Publication Tech Foot & Ankle

Une technique originale de réparation d’une rupture chronique de l’EHL

Z-lengthening Plasty of the Extensor Hallucis Longus (EHL) Tendon Proximal to the Retinaculum Extensorum to Repair a Chronic Rupture of the Distal EHL Tendon

Paul Gilliéron, Matthias Vautrin, Katarina Stanekova, Xavier Crevoisier

Tech Foot & Ankle 2025

Résumé

Extensor hallucis longus (EHL) tendon injuries may be diagnosed late, which can result in a nonreducible gap. When end-toend suture is impossible, a reconstruction with a graft or a transfer may be necessary to restore hallux alignment and active dorsiflexion. We propose a new surgical technique and postoperative protocol to repair a traumatic EHL rupture with a nonreducible gap by using a Z-lengthening of the EHL tendon proximal to the superior retinaculum of the extensors, thus creating sufficient length of the proximal stump to allow end-to-end suture. Our patient recovered at 3 months with an active hallux dorsiflexion of 50 degrees at the metatarsophalangeal joint (60 degrees on the healthy side). There was no loss of active or passive plantarflexion in the metatarsophalangeal or interphalangeal joint. At 3-month follow-up, the FAAM score was 83/84 (activities of daily living) and 12/12 (sports). The AOFAS score was 90/100 and the EQ-5D was 0.8. This method to repair a distal EHL rupture appears safe and simple. It eliminates the need for an allo-/autograft, and potential donor site morbidity.