Case series of traumatic neglected EHL lacerations: choice of surgical treatment based on injury type.

Main Article Content

Miriam Grassi
Luca Faugno
Marco Mattia Larghi
Giuliano Salvadori del Prato
Alfonso Manzotti


orthopedic surgery, extensor hallucis longus, tendon repair, tissue scaffolds


Background and aim: Extensor Hallucis Longus (EHL) tendon rupture is a rare injury of the foot, representing only 1% of overall tendon rupture. Early diagnosis and surgical repair are recommended but there is still no consensus regarding the ideal treatment. The purpose of this study was to evaluate a case series of patients with neglected extensor hallucis longus (EHL) tendon rupture.

Methods: We report a case series of 3 patients affected by traumatic neglected EHL lacerations treated with reconstructive surgery using tissue scaffolds, between November 2019 and May 2020. Demographics data, mechanism of injury, zone of injury, tendon gap, time to surgery, type of surgical repair, preoperative and postoperative functional score were collected with a minimum follow-up of 6 months.

Results: The zone of injury (according to Al-Qattan classification) involved was in 1 case zone 2, in 1 case zone 4 and in the last case zone 5. The mean value of intraoperative tendon gap was of 3,4 cm. The elapsed time from injury to surgery was an average of 3,3 months. One tendon transfer surgery and two primary repairs with Krakow fashion were performed, all augmented with tissue scaffolds. The mean preoperative and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scores were, respectively, 43 and 97,33.

Conclusions: Our results highlight good functional result and satisfaction with active extension of the hallux restored in all patients. According to our experience, we recommend choosing reconstruction technique basing on the topographic zone of lesion and intraoperative tendon gap.


Download data is not yet available.
Abstract 94 |


1. Bastías G F, Cuchacovich N, Schiff A, Carcuro G, & Pellegrini M J; Technique tip: EDL-to-EHL double loop transfer for extensor hallucis longus reconstruction. Foot Ankle Surg., 2019, 25(3): 272–277.
2. Joseph R M, & Barhorst J; Surgical reconstruction and mobilization therapy for a retracted extensor hallucis longus laceration and tendon defect repaired by split extensor hallucis longus tendon lengthening and dermal scaffold augmentation. J Foot Ankle Surg., 2012,
51(4): 509–516.
3. Leung Y F, Ip S P S, & Chung O M; A new method of functional tendon transfer for the dysfunction of extensor hallucis longus. Foot Ankle Int., 2002, 23(12): 1124–1125.
4. Lohrer H, Nauck T; Subcutaneous extensor hallucis longus tendon rupture: case report and literature review. Foot Ankle Int, 2012; 33(10): 905–911
5. Park H G, Lee B K, & Sim J A; Autogenous graft repair using semitendinous tendon for a chronic multifocal rupture of the extensor hallucis longus tendon: A case report. Foot Ankle Int., 2003, 24(6): 506–508.
6. Robertson A, Nutton R W, & Keating J F; Current trends in the use of tendon allografts in orthopaedic surgery. J Bone Joint Surg Br., 2006, 88(8): 988–992.
7. Smith B, & Coughlin M; Reconstruction of a chronic extensor hallucis longus tendon laceration with a gracilis tendon autograft. Orthopedics, (2008), 31(10):
8. Zdilla M J, Paulet J E, Lear J J, Addie K M, Lambert H W; A Review of Extensor Hallucis Longus Variants Featuring a Novel Extensor Primi Internodii Hallucis Muscle Merging With Extensor Hallucis Brevis. J Foot Ankle Surg., 2018, 57(6): 1218-1220.
9. Scaduto A A, Cracchiolo A L; Lacerations and rupture of the flexor or extensor hallucis longus tendons. Foot Ankle Clin., 2000, 5 (3): 725-736.
10. Pedrazzini A, Valenti P G, Bertoni N, et al.; Traumatic extensor tendons injuries of the foot in childhood: a case report. Acta Biomed., 2019, 90(12-S): 202-206.
11. Al-Qattan M M; Surgical treatment and results in 17 cases of open lacerations of the extensor hallucis longus tendon. J Plast Reconstr Aesthet Surg, 2007, 60(4): 360–367.
12. Min J H, Yun I S, Lew D H, Roh T S, Lee W J; The use of matriderm and autologous skin graft in the treatment of full thickness skin defects. Arch Plast Surg, 2014, 41(4): 330-336.