Reconstruction of a neglected extensor hallucis tendon rupture with an iliotibial band autologous graft: case report

Background: Injury to the lower extremity, especially rupture of the extensor hallucis longus (EHL) tendon, is relatively rare. This case report presents a neglected case of EHL tendon rupture with a 10 cm gap, treated with a novel graft source – the iliotibial band (ITB) – using the Pulvertaft technique. Case report: A 34-year-old man presented with a previous rupture of the EHL tendon of his right great toe, with a 10 cm gap, 12 months before admission, for which a primary repair had already been performed immediately after the trauma. The pain persisted even 6 weeks post-surgery; therefore, after clinical and ultrasound evaluation, we found a rupture of the EHL tendon with the gap filled with fibrotic tissue. We performed a tendon graft for EHL reconstruction using the ITB with the Pulvertaft technique, which showed a good postoperative result. Discussion: Rupture of the EHL has proved to be troublesome, and the management of this case can be performed by direct repair in the acute setting or by tendon transfer or tendon graft. It should be performed properly to restore function. Conclusion: After the tendon grafting was performed, intraoperative evaluation found that there was no lag in the gliding of the tendon as it passed through the extensor retinaculum, and the excursion of the tendon was preserved.