Rupture of the Posterior Tibial Tendon. Evaluation of Injury of the Spring Ligament and Clinical Assessment of Tendon Transfer and Ligament Repair*

Surgical correction was performed on nine patients who had equinovarus deformity caused by severe crush injury of the leg sustained in an earthquake. The operative procedure used involved the transfer of the posterior tibial tendon to the dorsum of the foot by passing it through the interosseous membrane using a modified procedure as published in 1978. 5 This procedure was combined with percutaneous Achilles tendon lengthening and tenotomy of toe flexors when needed. The average follow-up time after the operation was 21 months. The treatment improved the heel-toe steppage gait in all patients and all were able to walk in standard shoes. There were no complications in the postoperative period. Recurrence of varus deformity was not seen in any of the patients. They had active dorsiflexion of the foot, with a median active dorsiflexion of 5° (0 to 10°) and median active plantarflexion of 16.1° (10 to 25°) compared to the median active dorsiflexion and plantarflexion on the uninvolved side. The total range-of-motion was 21.1° (10 to 35°).

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Role of Tendoscopy in Treating Stage II Posterior Tibial Tendon Dysfunction

Foot & Ankle International ◽

10.1177/1071100717746192 ◽

2018 ◽

Vol 39 (4) ◽

pp. 433-442 ◽

Cited By ~ 8

Author(s):

Alessio Bernasconi ◽

Francesco Sadile ◽

Matthew Welck ◽

Nazim Mehdi ◽

Julien Laborde ◽

...

Keyword(s):

Invasive Surgery ◽

Stage Ii ◽

Preoperative Imaging ◽

Tibialis Posterior ◽

Posterior Tibial Tendon ◽

Posterior Tibial ◽

Spring Ligament ◽

Sf 36

Background: Stage II tibialis posterior tendon dysfunction (PTTD) resistant to conservative therapies is usually treated with invasive surgery. Posterior tibial tendoscopy is a novel technique being used in the assessment and treatment of posterior tibial pathology. The aims of this study were (1) to clarify the role of posterior tibial tendon tendoscopy in treating stage II PTTD, (2) to arthroscopically classify spring ligament lesions, and (3) to compare the arthroscopic assessment of spring ligament lesions with magnetic resonance imaging (MRI) and ultrasonographic (US) data. Methods: We reviewed prospectively collected data on 16 patients affected by stage II PTTD and treated by tendoscopy. We report the reoperation rate and functional outcomes evaluated by comparing pre- and postoperative visual analogic scale for pain (VAS-pain) and the Short-Form Health Survey (SF-36; with its physical [PCS] and mental [MCS] components). Postoperative satisfaction was assessed using a VAS-satisfaction scale. One patient was lost to follow-up. Spring ligament lesions were arthroscopically classified in 3 stages. Discrepancies between preoperative imaging and intraoperative findings were evaluated. Results: At a mean of 25.6 months’ follow-up, VAS-pain ( P < .001), SF-36 PCS ( P = .039), and SF-36 MCS ( P < .001) significantly improved. The mean VAS-satisfaction score was 75.3/100. Patients were relieved from symptoms in 80% of cases, while 3 patients required further surgery. MRI and US were in agreement with intraoperative data in 92% and 67%, respectively, for the tendon assessment and in 78% and 42%, respectively, for the spring ligament. Conclusions: Tendoscopy may be considered a valid therapeutic tool in the treatment of stage II PTTD resistant to conservative treatment. It provided objective and subjective encouraging results that could allow continued conservative therapy while avoiding more invasive surgery in most cases. MRI and US were proven more useful in detecting PT lesions than spring ligament tears. Further studies on PT could use this tendoscopic classification to standardize its description. Level of Evidence: Level IV, therapeutic study, case series.

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