Neglected and Large Defect of Extensor Hallucis Longus Tendon Injuries reconstructed by Double looping with Extensor Digitorum Longus by an Improvised Surgical Method
Introduction: Laceration to the dorsum of the foot is usually associated with injury to the extensor hallucis longus (EHL) tendon. But in chronic cases or neglected EHL injuries, the patient develops EHL dysfunction causing a flexion deformity of the great toe at the level of the IP joint. There are...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Jaypee Brothers Medical Publisher
2023-07-01
|
| Series: | Journal of Orthopedics and Joint Surgery |
| Subjects: | |
| Online Access: | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1115 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849236795015823360 |
|---|---|
| author | Makesh Ram Sriraghavan Poornima Kumararja Pavalan Louis |
| author_facet | Makesh Ram Sriraghavan Poornima Kumararja Pavalan Louis |
| author_sort | Makesh Ram Sriraghavan |
| collection | DOAJ |
| description | Introduction: Laceration to the dorsum of the foot is usually associated with injury to the extensor hallucis longus (EHL) tendon. But in chronic cases or neglected EHL injuries, the patient develops EHL dysfunction causing a flexion deformity of the great toe at the level of the IP joint. There are various methods (autograft and allograft) for the treatment of large defects in EHL tendons. Tendon diameter mismatch and diminished resistance are common issues in other tendon transfers.
Materials and methods: This study had 12 patients with EHL injuries—reconstructed by double looping with extensor digitorum longus (EDL) done from 1<sup>st</sup> September 2019 to 28<sup>th</sup> February 2023. But intraoperatively, there was a defect of up to 4–6 cm and so in all cases, EDL of the second toe was rerouted and double looping done, and transferred to EHL. The distal part of EDL was tenodesed with extensor digitorum brevis (EDB). In the case of associated fractures, they were anatomically reduced and the EHL defect was repaired.
Results and discussion: This is a surgical technique where rerouting of EDL of the second toe along with the EHL and to improve the results further both the tendons were enclosed in the paratenon to promote good tendon healing and to prevent adhesions. This technique provides greater tensile strength and better function. At the final follow-up, all patients recovered with good active hallux extension with good functional results. No reruptures or other complications were reported in this group of patients.
Conclusion: Second EDL-to-EHL double loop transfer for EHL reconstruction is a safe, reproducible, and low-cost technique to address EHL ruptures when a primary repair is not possible. |
| format | Article |
| id | doaj-art-bc60f7db2c064f18adbb00051f07e0d9 |
| institution | Kabale University |
| issn | 2582-7863 |
| language | English |
| publishDate | 2023-07-01 |
| publisher | Jaypee Brothers Medical Publisher |
| record_format | Article |
| series | Journal of Orthopedics and Joint Surgery |
| spelling | doaj-art-bc60f7db2c064f18adbb00051f07e0d92025-08-20T04:02:09ZengJaypee Brothers Medical PublisherJournal of Orthopedics and Joint Surgery2582-78632023-07-0152505510.5005/jojs-10079-11153Neglected and Large Defect of Extensor Hallucis Longus Tendon Injuries reconstructed by Double looping with Extensor Digitorum Longus by an Improvised Surgical MethodMakesh Ram Sriraghavan0Poornima Kumararja1Pavalan Louis2Department of Orthopaedics, Government Thoothukudi Medical College, Thoothukudi, Tamil Nadu, India, Phone: +91 9841617765Department of Pathology, ACS Medical College, Chennai, Tamil Nadu, IndiaDepartment of Orthopaedics, Government Thoothukudi Medical College, Thoothukudi, Tamil Nadu, IndiaIntroduction: Laceration to the dorsum of the foot is usually associated with injury to the extensor hallucis longus (EHL) tendon. But in chronic cases or neglected EHL injuries, the patient develops EHL dysfunction causing a flexion deformity of the great toe at the level of the IP joint. There are various methods (autograft and allograft) for the treatment of large defects in EHL tendons. Tendon diameter mismatch and diminished resistance are common issues in other tendon transfers. Materials and methods: This study had 12 patients with EHL injuries—reconstructed by double looping with extensor digitorum longus (EDL) done from 1<sup>st</sup> September 2019 to 28<sup>th</sup> February 2023. But intraoperatively, there was a defect of up to 4–6 cm and so in all cases, EDL of the second toe was rerouted and double looping done, and transferred to EHL. The distal part of EDL was tenodesed with extensor digitorum brevis (EDB). In the case of associated fractures, they were anatomically reduced and the EHL defect was repaired. Results and discussion: This is a surgical technique where rerouting of EDL of the second toe along with the EHL and to improve the results further both the tendons were enclosed in the paratenon to promote good tendon healing and to prevent adhesions. This technique provides greater tensile strength and better function. At the final follow-up, all patients recovered with good active hallux extension with good functional results. No reruptures or other complications were reported in this group of patients. Conclusion: Second EDL-to-EHL double loop transfer for EHL reconstruction is a safe, reproducible, and low-cost technique to address EHL ruptures when a primary repair is not possible.https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1115allograftautograftlisfranc injurymetatarsal fractureparatenonrehabilitationtenodesistendon reconstruction |
| spellingShingle | Makesh Ram Sriraghavan Poornima Kumararja Pavalan Louis Neglected and Large Defect of Extensor Hallucis Longus Tendon Injuries reconstructed by Double looping with Extensor Digitorum Longus by an Improvised Surgical Method Journal of Orthopedics and Joint Surgery allograft autograft lisfranc injury metatarsal fracture paratenon rehabilitation tenodesis tendon reconstruction |
| title | Neglected and Large Defect of Extensor Hallucis Longus Tendon Injuries reconstructed by Double looping with Extensor Digitorum Longus by an Improvised Surgical Method |
| title_full | Neglected and Large Defect of Extensor Hallucis Longus Tendon Injuries reconstructed by Double looping with Extensor Digitorum Longus by an Improvised Surgical Method |
| title_fullStr | Neglected and Large Defect of Extensor Hallucis Longus Tendon Injuries reconstructed by Double looping with Extensor Digitorum Longus by an Improvised Surgical Method |
| title_full_unstemmed | Neglected and Large Defect of Extensor Hallucis Longus Tendon Injuries reconstructed by Double looping with Extensor Digitorum Longus by an Improvised Surgical Method |
| title_short | Neglected and Large Defect of Extensor Hallucis Longus Tendon Injuries reconstructed by Double looping with Extensor Digitorum Longus by an Improvised Surgical Method |
| title_sort | neglected and large defect of extensor hallucis longus tendon injuries reconstructed by double looping with extensor digitorum longus by an improvised surgical method |
| topic | allograft autograft lisfranc injury metatarsal fracture paratenon rehabilitation tenodesis tendon reconstruction |
| url | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1115 |
| work_keys_str_mv | AT makeshramsriraghavan neglectedandlargedefectofextensorhallucislongustendoninjuriesreconstructedbydoubleloopingwithextensordigitorumlongusbyanimprovisedsurgicalmethod AT poornimakumararja neglectedandlargedefectofextensorhallucislongustendoninjuriesreconstructedbydoubleloopingwithextensordigitorumlongusbyanimprovisedsurgicalmethod AT pavalanlouis neglectedandlargedefectofextensorhallucislongustendoninjuriesreconstructedbydoubleloopingwithextensordigitorumlongusbyanimprovisedsurgicalmethod |