Endoscopic All-inside Repair of the Flexor Hallucis Longus Tendon in Posterior Ankle Impingement Patients

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Abstract

Longitudinal flexor hallucis longus (FHL) tendon tears are sometimes complicated by posterior ankle impingement syndrome (PAIS), especially in ballet dancers. In recent years, PAIS has been treated endoscopically, but it is difficult to suture FHL tendon tears endoscopically. In this report, we describe how to suture the FHL tendon endoscopically with the Meniscal Viper Repair system (Arthrex, Naples, FL). Without our endoscopic technique, when a patient is found to have a longitudinal tear of the FHL under endoscopy, we must choose to either neglect the tear or convert to an open repair. Open tendon suture techniques have reportedly had relatively good results but require a longer skin incision than endoscopic surgery for PAIS. Compared with the open repair, the advantages of our technique include earlier recovery, less pain, a lower rate of soft tissue complications, and improved healing through better preservation of the blood supply. This technique is an attractive and useful option because it is an easy and safe method for longitudinal FHL tendon tears.

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Most cited references 12

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A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.

Nguyen Thuan, Rob Scholten, R Krips (2000)

We describe a 2-portal endoscopic approach of the hindfoot with the patient in the prone position. By means of this approach, it is possible to visualize and treat a variety of posterior ankle problems. Not only can pathology of the posterior ankle joint and subtalar joint be visualized and treated, but also periarticular pathology, such as calcifications or scar tissue, can be diagnosed and treated. We describe a professional ballet dancer with chronic flexor hallucis longus tendinitis and a posterior ankle impingement syndrome caused by an os trigonum of both ankles. The patient was successfully treated by removing the os trigonum and releasing the flexor hallucis longus tendon. She resumed her professional activities within 2 months after endoscopic treatment.

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Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment.

Cynthia M A Geppert, R Thompson, Peter W Hamilton (1996)

A retrospective review was performed of the results of operative treatment of stenosing tenosynovitis of the flexor hallucis longus tendon or posterior impingement syndrome, or both, in thirty-seven dancers (forty-one operations). The average duration of follow-up was seven years (range, two to thirteen years). The results were assessed with use of a questionnaire for all patients, and a clinical evaluation was performed for twenty-one patients (twenty-two ankles). Twenty-six operations were performed for tendinitis and posterior impingement; nine, for isolated tendinitis; and six, for isolated posterior impingement syndrome. A medial incision was used in thirty-three procedures; a lateral incision, in six; an anterior and a medial incision, in one; and a lateral and a medial incision, in one. Thirty ankles had a good or excellent result; six, a fair result; and four, a poor result. (The result of the second procedure on an ankle that was operated on twice was not included.) The result was good or excellent for twenty-eight of the thirty-four ankles in professional dancers, compared with only two of the six ankles in amateur dancers.

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Hindfoot endoscopy for posterior ankle impingement. Surgical technique.

Rob Scholten, R Bie, Tineke C. T. M. van der Pouw Kraan (2009)

The surgical treatment of posterior ankle impingement is associated with a high rate of complications and a substantial time to recover. An endoscopic approach to the posterior ankle (hindfoot endoscopy) may lack these disadvantages. We hypothesized that hindfoot endoscopy causes less morbidity and facilitates a quick recovery compared with open surgery. Fifty-five consecutive patients with posterior ankle impingement were treated with an endoscopic removal of bone fragments and/or scar tissue. The symptoms were caused by trauma (65%) or overuse (35%). All patients were enrolled in a prospective protocol. At baseline, the age, sex, work and sports activities, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, and preinjury Tegner scores were determined for all patients. At the time of follow-up, AOFAS hindfoot scores and Tegner scores were assessed and the time to return to work and sports activities was determined. Complications were recorded. Patients scored the overall result as poor, fair, good, or excellent by means of a 4-point Likert scale. The median duration of follow-up was thirty-six months, and no patient was lost to follow-up. The median AOFAS hindfoot score increased from 75 points preoperatively to 90 points at the time of final follow-up. The median time to return to work and sports activities was two and eight weeks, respectively. At the time of follow-up, patients in the overuse group were more satisfied than those in the posttraumatic group, and the AOFAS hindfoot scores were higher in patients in the overuse group (median, 100 points) compared with patients in the posttraumatic group (median, 90 points). A complication occurred in one patient who had a temporary loss of sensation of the posteromedial aspect of the heel. The outcome after endoscopic treatment of posterior ankle impingement compares favorably with the results of open surgery reported in the literature. Hindfoot endoscopy appears to cause less morbidity than open ankle surgery and facilitates a quick recovery. Patients treated for posterior ankle impingement caused by overuse have better results than those treated following trauma.

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Author and article information

Contributors

Akinobu Nishimura

Journal

Journal ID (nlm-ta): Arthrosc Tech

Journal ID (iso-abbrev): Arthrosc Tech

Title: Arthroscopy Techniques

Publisher: Elsevier

ISSN (Electronic): 2212-6287

Publication date PMC-release: 09 October 2017

Publication date Collection: October 2017

Publication date (Electronic): 09 October 2017

Volume: 6

Issue: 5

Pages: e1829-e1835

Affiliations

[1]Department of Orthopaedic and Sports Medicine, Graduate School of Medicine, Mie University, Tsu, Mie, Japan

Author notes

[∗ ]Address correspondence to Akinobu Nishimura, M.D., Ph.D., Department of Orthopaedic and Sports Medicine, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.Department of Orthopaedic and Sports MedicineGraduate School of MedicineMie University2-174 EdobashiTsuMie514-8507Japan meiten@ 123456clin.medic.mie-u.ac.jp

Article

Publisher ID: S2212-6287(17)30227-X

DOI: 10.1016/j.eats.2017.06.059

PMC ID: 5794487

PubMed ID: 29399465

SO-VID: 767f5779-63c4-47e7-8314-f595f6d02c9a

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Endoscopic All-inside Repair of the Flexor Hallucis Longus Tendon in Posterior Ankle Impingement Patients

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Abstract

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Orthopedics

Most cited references 12

A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.

Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment.

Hindfoot endoscopy for posterior ankle impingement. Surgical technique.

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