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Tibialis Anterior Tendon and Extensor Retinaculum: Imaging in Cadavers and Patients with Tendon Tear

Min Hee Lee1,2, Christine B. Chung1, Jae Hyun Cho1,3, Aurea V. Mohana-Borges1, Micheal L. Pretterklieber1,4, Debra J. Trudell1 and Donald Resnick1

1 Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161.
2 Present address: Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
3 Present address: Department of Radiology, Ajou University Medical Center, Suwon, Korea.
4 Present address: Institute of Anatomy, University of Vienna, Vienna, Austria.


Figure 1
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Fig. 1A Extensor retinaculum and extensor tendons of foot and ankle. Schematic drawing of frontal aspect of foot and ankle shows components of extensor retinaculum and main extensor tendons. Superior and inferior extensor retinacula cover anterior aspect of ankle and foot, bracing extensor tendons.

 

Figure 2
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Fig. 1B Extensor retinaculum and extensor tendons of foot and ankle. Photograph of dissected cadaveric ankle and foot shows Y-shaped inferior extensor retinaculum and extensor tendons in anterior aspect. Tibialis anterior tendon (arrowheads) is most medially located and passes though tunnels formed by oblique superomedial limb (short arrows) and oblique inferomedial limb (long arrows) of inferior extensor retinaculum.

 

Figure 3
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Fig. 2A Tibialis anterior tendon and superior extensor retinaculum in cadaveric ankle. Transverse T1-weighted MR image (TR/TE, 600/24) obtained at level of musculotendinous junction of extensor tendons (A) and transverse anatomic section (B) show superior extensor retinaculum (arrows) covering extensor tendons, including tibialis anterior tendon (A), which is visualized as linear structure of low signal intensity in A.

 

Figure 4
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Fig. 2B Tibialis anterior tendon and superior extensor retinaculum in cadaveric ankle. Transverse T1-weighted MR image (TR/TE, 600/24) obtained at level of musculotendinous junction of extensor tendons (A) and transverse anatomic section (B) show superior extensor retinaculum (arrows) covering extensor tendons, including tibialis anterior tendon (A), which is visualized as linear structure of low signal intensity in A.

 

Figure 5
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Fig. 3A Inferior extensor retinaculum with tibialis anterior tendon and other extensor tendons in cadaveric foot. Oblique coronal T1-weighted MR image (TR/TE, 600/24) obtained at level of tarsal sinus (A) and corresponding anatomic section (B) show tibialis anterior tendon located within tunnel formed by oblique superomedial limb of inferior extensor retinaculum (straight arrows), visualized as low-signal-intensity band in A. This limb inserts at anterior crest of tibia (T) medially and continues to stem (curved arrow) laterally. From stem, intermediary (crossed arrow) and lateral (arrowheads) roots are seen, forming another tunnel for extensor tendon. A = tibialis anterior tendon, H = extensor hallucis longus tendon, D = extensor digitorum longus tendon.

 

Figure 6
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Fig. 3B Inferior extensor retinaculum with tibialis anterior tendon and other extensor tendons in cadaveric foot. Oblique coronal T1-weighted MR image (TR/TE, 600/24) obtained at level of tarsal sinus (A) and corresponding anatomic section (B) show tibialis anterior tendon located within tunnel formed by oblique superomedial limb of inferior extensor retinaculum (straight arrows), visualized as low-signal-intensity band in A. This limb inserts at anterior crest of tibia (T) medially and continues to stem (curved arrow) laterally. From stem, intermediary (crossed arrow) and lateral (arrowheads) roots are seen, forming another tunnel for extensor tendon. A = tibialis anterior tendon, H = extensor hallucis longus tendon, D = extensor digitorum longus tendon.

 

Figure 7
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Fig. 4A Tibialis anterior tendon and oblique inferomedial limb of inferior extensor retinaculum in cadaveric foot. Coronal T1-weighted MR image (TR/TE, 600/24) obtained at level of cuneiform bones (A) and nearly corresponding anatomic section (B) show tibialis anterior tendon (A) passing under oblique inferomedial limb of inferior extensor retinaculum (arrows) as thin low-signal-intensity line in A.

 

Figure 8
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Fig. 4B Tibialis anterior tendon and oblique inferomedial limb of inferior extensor retinaculum in cadaveric foot. Coronal T1-weighted MR image (TR/TE, 600/24) obtained at level of cuneiform bones (A) and nearly corresponding anatomic section (B) show tibialis anterior tendon (A) passing under oblique inferomedial limb of inferior extensor retinaculum (arrows) as thin low-signal-intensity line in A.

 

Figure 9
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Fig. 5A Partial tear of tibialis anterior tendon in 63-year-old man. (Reprinted from Internal Derangements of Joints: Emphasis on MRI, Resnick and Kang, 1997: p. 870 with permission from Elsevier) Sagittal T2-weighted MR image (TR/TE, 5,200/90) of ankle shows torn tendon (arrow) appearing as bulbous mass at level of ankle joint, which corresponds to interval between superior extensor retinaculum and oblique superomedial limb of inferior extensor retinaculum.

 

Figure 10
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Fig. 5B Partial tear of tibialis anterior tendon in 63-year-old man. (Reprinted from Internal Derangements of Joints: Emphasis on MRI, Resnick and Kang, 1997: p. 870 with permission from Elsevier) Transverse T1-weighted MR images (600/13) of ankle with fat saturation after IV contrast enhancement show prominent enhancement of tendon sheath surrounding torn tendon (A) in B and along oblique superomedial limb of inferior extensor retinaculum (arrows) in C.

 

Figure 11
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Fig. 5C Partial tear of tibialis anterior tendon in 63-year-old man. (Reprinted from Internal Derangements of Joints: Emphasis on MRI, Resnick and Kang, 1997: p. 870 with permission from Elsevier) Transverse T1-weighted MR images (600/13) of ankle with fat saturation after IV contrast enhancement show prominent enhancement of tendon sheath surrounding torn tendon (A) in B and along oblique superomedial limb of inferior extensor retinaculum (arrows) in C.

 

Figure 12
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Fig. 6A Complete tear of tibialis anterior tendon in 33-year-old man. Sagittal proton density-weighted MR image (TR/TE, 1,800/20) of ankle reveals complete rupture of tibialis anterior tendon (arrow) at level around oblique superomedial limb of inferior extensor retinaculum.

 

Figure 13
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Fig. 6B Complete tear of tibialis anterior tendon in 33-year-old man. Coronal T2-weighted MR image (7,500/60) of ankle with fat saturation shows oblique superomedial limb of inferior extensor retinaculum (arrows) around proximal torn tendon.

 

Figure 14
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Fig. 6C Complete tear of tibialis anterior tendon in 33-year-old man. Coronal T2-weighted MR image (7,500/60) of ankle with fat saturation distal to B shows empty tendon sheath filled with fluid (arrows).

 

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