Reconstruction of Neglected Tibialis Anterior and Extensor Hallucis Tendon Ruptures

Case: A 37-year-old woman presented with foot and toe drop due to neglected traumatic ruptures of the tibialis anterior (TA) and extensor hallucis longus (EHL) tendons. She underwent reconstruction using autologous hamstring grafts for the EHL and a peroneus longus tendon graft for the TAT. At 18-month final follow-up, the patient had active functional ankle and toe movements. Conclusion: Concomitant chronic TA and EHL tendon tears with large defects are rare. Autologous reconstruction using a peroneus longus graft is a viable solution, restoring function and offering an effective alternative when multiple tendon injuries preclude direct repair or standard transfers.