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.