Bilateral Posterior Tibial Tendon and Flexor Digitorum Longus Dislocations.
The authors present a case of a previously healthy and athletic 17-year-old female who presented with a 3.5-year history of medial left ankle pain after sustaining an inversion injury while playing basketball. Prior to presentation, she had failed prior immobilization and physical therapy for a presumed ankles sprain. Physical examination revealed a dislocated posterior tibial tendon (PTT) that was temporarily reducible, but would spontaneously dislocate immediately after reduction. She had pain and snapping of the PTT with resisted ankle plantar flexion and resisted inversion as well as 4/5 strength in ankle inversion. The diagnosis of dislocated PTT was confirmed on magnetic resonance imaging (MRI). The patient underwent suture anchor repair of the medial retinaculum of the left ankle. At the time of surgery both the PTT and flexor digitorum longus (FDL) were dislocated. Three months postoperatively, the patient represented with PTT dislocation of the right (nonoperative) ankle confirmed by MRI. After failure of immobilization, physical therapy, and oral anti-inflammatory medications, the patient underwent suture anchor repair of the medial retinaculum of the right ankle. At 6 months postoperatively, the patient has 5/5 strength inversion bilaterally, no subluxation of either PTT, and has returned to all activities without limitation. The authors present this unique case of bilateral PTT dislocation and concurrent PTT/FDL dislocation along with review of the literature for PTT dislocation. The authors highlight the common misdaiganosis of this injury and highlight the successful results of surgical intervention.


METHODS
Level V: Case report.
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EMP, DMB).|The Rothman Institute, Thomas Jefferson University Hospital Philadelphia, Pennsylvania (DIP).
Eric M
EM
Padegimas
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EMP, DMB).|The Rothman Institute, Thomas Jefferson University Hospital Philadelphia, Pennsylvania (DIP).
David M
DM
Beck
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EMP, DMB).|The Rothman Institute, Thomas Jefferson University Hospital Philadelphia, Pennsylvania (DIP).
David I
DI
Pedowitz
D000293:Adolescent; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D001265:Athletic Injuries / Q000175:diagnosis / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007103:Immobilization; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D019637:Orthopedic Procedures / Q000379:methods*; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D019233:Retreatment; D018570:Risk Assessment; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D013710:Tendons / Q000601:surgery; D017211:Treatment Failure; D016896:Treatment Outcome
age-related problems; ankle injuries; ankle, adolescent foot problems; heel; rearfoot