Tendoscopy of the posterior tibial tendon.
An anatomic cadaver study was performed and subsequently, in a prospective study, diagnostic and therapeutic tendoscopy (tendon sheath endoscopy) was performed in 16 consecutive patients with a history of persistent posteromedial ankle pain for at least 6 months. All patients had pain on palpation over the posterior tibial tendon, a positive tibial tendon resistance test, and local swelling. The indications were diagnostic procedure after surgery in 5 patients, diagnostic procedure after fracture in 5, diagnostic after trauma in 1, chronic tenosynovitis in 2, screw removal in 1, and posterior ankle arthrotomy in 2 patients. Inspection and surgery of the complete tendon and its tendon sheath can be performed by a standard two-portal technique. A new finding is the vincula that was consistently present in all our autopsy specimens as well as all our patients. At 1-year follow-up, 3 of the 4 patients in whom resection of a pathological thickened vincula, and 2 patients in whom tenosynovectomy and tendon sheath release were performed, were free of symptoms. Other procedures such as removal of adhesions and screw removal could well be performed. In 2 patients with a posteromedially located loose body, successful removal took place by means of a posterior tibial tendoscopic approach. There were no complications.
van Dijk
C N
CN
Department of Orthopaedic Surgery, University of Amsterdam, The Netherlands.
Kort
N
N
Scholten
P E
PE
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery; D000843:Ankle Joint / Q000601:surgery; D018771:Arthralgia / Q000175:diagnosis / Q000601:surgery; D001182:Arthroscopy; D001863:Bone Screws; D002102:Cadaver; D002908:Chronic Disease; D004487:Edema / Q000175:diagnosis / Q000601:surgery; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007594:Joint Loose Bodies / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D000074402:Synovectomy; D013710:Tendons / Q000473:pathology / Q000601:surgery*; D013717:Tenosynovitis / Q000175:diagnosis / Q000601:surgery; D013977:Tibia / Q000293:injuries; D013978:Tibial Fractures / Q000175:diagnosis / Q000601:surgery; D000267:Tissue Adhesions / Q000601:surgery; D016896:Treatment Outcome