Results of a shuttle catheter technique for surgical repair of acute extensor hallucis longus tears

Abstract

Background and study aims: The proximal end of a torn Extensor hallucis longus (EHL) is usually so retracted that a proximal wound extension is always required to retrieve it; leading to more adhesions and stiffness. This study aims at assessment of a novel technique for proximal stump retrieval and repair of acute EHL injuries with no need for wound extension.

Material and methods: Thirteen patients with acute EHL tendon injuries at zones III, IV were prospectively included in our series. Patients with underlining bony injuries, chronic tendon injuries and previous nearby skin lesions were excluded. Dual Incision Shuttle Catheter (DISC) technique was applied with subsequent evaluation by the American Orthopedic Foot and Ankle Society (AOFAS) hallux scale, Lipscomb and Kelly score, range of motion and muscle power.

Results: Dorsiflexion at the metatarsophalangeal (MTP) joint significantly improved from a mean of 38.4±6.2º at one month to 58±9.6º at three months to 78.8±3.1º at one year postoperatively (P=0.0004). Plantar flexion at MTP joint significantly inclined from 16±3.8º at 3 months to 30.6±7.8º at the last follow-up (P=0.006). The big toe dorsiflexion power surged from 6.1±0.9N to 11.1±2.5N to 19.7±3.4N at 1 month, 3 months and one-year follow-up periods respectively (P=0.013). As per the AOFAS hallux scale, pain score was 40 of 40 points. The mean functional capability score was 43.7 out of 45 points. On Lipscomb and Kelly scale, all were graded “good” except for one patient who was graded “fair”.

Conclusion: Dual Incision Shuttle Catheter (DISC) technique represents a reliable method for repair of acute EHL injury at zones III, IV.