daily Living subscale) and from 64% to 94% (the Sports subscale). Scar tissue reconstruction is as effective as tendon autografting or allografting, eliminates the risk of donor site morbidity and infection, and requires only a small incision and a short operative time.Woo-Jong KimKi-Jin JungHyein AhnEui-Dong YeoHong-Seop LeeSung-Hun WonDhong-Won LeeJae-Young JiSung-Joon YoonYong-Cheol HongMDPI AGarticlefootextensor hallucis longusreconstructionscar tissueMedicineRENInternational Journal of Environmental Research and Public Health, Vol 18, Iss 12157, p 12157 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	foot extensor hallucis longus reconstruction scar tissue Medicine R
spellingShingle	foot extensor hallucis longus reconstruction scar tissue Medicine R Woo-Jong Kim Ki-Jin Jung Hyein Ahn Eui-Dong Yeo Hong-Seop Lee Sung-Hun Won Dhong-Won Lee Jae-Young Ji Sung-Joon Yoon Yong-Cheol Hong Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review
description	Injury of the extensor hallucis longus (EHL) tendon is relatively rare, but surgical repair is necessary to prevent deformity and gait disturbance. Primary suturing is possible if the condition is acute, but not when it is chronic. The scar tissue between the ruptured ends is a proliferative tissue composed of fibroblasts and collagen fibers. Given the histological similarity to normal tendons, several studies have reported tendon reconstruction using scar tissue. Here, we report a reconstruction of a neglected EHL rupture using interposed scar tissue. A 54-year-old female visited our clinic with a weak extension of a big toe. She had dropped a knife on her foot a month prior, but did not go to hospital. The wound had healed, but she noted dysfunctional extension of the toe and increasing pain. Magnetic resonance imaging (MRI) revealed that EHL continuity was lost and that the proximal tendon stump was displaced toward the midfoot. Scar tissue running in the direction of the original ligament was observed between the ruptured ends. In the surgical field, the scar tissue formed a shape similar to the extensor tendon. Therefore, we performed tendon reconstruction using the interposed scar tissue. For the first 2 postoperative weeks, the ankle and foot were immobilized to protect the repair. Six weeks after surgery, the patient commenced full weight-bearing. At the 3-month follow-up, active extension of the hallux was possible, with a full range of motion. The patient did not feel any discomfort during daily life. Postoperative MRI performed at 1 year revealed that the reconstructed EHL exhibited homogeneously low signal intensity, and was continuous. The AOFAS Hallux Metatarsophalangeal-Interphalangeal scale improved from 57 to 90 points and the FAAM scores improved from 74% to 95% (the Activities of Daily Living subscale) and from 64% to 94% (the Sports subscale). Scar tissue reconstruction is as effective as tendon autografting or allografting, eliminates the risk of donor site morbidity and infection, and requires only a small incision and a short operative time.
format	article
author	Woo-Jong Kim Ki-Jin Jung Hyein Ahn Eui-Dong Yeo Hong-Seop Lee Sung-Hun Won Dhong-Won Lee Jae-Young Ji Sung-Joon Yoon Yong-Cheol Hong
author_facet	Woo-Jong Kim Ki-Jin Jung Hyein Ahn Eui-Dong Yeo Hong-Seop Lee Sung-Hun Won Dhong-Won Lee Jae-Young Ji Sung-Joon Yoon Yong-Cheol Hong
author_sort	Woo-Jong Kim
title	Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review
title_short	Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review
title_full	Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review
title_fullStr	Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review
title_full_unstemmed	Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review
title_sort	reconstruction of a neglected, extensor hallucis longus tendon rupture using interposed scar tissue: a case report and literature review
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/b7b83c6ad6db4824964d45ec08d3940d
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Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review

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