Ewha Med J.  2023 Oct;46(4):e20. 10.12771/emj.2023.e20.

A 12-Week Rehabilitation Protocol for the Management of Chronic Extensor Hallucis Longus Rupture Repaired with an Autograft of the Semitendinosus Tendon

• Pitarini A
• M
• Gani KS
• Moniqa R
• Kholinne E

• KMID: 2547924
• DOI: http://doi.org/10.12771/emj.2023.e20

Abstract

Traumatic rupture of the extensor hallucis longus (EHL) is an uncommon finding in an outpatient setting. Surgical repair is typically necessary, particularly in chronic conditions that have persisted for six weeks or more. While several studies have reported EHL repair using autograft tendons, rehabilitation regimes vary, and standardized protocols have not yet been established. This case report presents with an inability to extend her left great toe. She underwent tendon reconstruction with an autograft semitendinosus tendon. At an 8-week follow-up, the patient reported greatly improved outcomes on the American Orthopaedic Foot and Ankle Society, Foot and Ankle Ability Measure, Foot and Ankle Disability Index questionnaire. Full recovery was achieved 12 weeks after surgery. The use of autograft semitendinosus tendon repair for chronic EHL tendon rupture, in conjunction with rehabilitation program, can be expected to yield favorable results.

Keyword

Extensor hallucis longus tendon; Rupture; Hamstring tendons; Rehabilitation

Figure

• 

  Fig. 1. Clinical presentation of the patient’s left foot reveals hallux flexion deformity.

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  Fig. 2. Preoperative ultrasonography was performed to evaluate the integrity of the extensor hallucis longus (EHL). (A) Longitudinal ultrasound imaging of the dorsal aspect of the left ankle showed complete rupture of the EHL tendon with a gap between the stumps (asterisk). (B) The proximal stump (asterisk) of the torn EHL tendon was at the medial cuneiform level. (C) The distal stump (asterisk) of the torn EHL tendon was isolated at the metatarsal level. EHL DIST, distal EHL; EHL PROX, proximal EHL; DORSUM PEDIS MED, dorsum pedis medial; PP1, proximal phalanx 1; MT1, metatarsal 1.

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  Fig. 3. Intraoperative findings. (A) Intraoperative view shows that the distal extensor hallucis longus (EHL) tendon width was 5 mm. (B) The gap between the proximal and distal EHL tendon stump was 6 cm; it is noteworthy that the proximal stump adhered to the fat tissue (asterisk).

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  Fig. 4. Intraoperative findings. (A, B) The semitendinosus tendon graft was sutured to the proximal and distal extensor hallucis longus (EHL) stumps using the Pulvertaft and Kessler technique. (C) The sutured tendon was pulled to assess tendon tension and extension of the big toe. (D) EHL vitality and function were tested using a nerve stimulation machine and showed extension of the great toe.

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  Fig. 5. An 8-week postoperative follow-up. (A) The left hallux position before surgery. (B) The hallux extension strength was nearly normal.

Reference

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