Extensor digitorum tendon rupture after anterior ankle arthroscopy

• Published in: Medicina fluminensis 2020-09, Vol.56 (3), p.341-344
• Main Authors: Šumanovac, Antun, Selthofer, Robert, Kokić, Tomislav, Mujkić, Robert
• Format: Article
• Language: English
• ISSN: 1847-6864; 1848-820X
• DOI: 10.21860/medflum2020_241514

Aim: The aim of this paper is to increase awareness of orthopaedic surgeons about an uncommon yet possible complication of ankle arthroscopy – iatrogenic extensor digitorum rupture. Ankle arthroscopy is becoming more widespread and according to the literature, the complication rate varies from 9% up to 17%. Case report: We are presenting a case of 32-year old police officer who recreationally plays soccer. The patient presented with clear signs of anterior ankle impingement confirmed by X-ray and the MRI. During ankle arthroscopy massive tibial and talar bone spurs were found with significant synovial reaction, nearly 10 loose intraarticular bodies and syndesmotic ossification. The patient was placed in a walking boot and early postoperative recovery went as planned. Physical therapy started 14 days after the procedure. Five weeks after the surgery while dorsiflexing his fingers patient felt a "snap" over his ankle followed by swelling. He couldn't dorsiflex his fingers afterwards. MRI showed a rupture of the common extensor digitorum tendon. The patient was treated with open reconstruction of the tendon and lower leg immobilisation for 6 weeks followed by physical therapy and partial weight bearing. The patient made a full recovery. Conclusion: It is of the utmost importance to keep in mind that ankle arthroscopy alongside it's obvious benefits is not void of complications. Iatrogenic tendon lesion is always possible and should be suspected with any loss of movement in foot and ankle after the procedure. Urgent MRI and immediate reconstruction showed good results in our case. Cilj: Cilj prikaza je podići svijest ortopeda o vrlo rijetkoj no mogućoj komplikaciji artroskopije gležnja – jatrogenoj rupturi tetive ekstenzor digitoruma. Artroskopija gležnja postaje sve raširenija i prema literaturi učestalost komplikacija varira od 9 % do 17 %. Prikaz slučaja: Prikazujemo slučaj 32-godišnjeg policajca koji se rekreativno bavi nogometom. Pacijent se javio s izraženim simptomima prednjeg sraza gležnja koji su potvrđeni RTG-om i MR-om. Tijekom artroskopije pronašli smo masivne koštane izdanke tibije i talusa uz znatnu sinovijalnu reakciju, 10 slobodnih zglobnih tijela te osifikaciju sindesmoze. Poslijeoperativno je postavljena hodna ortoza te je poslijeoperacijski oporavak išao prema planu. Fizikalna terapija započeta je 14 dana od zahvata. Pet tjedana od zahvata, kada je pacijent učinio dorzifleksiju prstiju, osjetio je kako je „nešto puknulo” u gležnju te se poja