The diagnosis of an acute tibialis anterior rupture in an active patient should be treated with primary repair and possible gastrocnemius lengthening prior to tensioning the repair to achieve adequate dorsiflexion.
Acute anterior tibialis tendon ruptures are an uncommon injury and often treated surgically to facilitate a return to pre-injury functional dorsiflexion and gait. When performing an end to end direct tendon repair prior to tensioning the repair ankle dorsiflexion should be assessed with the knee in full extension. If the patient is unable to achieve at least 5° of passive dorsiflexion it is recommended that a gastrocnemius recession be performed.