Endoscopic Release of Posterior Tibial Tendon Sheath for Stenosing Tenosynovitis of Posterior Tibial Tendon

Abstract

Stenosing tenosynovitis of the posterior tibial tendon is a cause of posteromedial ankle pain. Conservative treatment is often ineffective, and surgery is usually required for alleviation of symptoms. Stenosis of the tendon sheath can be overcome by release of the tendon sheath or deepening of the retromalleolar groove. These procedures can be performed endoscopically. The purpose of this Technical Note is to describe the technical details of endoscopic release of the posterior tibial tendon sheath with the advantage of minimal soft tissue dissection and titrated tendon sheath release according to the extent of stenosis. Associated tendon pathology and hindfoot malalignment should be treated accordingly.

Fibrocartilaginous Bed Injury of the Posterior Tibial Tendon Sheath

“…Indications for tendoscopy of the PTT include tenosynovitis, tendinosis, degenerative tears, tendon adhesion, and dislocation. 14-17 In these patients, hydrocele of the PTT sheath was seen on MRI and tenosynovitis was suspected 18 , although tenosynovitis was not particular, and rupture of the cartilaginous bed was detected. Leakage of joint fluid into the tendon sheath after injury to the joint capsule or ligament can be confirmed by arthrography.…”

Stenosing Tenosynovitis Following Ankle Fracture Causing Progressive Acquired Tibialis Posterior Dysfunction: A Case Report

“…Conservative methods, including modification of activities and footwear, anti-inflammatory medications, orthoses, and injections can be tried, but they are often not successful [ 16 ]. Lau et al described a technique for endoscopic release of the TPT along with synovectomy [ 17 ]. Wertheimer et al claimed good results with the endoscopic approach in treating posterior tibial tenosynovitis resistant to nonsurgical treatment [ 18 ].…”