Neglected and Large Defect of Extensor Hallucis Longus Tendon Injuries Reconstructed by Double Looping with Extensor Digitorum Longus by an Improvised Surgical Method

摘要

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 extensordigitorum longus (EDL) done from 1st September 2019 to 28th 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.