title: Foot and ankle tendoscopy: evidence-based recommendations.
abstract: OBJECTIVE
  The purpose of this study was to provide a comprehensive review of the current literature on tendoscopy of the foot and ankle and assign an evidence-based grade of recommendation for or against intervention.
  
  
  METHODS
  A comprehensive review of the literature was performed on May 26, 2013, using the PubMed, Cochrane, and Scopus databases. Studies focusing on the use of foot and ankle tendoscopy were isolated, and these articles were then reviewed and assigned a Level of Evidence (I through V). The literature was then analyzed, and a grade of recommendation was assigned for tendoscopy of the tendons of the foot and ankle on which the procedure is generally performed.
  
  
  RESULTS
  There is weak evidence (grade Cf) to support the use of tendoscopy on the Achilles, flexor hallucis longus, and peroneal tendons. Insufficient evidence (grade I) exists to assign a grade of recommendation for tendoscopy of the tibialis posterior, tibialis anterior, flexor digitorum longus, extensor hallucis longus, and extensor digitorum longus.
  
  
  CONCLUSIONS
  A comprehensive review of the literature on foot and ankle tendoscopy has shown predominantly Level IV and V studies, with just 1 Level II study. On the basis of the current literature available, there is poor evidence (grade Cf) in support of Achilles, flexor hallucis longus, and peroneal tendoscopy for the common indications. There is insufficient evidence to make a recommendation (grade I) for or against tendoscopy of the tibialis posterior, tibialis anterior, flexor digitorum longus, extensor hallucis longus, and extensor digitorum longus. Although current literature suggests that tendoscopy is a safe and effective procedure, original scientific articles of higher levels of evidence are needed before a stronger recommendation can be assigned.
  
  
  METHODS
  Level IV, systematic review of Level II, IV, and V studies.
authors.affiliation: Carver College of Medicine, The University of Iowa, Iowa City, Iowa, U.S.A.
authors.forename: Chris C
authors.initials: CC
authors.lastname: Cychosz
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.. Electronic address: phinit-phisitkul@uiowa.edu.
authors.forename: Phinit
authors.initials: P
authors.lastname: Phisitkul
authors.affiliation: Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
authors.forename: Alexej
authors.initials: A
authors.lastname: Barg
authors.affiliation: Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Nickisch
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: C Niek
authors.initials: CN
authors.lastname: van Dijk
authors.affiliation: Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Glazebrook
mesh_terms: D000125:Achilles Tendon; D000842:Ankle; D000843:Ankle Joint; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D005528:Foot; D006801:Humans; D017410:Practice Guidelines as Topic; D052256:Tendinopathy / Q000175:diagnosis*; D013710:Tendons