Extensor digitorum longus (EDL) to extensor hallucis longus (EHL) tendon transfer for delayed EHL tendon rupture following anterior ankle arthroscopy – Case report

BACKGROUND: Arthroscopy of the ankle is an important surgical technique that has become increasingly popular over the years due to its usefulness in the treatment of many ankle conditions. Nevertheless, it's not deprived of complications. Extensor hallucis longus (EHL) tendon ruptures following anterior ankle arthroscopy have only been reported 3 times in the literature. CASE REPORT: We report the case of a 52-year-old female submitted to ankle arthroscopy with removal of a bony fragment located at the tip of the lateral malleolus and ATFL ligament repair (arthroscopic Bröstrom-Gould). At the sixth postoperative week, she experienced a sudden “pop” located at the anterior aspect of the ankle with inability to actively extend the hallux and difficulty in walking barefoot with disruption of normal gait. MRI showed a complete rupture of the extensor hallucis longus tendon with approximately 6 cm separation between the tendon ends. Surgical treatment was performed: tendinous transfer of the extensor digitorum longus (EDL) to the EHL using a Pulvertaft technique. At the 12th postoperative week, the patient could actively extend the hallux and the second toe with a range of motion similar to the contralateral foot. CONCLUSION: This case reports a delayed EHL tendon rupture following ankle arthroscopy treated surgically with a good functional result. To our knowledge, this is the first published case of delayed EHL tendon rupture following anterior ankle arthroscopy treated surgically with a tendinous transfer of the EDL to the EHL. The possible causes leading to this complication and the different surgical techniques that could have been used to treat this pathology were discussed.