Tibialis Anterior Muscle Herniation Managed with Ovine Extracellular Matrix Patch: Case Report

Introduction: Muscle herniation occurs when muscle protrudes through a defect in its deep fascia. The tibialis anterior is most frequently involved and symptomatic cases present with an activity-dependent bulge and pain. Dynamic ultrasonography (USG) confirms the diagnosis while magnetic resonance imaging can delineate the defect and exclude other differentials. Case Report: A 35-year-old male had exertional anterior shin pain with a reducible swelling over mid-tibialis anterior that accentuated on dorsiflexion. Dynamic USG confirmed a focal fascial defect with herniation. After failed conservative treatment, the defect was bridged using an inlay ovine extracellular matrix patch to avoid high-tension primary closure. Post-operative rehabilitation enabled return to full sport within weeks; he remained symptom-free at follow-up. Conclusion: For tibialis anterior herniation, tension-free patch reconstruction is a reasonable option to preserve function and reduce the risk of compartment syndrome associated with tight fascial approximation.