Irreducible Fractures and Dislocations of the Ankle Associated With Entrapment of the Posterior Tibial Tendon Within the Tibiofibular Interosseous Space:: A Case Series and Literature Review

Objective: The aim of this study was to present a case series of patients undergoing posterior tibial tendoscopy, assess their clinical outcome, and describe surgical findings and treatment complications. Methods: This is a clinical, retrospective, observational study of 11 consecutive cases of tenosynovitis of the posterior tibial tendon. All 11 patients underwent tendoscopy of the posterior tibial tendon. All procedures were performed by the same surgeon in 2 different hospitals. Minimum follow-up was 2 years. Results: All patients had their preoperative and postoperative AOFAS and VAS scores assessed. Both scores had an important improvement at 12 months that persisted at 24 months. Moreover, 72.72% of the patients were very satisfied with the procedure, and no patient reported to be dissatisfied. Additionally, 90.91% of the patients had no postoperative complications. The present results are consistent with those previously reported in the literature. Conclusion: Endoscopic or tendoscopic repair of the posterior tibial tendon is a simple and reproducible procedure that provides good functional and cosmetic outcomes with a low complication rate. It is important to increase the number of patients in this series in order to expand our conclusions. Level of Evidence IV; Therapeutic Studies; Case Series.

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A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121989988 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712198998

Author(s):

Yong Hu ◽

Cheng Yue ◽

Xiucun Li ◽

ZhengXun Li ◽

Dongsheng Zhou ◽

...

Keyword(s):

Case Series ◽

High Rate ◽

Osteochondral Lesions ◽

Medial Malleolus ◽

Posterior Tibial Tendon ◽

The Novel ◽

Level Of Evidence ◽

Posterior Tibial ◽

Medial Malleolar Osteotomy ◽

Osteotomy Technique

Background: The current techniques for medial malleolar osteotomy may lead to posterior tibial tendon injury and have a high rate of malunion. Purpose: To describe a novel partial step-cut medial malleolar osteotomy technique and evaluate its technical feasibility and its advantages compared with traditional methods. Study Design: Case series; Level of evidence, 4. Methods: The novel technique consisted of osteotomy of the anterior one-third to two-thirds of the medial malleolus. A total of 19 ankles (18 patients) with osteochondral lesions of the talus underwent the novel osteotomy technique before osteochondral reconstruction. All patients were evaluated for more than 2 years. Radiographs were analyzed for postoperative displacement and malunion, and postoperative ankle function was evaluated according to the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the visual analog scale (VAS) for pain. Results: The partial step-cut osteotomy technique was able to provide adequate intra-articular exposure without disturbing the posterior tibial tendon. The 19 ankles healed at a mean of 7.3 ± 1.5 weeks (range, 6-12 weeks). There was slight incongruence in 4 ankles, with a displacement of 1.0 ± 0.1 mm proximally and 0.3 ± 0.1 mm medially. The mean postoperative AOFAS and VAS scores improved compared with preoperatively, from 54.2 ± 12.1 to 84.6 ± 6.6 and from 6.4 ± 1.0 to 1.8 ± 1.3, respectively ( P < .001 for both). No intraoperative tendon injuries were observed. Conclusion: Results indicated that partial step-cut osteotomy is a reliable and effective method for providing enough exposure, avoiding displacement after reduction, and not disturbing the anatomic structures behind the medial malleolus.

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Combined Spring and Deltoid Ligament Repair in Adult-Acquired Flatfoot

Foot & Ankle International ◽

10.1177/1071100718770132 ◽

2018 ◽

Vol 39 (8) ◽

pp. 903-907 ◽

Cited By ~ 14

Author(s):

Caio Nery ◽

André Vitor Kerber C. Lemos ◽

Fernando Raduan ◽

Nacime Salomão B. Mansur ◽

Daniel Baumfeld

Keyword(s):

Case Series ◽

Deltoid Ligament ◽

Posterior Tibial Tendon ◽

Retrospective Case ◽

Level Of Evidence ◽

Posterior Tibial ◽

Novel Technique ◽

Spring Ligament ◽

Tissue Healing ◽

Internal Brace

Background: Adult-acquired flatfoot deformity (AAFD) is usually due to a combination of mechanical failure of the osteoligamentous complex that maintains the medial longitudinal arch of the foot and attenuation or complete tear of the posterior tibial tendon. Magnetic resonance imaging studies in patients with flatfoot deformities have reported the posterior tibial tendon to be pathologic in up to 100% of patients, the spring ligament in up to 87%, and the deltoid ligament in 33%. Many studies in the literature describe reconstruction of the spring ligament or the deltoid ligament associated with AAFD, but there is no study in which both (spring and deltoid) ligaments are reconstructed at the same time. We describe a novel technique to reconstruct the deltoid ligament and the spring ligament at the same time. Methods: We described the technique and evaluated 10 consecutive patients with AAFD and insufficient ankle and midfoot ligaments. Results: We found no postoperative complications, stiffness, or loss of correction. Conclusion: We present a novel technique to reconstruct the failed deltoid and spring ligament during flatfoot correction. It is unique in that it uses internal brace augmentation with FiberTape® to help and protect the soft tissue healing. Level of Evidence: Level IV, retrospective case series.

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Assessment of imaging, pathoanatomy and terminology in posterior tibial tendon dysfunction

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1181 ◽

2020 ◽

Vol 14 (2) ◽

pp. 126-131

Author(s):

Matthew Workman ◽

Nick Saragas ◽

Paulo Ferrao

Keyword(s):

Case Series ◽

Tendon Sheath ◽

Pathological Process ◽

Preoperative Imaging ◽

Research Assessment ◽

Posterior Tibial Tendon ◽

Posterior Tibial Tendon Dysfunction ◽

Mri Findings ◽

Level Of Evidence ◽

Posterior Tibial

Objective: This study aimed to determine damage/change occurring in the posterior tibial tendon of patients undergoing surgery for posterior tibial tendon dysfunction (PTTD) and to correlate preoperative imaging and intraoperative findings with histology to determine the most appropriate investigations for diagnosis. The secondary aim was to clarify terminology used in describing the tendon pathology, to improve descriptive terminology for research, assessment, and treatment of PTTD. Methods: The records of patients who had undergone surgery for stage 2 PTTD were retrospectively reviewed. Cases in which preoperative diagnostic imaging was done and a posterior tibial tendon specimen was sent for histology were included. Ultrasound (US) and MRI findings, surgical notes and histopathological reports were evaluated. Results: Nineteen patients met the inclusion criteria. Fourteen had US showing degenerative changes and synovitis. Five had MRI showing tendon degeneration, with rupture in two cases. Intraoperatively, all tendons showed gross abnormality, with surrounding synovitis. Microscopically, no acute inflammation was noted within any tendon specimens. All had non-specific reactive changes within the visceral synovium. Conclusion: This study confirms clear histological degeneration within the posterior tibial tendon of patients undergoing corrective surgery for PTTD. Preoperative imaging and surgical findings identified tendon sheath synovitis. Pre-operative ultrasound imaging and intraoperative confirmation of PTTD is accurate; thus, histological confirmation is unnecessary. The pathological changes in PTTD have been described as a tendinopathy in the literature. We suggest using the term pantendinopathy, which is a combination of peritendinitis with tendinosis, as it better describes the pathological process. Level of Evidence IV; Therapeutic Studies; Case Series

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Prevalence of Abnormal Ultrasound Findings in Asymptomatic Posterior Tibial Tendons

Foot & Ankle International ◽

10.1177/1071100720931085 ◽

2020 ◽

Vol 41 (9) ◽

pp. 1049-1055

Author(s):

F. Baker Mills ◽

Kevin Williams ◽

Christopher H. Chu ◽

Paul Bornemann ◽

J. Benjamin Jackson

Keyword(s):

Pathological Condition ◽

Case Series ◽

Institutional Review Board ◽

Posterior Tibial Tendon ◽

Posterior Tibial Tendon Dysfunction ◽

Level Of Evidence ◽

Posterior Tibial ◽

Institutional Review Board Approval ◽

Institutional Review ◽

Ultrasound Findings

Background: Posterior tibial tendon dysfunction (PTTD) is a pathological condition that can cause failure of the posterior tibial tendon (PTT). Initially, patients with PTTD are often asymptomatic, making early identification and treatment challenging. Certain ultrasound (US) characteristics have been implicated in the presence of tendinopathy, but their frequency has yet to be assessed in the PTT. The purpose of this study was to identify and report on the frequency of incidental, or potentially early subclinical, tendinopathic US characteristics in asymptomatic PTTs. Methods: Following institutional review board approval, 150 participants underwent a bilateral-comprehensive US assessment. The resulting images were reviewed and assessed to identify the presence of abnormalities demonstrated to represent tendinopathy. Results: Overall, 266 tendons were assessed and 128 (48.1%) were determined to have at least one tendinopathic trait. Specifically, 51 (19.2%) had circumferential fluid, 69 (25.9%) had noncircumferential fluid, 22 (8.3%) had thickening, 31 (11.7%) had heterogenicity, 19 (7.1%) had hyperemia, and 2 (0.8%) had calcification. Additionally, Caucasian participants were found to be nearly 3 times more likely to have tendinopathic findings when compared with African American participants. Conclusion: Sixty-seven percent of participants and 48.1% of PTTs evaluated had at least one tendinopathic feature identified on US. The prevalence rates of these findings, observed in participants, were as follows: noncircumferential fluid, circumferential fluid, heterogenicity, and thickening. Knowing the frequency of these traits may help clinicians to identify subclinical tendinopathy in the PTT before it progresses to PTTD. Level of Evidence: Level IV, case series.

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Postoperative evaluation of posterior tibial tendon transfer

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2018.v12.787 ◽

2018 ◽

Vol 12 (2) ◽

pp. 145-149

Author(s):

Larissa Miranda Xavier Vieira ◽

Rodrigo Barra Caiado Fleury ◽

Bruno Severino Nunes ◽

Jefferson Soares Martins ◽

Edegmar Nunes Costa

Keyword(s):

Tendon Transfer ◽

Case Series ◽

Interference Screw ◽

Posterior Tibial Tendon ◽

Drop Foot ◽

Level Of Evidence ◽

Posterior Tibial ◽

Before And After ◽

Life Improvement ◽

Therapeutic Study

Objectives: To analyse and report the advantages of posterior tibial tendon transfer amongst patients with drop-foot as well as evaluate the degrees of foot biomechanical restoration and patient quality of life improvement. Methods: Seven patients diagnosed with drop-foot received surgery in which the posterior tibial tendon was transferred via the syndesmotic membrane, and the tendon was fixed to the lateral cuneiform bone using an interference screw. Results: The patients completed the Stanmore questionnaire before and after surgery to report their improvements with regard to all of the questionnaire criteria.Conclusion: The adopted surgical technique is an effective method of disease correction, with associated pain improvement, resumption of wearing shoes, elimination of the regular use of an ankle-foot orthosis (AFO), muscle strength gain, and functional capacity improvement. Level of Evidence IV; Therapeutic Study; Case Series.

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Thrombosed Urethral Prolapse: a case series and review of the literature

Journal of Clinical Urology ◽

10.1177/20514158211032853 ◽

2021 ◽

pp. 205141582110328

Author(s):

Abisola Oliyide ◽

Ijeoma Chibuzo ◽

Magda Kujawa

Keyword(s):

Clinical Condition ◽

Correct Diagnosis ◽

Age Distribution ◽

Case Series ◽

Review Of The Literature ◽

Level Of Evidence ◽

Case Presentation ◽

Urethral Prolapse ◽

Evidence Level

Thrombosed urethral prolapse is a rare clinical condition. In this context, we describe our experience and compare our findings with the literature, following presentation of five consecutive cases over 2 years. This will hopefully improve awareness and appropriateness of specialty referrals as a correct diagnosis is rarely established prior to the patient being seen by a urologist. We also wish to highlight a case presentation of thrombosed urethral prolapse outside the bimodal age distribution which has been recorded in the literature. Level of Evidence: Level 4

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Acute Posterior Tibial Tendon Tear in an Ice-Hockey Player: A Case Report

Foot & Ankle International ◽

10.3113/fai.2008.1045 ◽

2008 ◽

Vol 29 (10) ◽

pp. 1045-1048 ◽

Cited By ~ 9

Author(s):

Sidney M. Jacoby ◽

James R. Slauterbeck ◽

Steven M. Raikin

Keyword(s):

Case Report ◽

Ice Hockey ◽

Posterior Tibial Tendon ◽

Tendon Tear ◽

Level Of Evidence ◽

Posterior Tibial ◽

Hockey Player

Level of Evidence: V, Case Report

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Classification and Nomenclature: Progressive Collapsing Foot Deformity

Foot & Ankle International ◽

10.1177/1071100720950722 ◽

2020 ◽

Vol 41 (10) ◽

pp. 1271-1276 ◽

Cited By ~ 1

Author(s):

Mark S. Myerson ◽

David B. Thordarson ◽

Jeffrey E. Johnson ◽

Beat Hintermann ◽

Bruce J. Sangeorzan ◽

...

Keyword(s):

Classification System ◽

Consensus Statement ◽

Classification Systems ◽

Posterior Tibial Tendon ◽

Foot Deformity ◽

New Classification ◽

Level Of Evidence ◽

3 Dimensional ◽

Posterior Tibial ◽

Consensus Statements

Recommendation: The historical nomenclature for the adult acquired flatfoot deformity (AAFD) is confusing, at times called posterior tibial tendon dysfunction (PTTD), the adult flexible flatfoot deformity, posterior tibial tendon rupture, peritalar instability and peritalar subluxation (PTS), and progressive talipes equinovalgus. Many but not all of these deformities are associated with a rupture of the posterior tibial tendon (PTT), and some of these are associated with deformities either primarily or secondarily in the midfoot or ankle. There is similar inconsistency with the use of classification schemata for these deformities, and from the first introduced by Johnson and Strom (1989), and then modified by Myerson (1997), there have been many attempts to provide a more comprehensive classification system. However, although these newer more complete classification systems have addressed some of the anatomic variations of deformities encountered, none of the above have ever been validated. The proposed system better incorporates the most recent data and understanding of the condition and better allows for standardization of reporting. In light of this information, the consensus group proposes the adoption of the nomenclature “Progressive Collapsing Foot Deformity” (PCFD) and a new classification system aiming at summarizing recent data published on the subject and to standardize data reporting regarding this complex 3-dimensional deformity. Level of Evidence: Level V, consensus, expert opinion. Consensus Statements Voted: CONSENSUS STATEMENT ONE: We will rename the condition to Progressive Collapsing Foot Deformity (PCFD), a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot varus. Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%. (Unanimous, strongest consensus) CONSENSUS STATEMENT TWO: Our current classification systems are incomplete or outdated. Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%. (Unanimous, strongest consensus) CONSENSUS STATEMENT THREE: MRI findings should be part of a new classification system. Delegate vote: agree, 33% (3/9); disagree, 67% (6/9); abstain, 0%. (Weak negative consensus) CONSENSUS STATEMENT FOUR: Weightbearing CT (WBCT) findings should be part of a new classification system. Delegate vote: agree, 56% (5/9); disagree, 44% (4/9); abstain, 0%. (Weak consensus) CONSENSUS STATEMENT FIVE: A new classification system is proposed and should be used to stage the deformity clinically and to define treatment. Delegate vote: agree, 89% (8/9); abstain, 11% (1/9). (Strong consensus)

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Occult Malignancy in Adult Tonsillectomy for Benign Indication

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420952474 ◽

2020 ◽

pp. 000348942095247

Author(s):

Noah Syme ◽

Stefan Brettfeld ◽

Ashley Dorneden ◽

Von Samedi ◽

Therese Bocklage ◽

...

Keyword(s):

Literature Review ◽

Chart Review ◽

Tertiary Care ◽

Case Series ◽

Retrospective Chart Review ◽

Pooled Analysis ◽

Level Of Evidence ◽

Occult Malignancy ◽

Pathologic Analysis ◽

Adult Tonsillectomy

Objective: National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued. Study design: Retrospective chart review and systematic review of the literature. Setting: Tertiary care academic hospital and multi-hospital private healthcare system. Subjects and methods: A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated. Results: Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000. Conclusion: Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens. Level of Evidence: Pooled analysis of case series from the literature and a single institution, level 4.

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