Luxación del tendón tibial posterior oculta tras un esguince de tobillo: reporte de caso / Hidden posterior tibial tendon dislocation after ankle sprain: case report

Resumen: Introducción: la luxación traumática del tendón tibial posterior es una entidad poco frecuente que puede pasar desapercibida en nuestra práctica clínica habitual. Material y métodos: un hombre de 31 años, sin antecedentes médicos de interés, sufrió un accidente de tráfico de alta energía. Presentaba una luxación del tendón tibial posterior que pasó desapercibida. Tras un diagnóstico precoz se consiguió realizar una reparación primaria del retináculo flexor y se logró la reducción anatómica del tendón. Resultados: el paciente pudo retomar la actividad deportiva a los tres meses de la lesión con buen resultado funcional. Conclusiones: debemos sospechar esta entidad tras un traumatismo de alta energía con entorsis de tobillo. El tratamiento quirúrgico de esta lesión ofrece buenos resultados funcionales.

Abstract: Introduction: traumatic posterior tibial tendon dislocation is a rare entity that can go unnoticed in our usual clinical practice. Material and methods: a 31-year-old man, with no relevant medical history, suffered a high-energy traffic accident. He presented a dislocation of the posterior tibial tendon that went unnoticed. After an early diagnosis, a primary repair of the flexor retinaculum was performed and the anatomical reduction of the tendon was achieved. Results: the patient was able to resume sports activity three months after the injury with good functional results. Conclusions: we should suspect this entity after high-energy trauma with ankle sprains. Surgical treatment of this lesion offers good functional results.

Outcome of modified Kidner procedure with tendoscopy for the treatment of painful accessory navicular / 中国骨伤

OBJECTIVE@#To evaluate clinical efficacy of modified kidner procedure with tendoscopy in treating painful accessory navicular.@*METHODS@#From February 2014 to April 2019, 19 patients with painful accessory navicular were admitted, including 13 males and 6 females with a mean age of 26 years old (ranged from 14 to 58 years old), all of which were unilateral symptoms. The courses of disease ranged from 6 to 60 months. All patients received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor, and the tendoscopy were used to examin the posterior tibial tendon. American Orthopedic Foot and Ankle Society(AOFAS) midfoot score and visual analogue scale(VAS) were used to evaluate efficacy before operation and at the latest follow-up.@*RESULTS@#All the patientswere followed up, and the duration ranged from 12 to 73 months, with an average of (35.0±20.9) months. VAS score was 0.20±0.41 at the latest follow-up, showing significant difference when compared with preoperative score of 6.33±1.95(@*CONCLUSION@#The modified kidner procedure with tendoscopy is a good choice for the treatment of painful accessory navicular, which could obviously relieve foot pain, improve foot function, and has certain clinical efficacy.

Acute tibialis posterior tendon rupture: a literature review based on 24 cases / 中华创伤骨科杂志

Objective To study the clinical features,treatment methods and clinical outcomes of acute tibialis posterior tendon rupture.Methods Using [(posterior tibial tendon) OR (tibialis posterior tendon)] AND (rupture OR injury OR disruption OR trauma OR tear) as the search words,we searched the PubMed database to retrieve the 19 articles involving 24 cases of acute tibialis posterior tendon rupture.The injury mechanisms,X-ray manifestations,operational findings,treatment methods and clinical outcomes were analyzed.Results The mechanisms of the fracture-related tibialis posterior tendon rupture included motor accident (50.0％,12/24),falling from a height (41.7％,10/24) and sports injury (8.3％,12/24).The tendon rupture was mostly complicated with malleolar fracture (91.7％,22/24),especially the pronation type (70.8％,17/24).Direct suture of the tendon was adopted in 91.7％ of the cases (22/24).Favorable outcomes were achieved in 95.5％ of the cases (21/24).Conclusions Acute tibialis posterior tendon rupture is mostly seen in high-energy medial malleolus fracture.The mechanism of the rupture might be tendon distraction or bone flake incision.Early operation can lead to favorable outcomes.

Complete Rupture of the Tibialis Anterior Tendon Due to Intratendinous Ganglion Cyst / 대한정형외과학회잡지

Spontaneous rupture of the tibialis anterior tendon is rare among ordinary people. The tendon rupture usually occurs in patients iatrogenically after local steroid injection to the tendon or with pre-existing systemic disease such as diabetes mellitus, gout, and rheumatic disease. However, no case of complete rupture of the tibialis anterior tendon due to an intratendinous ganglion cyst has been reported. We report on a case of a 39-year-old female with spontaneous rupture of the tibialis anterior tendon due to intratendinous ganglion cyst and her clinical results.

Tenodesis vs. tunelización del tendón flexor largo de los dedos en el tratamiento de la disfunción del tendón tibial posterior en estadio II / Tenodesis Vs. Tunneling of Flexor tendon length of the fingers in the treatment of Posterior Tibial Tendon Dysfunction Stage II

El tratamiento , en el estadio II de disfunción del tendón tibial posterior (DTTP) consiste en la transferencia del tendón Flexor Largo de los dedos (FLD) para suplir al tendón tibial posterior insuficiente y un procedimiento óseo para corregir la deformidad adquirida del retropié. En este estudio, evaluamos la función y eficacia de la transferencia del FLD tunelizado en el escafoide tarsiano vs la tenodesis del mismo al muñón distal del tendón tibial posterior. Material y método: Se realizó un estudio retrospectivo y comparativo de los pacientes intervenidos por esta patología en la Unidad de Pie y Tobillo del HCC, entre los años 2005 y 2012. En 27 pacientes se realizó tunelización del FLD en el escafoides tarsiano y en 49 pacientes se realizó tenodesis del FLD al muñón distal del tendón tibial posterior; en todos los pacientes se realizó un procedimiento óseo para corregir la deformidad adquirida del retropié. Se midió goniometricamente, inversión y flexión plantar del pie al año de postoperatorio en todos los pacientes y se comparó con el pie sano. Se evaluó pérdida de función ó dolor en zona de la transferencia. El análisis estadístico se realizó con t-student. Resultados: 6 pacientes presentaron DTTP bilateral y fueron descartados de este estudio. Los pacientes con tunelización del FLD en el escafoides tarsiano, presentaron una media de 62% de inversión y 86% de flexión plantar, los pacientes con tenodesis de FLD, presentaron una media de 86% de inversión y 89% de flexión plantar. Perdieron función del tendón, 1 paciente con tendón tunelizado, y 2 con tenodesis; presentaron dolor en la zona de la transferencia 2 pacientes con tenodesis del FLD. Conclusión: De nuestro estudio podemos concluir, que la tenodesis del FLD al muñón distal del tendón Tibial posterior, produce una mejor inversión del pie que la tunelización del FLD en el escafoides tarsiano(AU)

The surgical treatment of stage II posterior tibial tendon dysfunction (PTTD) is the transfer of the flexor digitorum longus tendon (FDL) to supply the posterior tibial tendon and a bone procedure to correct the acquired deformity of the hindfoot. In this study we evaluated the role and effectiveness of the FDL transfer to a tarsal scaphoid tunnel vs tenodesis of the distal stump of the posterior tibial tendon. Materials and methods: We performed a retrospective comparative study of patients with this disease in the Foot and Ankle Unit of HCC between 2005 and 2012, in 27 patients FDL tunnel was performed in the tarsal navicular and in 49 patients FDL tenodesis was performed to the distal posterior tibial tendon stump; in all patients a bone procedure was performed to correct acquired deformity of the hindfoot. Goniometrical measure was performed for forefoot inversion and plantar flexion at 12 months postop and compared with the healthy foot. Pain or loss of function in the transfer zone was evaluated. Statistical analysis was performed using T-student. Results: 6 patients had bilateral and PTTD and were excluded from this study. Patients with tarsal scaphoid FDL tunnel showed a mean of 62% forefoot inversion and 86% of plantar flexion, patients with FDL tenodesis, showed an average of 86% forefoot inversion and 89% of plantar flexion. One tendon tunnel patient lost tendon function and 2 tenodesis patient lost tendon function. 2 patients with FDL tenodesis had pain in the transfer area. Conclusion: From our study we can conclude that FDL tenodesis to the distal posterior tibial tendon stump produces a better forefoot inversion than the FDL tarsal navicular tunnel(AU)

Tenoscopía tibial posterior: Reporte de un caso / Posterior tibial tenoscopy: Case report

La tendinitis del tibial posterior se presenta comúnmente en pacientes con actividades deportivas. Se puede originar ya sea por exceso de uso o una sobrecarga brusca sobre el tendón. Esta tendinitis también se puede presentar en pacientes con enfermedades inflamatorias sistémicas, y se clasifica como el estadio I en la disfunción del tendón tibial posterior. El tratamiento inicial, con el que se han presentado buenos resultados, se basa en la inmovilización y rehabilitación. En los casos que no presentan mejoría del cuadro clínico o la tendinitis se asocia a una ruptura parcial del tendón, existen técnicas abiertas para realizar tenosinovectomías y revisiones del tendón para mejorar la sintomatología dolorosa. Con el advenimiento de las técnicas miniinvasivas se pueden realizar revisiones amplias del tendón con una mínima agresión o combinarlas con técnicas tradicionales si se asocian con roturas parciales. En este artículo se describe el caso clínico de un paciente femenino de 35 años con patología y dolor crónico a nivel de tibial posterior, la cual fue manejada mediante tenoscopía del tibial posterior y su evolución postquirúrgica a 24 meses. El tratamiento endoscópico y/o tenoscópico es una técnica simple y reproducible. En esta paciente encontramos excelentes resultados funcionales y cosméticos. Es necesario aumentar nuestra casuística sobre este método de tratamiento...

Posterior tibial tendinitis occurs commonly in patients involved in sports activities. It may result from either excessive use or sudden overload of the tendon. This tendinitis may also occur in patients with systemic inflammatory conditions and is classified as posterior tibial tendon dysfunction stage I. Initial treatment, which has produced good results, is based on immobilization and rehabilitation. In cases without clinical improvement or in which tendinitis is associated with partial tendon rupture, open techniques may be used to perform tenosynovectomy and tendon revisions to improve painful symptoms. With the advent of minimally invasive techniques broad tendon revisions may be done that cause minimal damage or they may be combined with traditional techniques in cases of partial rupture. This paper describes the clinical case of a 35 year-old female patient with posterior tibial pathology and chronic pain. She underwent posterior tibial tenoscopy and was followed-up postoperatively for 24 months. Endoscopic and/or tenoscopic treatment is a simple and reproducible technique. We obtained excellent functional and cosmetic results in this patient. We need larger case series of patients subjected to this treatment...

Acquired Adult Flatfoot: Pathophysiology, Diagnosis, and Nonoperative Treatment / 대한족부족관절학회지

Acquired adult flatfoot is a deformity characterized by a decreased medial longitudinal arch and a hindfoot valgus with or without forefoot abduction. The etiologies of this deformity include posterior tibial tendon dysfunction, rheumatoid arthritis, trauma, Charcot's joint, neurologic deficit, and damage to the medial spring ligament complex or plantar fascia. Among these, posterior tibial tendon dysfunction is the most well-known cause. Although posterior tibial tendon dysfunction has been regarded as a synonym of acquired adult acquired flatfoot, failure of the ligaments supporting the arch can also result in progressive deformity even without a posterior tibial tendon problem. The authors describe the pathophysiology, diagnosis, and nonoperative treatment of acquired adult flatfoot, focusing on posterior tibial tendon dysfunction.

Operative Treatment of Acquired Adult Flatfoot / 대한족부족관절학회지

Acquired adult flatfoot deformity is characterized by flattening of the medial longitudinal arch and dysfunction of the posteromedial soft tissues, including the posterior tibial tendon. When the non-operative treatment fails to result in improvement of symptoms, surgery should be considered. Operative techniques include flexor digitorum longus tendon transfer, calcaneal medial slide osteotomy, lateral column lengthening, and arthrodesis of the hindfoot. The principle of correcting the deformity while avoiding overcorrection and excessive stiffness is important in achievement of good outcomes in these patients.

The medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular for the flatfoot related with accessory navicular / 中华骨科杂志

Objective To investigate the clinical outcomes of the medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular for the flatfoot related with accessory navicular.Methods From March 2009 to October 2011,13 patients (16 feet) with flatfoot related with accessory navicular received treatment by the medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular.There were 4 males and 9 females,with an average age of 41.3 years (range,18-64 years).All patients had obvious valgus calcaneus,the angle of which was 11.3°± 1.4°.According to AOFAS ankle-hindfoot scores,the arch height,calcaneus inclination angle (CI),talocalcaneal angle (TC),talar first metatarsal angle (TMT) on the lateral weight-bearing radiograph of foot,and the talocalcaneal angle (TC),talar first metatarsal angle (TMT) on the AP view of the weight-bearing radiograph of foot,and the heel valgus alignment on axial radiographs of the hindfoot were measured on the X-ray film.Results All patients were followed up for 12 to 31 months,with the average of 16.8 months.Eleven patients (13 feet) felt no pain 6 months after operation,while 2(3 feet) felt pain after long walking.There was no complication,including infection,nerve injury,un-union,and so on.The average AOFAS ankle-hindfoot score improved from 56.4-±6.4 preoperatively to 88.1±2.8 at the last follow-up.Radio graphically,all parameters were statistically significant between pre-operation and the last follow-up,including the arch height,CI,TC,TMT modifying from 3.8±0.3 mm,9.5°±1.1°,47.3°±2.5°,17.6°±1.6° to 12.0±1.1 mm,20.1°±1.5°,32.3°±2.5°,6.8°±1.0° respectively on the lateral weight-bearing view; TC improving from 39.5°±2.3° to 26.2°±2.0°and TMT improving from 15.2°±1.7° to 6.3°±1.0° on the AP weight-bearing view.Conclusion The medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular with excellent clinical outcomes.

Checkrein Deformity by Incarcerated Posterior Tibial Tendon and Displaced Flexor Hallucis Longus Tendon following Ankle Dislocation: A Case Report

We report a case of 20 year-old man who had unusual equinus and checkrein deformity following dislocation of his right ankle joint. He had been treated with distal tibiofibular screw fixation and external fixation. After removal of external fixator, he had suffered from progressive deformity of foot and ankle. Widening of distal tibiofibular joint and medial clear space was found on radiograph and it was revealed that posterior tibial tendon had been dislocated and incarcerated into the distal tibiofibular joint on MRI. We corrected the deformity with excision of incarcerated posterior tibial tendon, adhesiolysis and lengthening of flexor hallucis longus tendon, reconstruction of deltoid ligament and flexor digitorum longus tendon transfer.

Comparación entre resultados obtenidos en la corrección de valgo tibial proximal en pacientes pediátricos con sistema de grapas y sistema de placas en el Hospital Ortopédico Infantil Caracas Venezuela 2000-2007 / Comparison of results obtained in the proximal tibial valgus correction in pediatric patients with staple system and system of plaques in the Hospital Ortopédico Infantil 2000-2007 Caracas Venezuela

Las deformidades axiales de los miembros inferiores, motivo de consulta habitual, no corregen espontáneamente si son persitentes y sginificativas. La epifisiodesis produce la corrección grudual de la deformidad en un procedimiento mínimamente invasivo, en pacientes esqueléticamente inmaduros, en genu valgum y varum, con grapas o placas y tornillos. Según las observaciones clínicas, las placas permiten un mejor resultado en tiempo más corto, menor daño a la fisis y menos riesgo de complicaciones o falla de material en comparación con las grapas. La comparación de las técnicas en engrapado y placa en la resolución de deformidades en valgo de tibia proximal en los pacientes pediátricos en el Hospital Ortopédico Infantil, durante el periodo 2000 al 2007. Estudio retrospectivo simple y comparativo, se evaluaron 36 pacientes de ambos sexos con el diagnostico de Valgo Proximal Tibial, idiopáticos o asociados a otras patologías, que fueron tratados en el Hospital Ortopédico Infantil durante 2000 al 2007 con las técnicas de grapa y placa, mediante revisión de controles pre y postoperatorios de la historia clínica, y por medición radiológica de los ángulos FDLm, TPMm y MAD en radiogrfías panorámicas pre y postoperatorias. Se estudiaron 36 pacientes de ambos sexos, (16 varones y 20 niñas), promedio de edad de 10 años +/- 3,3 años. Existen similitudes en los primeros 12 meses en esta muestra, pero a partir de ese momento la Placa alcanza los valores de corrección antes que las grapas. Según la pendiente Y, la placa se proyecta para correcciones de 6,62 mm cada 6 meses, en cambio la grapa se proyecta para correciones de 5,72 mm cada 6 meses. Los valores del ángulo se estabilizan con la placa, y en cuanto a la grapa, se continúa la corrección en sentido contrario. La pendiente Y indica que la placa corrige -1,95º cada 6 meses, y la grapa corrige -2,95º cada 6 meses hacia el varo. Según la prueba ANOVA, combinando las variables Tiempo-Material, la placa alcanza....

The axial deformities of the lower limbs, common reason for consulation, will not correct spontaneously if they are persistent and significant. Epiphysiodesis produce gradual correction of deformity in a minimally invasive procedure in skeletally immature patients in valgum and genu varum with staples or plates and screws. According to clinical observations, the plates allow a better result in shorter time, less damage to the physis and less risk of complications or failure of material compared with the staples. Comparison of stapling techniques and plaque in the resolution of valgus deformity of proximal tibian in pediatric patients at Children's Orthopedic Hospital during the period 2000 to 2007. A retrospective and comparative simple, we evaluated 36 patients of both sexes with a diagnosis of Proximal Tibial Valgus, idiopathic or associated with other diseases, which were treated at the Children's Orthopedic Hospital during the period 2000 to 2007 with the techniques staple and plate by reviewing pre-and postoperative checks of medical record, and radiological measurements of the angeles FDLm, TPMm, and MAD in pre-and postoperative panoramic radiographs. We studied 36 patients of both sexes (16 boys and 20 girls), mean age 10 +/- 3,3 years. There are similarities in the first 12 months in this sample, but from that moment on the plate reaches the values of correction rather than staples. According to the slope and The plate is projected to corrections from 6,62 mm every 6 months, however the clip is projected to corrections of 5,72 mm every 6 months. The angle values are e¡stabilized with the plate, and as for the clip, continue the correction in the opposite direction. The slope indicates that the board and fixes -1,95º every six months, and the clip fixes -2,95º every six months into varus. According to the ANOVA test, combining the time-material variables, the plate reaches the expected correction before on the staple, the period aroun 12 months would.....

Body Mass Index in Patients with Early Posterior Tibial Tendon Dysfunction in Korea / 대한정형외과학회잡지

PURPOSE: Posterior tibial tendon dysfunction (PTTD) is known as the most common cause of adult acquired flatfoot syndrome and is common in middle-aged obese women. The purpose of this study was to describe the relationship between BMI (body mass index) and early stage PTTD in Korea. MATERIALS AND METHODS: Between May 2005 and June 2006 we evaluated 42 patients (58 feet) who were diagnosed and treated for early stage PTTD. We analyzed demographic data such as sex, age, BMI, physical findings, radiologic findings and clinical results. RESULTS: All 42 patients were women; their mean age was 52.6 years. Of the 42, 77% were middle aged (40-69). Increased BMI was detected in 75% of the 42 patients. There was no statistical significance in age-matched comparisons of BMI in Korea (p>0.05), or in the correlation between BMI and progression (p=0.293). Non-obese patients had superior clinical results (p=0.017). CONCLUSION: Overweight and obesity are commonly seen in patients with early stage PTTD in Korea but there do not appear to be any significant correlation between obesity and early stage PTTD and also no significant correlation between obesity and progression to later stages.

The Effect of the Combined Stretching and Strengthening Exercise on the Clinical Symptoms in Posterior Tibial Tendon Dysfunction Patient / 대한족부족관절학회지

PURPOSE: The isolated exercise therapy and its effect for the treatment of posterior tibial tendon dysfunction (PTTD) is not well known. The purpose of this study was to identify the clinical effect of stretching and strengthening exercise program on the patients' muscle function and range of motion, pain and gait in the management of the early stage PTTD. MATERIALS AND METHODS: From October 2006 to March 2007, 14 patients with early stage PTTD (stage I or IIa) without surgical intervention were randomly assigned into two groups and we analyzed their clinical results. All patients were female and one who have sprained the same ankle during the program and one who withdrew from the program due to her private reason were excluded. At the last, the exercise group (EG) was seven and the control group (CG) was five. Mann-Whitney U test was used for the comparison of pain, ROM, muscle power, AOFAS score and 5 minute walking test of both groups. Wilcoxon-signed rank test was used for the comparison between the pre and post exercise program in EG. RESULTS: The pain was significantly reduced in EG compare to CG and only the dorsiflexion was significantly increased in EG in the analysis of ROM. The dorsi flexion and plantar flexion power were significantly increased in EG. CONCLUSION: Our 6 weeks stretching and strengthening exercise program showed noticeably improved clinical result, and therefore it is recommended as one of the useful treatment option in the management of early stage PTTD.

Changes in histoanatomical distribution of types I, III and V collagen promote adaptative remodeling in posterior tibial tendon rupture

INTRODUCTION: Posterior tibial tendon dysfunction is a common cause of adult flat foot deformity, and its etiology is unknown. PURPOSE: In this study, we characterized the morphologic pattern and distribution of types I, III and V collagen in posterior tibial tendon dysfunction. METHOD: Tendon samples from patients with and without posterior tibial tendon dysfunction were stained by immunofluorescence using antibodies against types I, III and V collagen. RESULTS: Control samples showed that type V deposited near the vessels only, while surgically obtained specimens displayed type V collagen surrounding other types of collagen fibers in thicker adventitial layers. Type III collagen levels were also increased in pathological specimens. On the other hand, amounts of collagen type I, which represents 95 percent of the total collagen amount in normal tendon, were decreased in pathological specimens. CONCLUSION: Fibrillogenesis in posterior tibial tendon dysfunction is altered due to higher expression of types III and V collagen and a decreased amount of collagen type I, which renders the originating fibrils structurally less resistant to mechanical forces.

Operative treatment for posterior tibial tendon dysfunction / 中华骨科杂志

Objective To discuss the methods of the operative treatment for posterior tibial tendon dysfunction (PTTD). Methods From December 2002 to June 2005, 8 cases of PTTD were treated with operations, including 2 males and 6 females with an average age of 47 years (range, 36 to 56 years). Left side was involved in 6 cases, and right side was affected in 2 cases. Stage Ⅱposterior tibial tendon dysfunction were 2 feet and stage Ⅲ were 6 feet. Every case with special operative treatment, for instance lateral column lengthening, arthrodesis, repair posterior tibial tendon, spring ligament reefing, flexor digitorum longus tendon transfer and so on. Every bone operation was combined with one or more than one sofe tissue operation. Anterior transfer and strengthening of posterior tibial tendon were performed in 4 cases, spring ligament reefing in 2 cases, flexor digitorum longus tendon transfer in 4 cases. All patients were fixed with plaster cast at inversion position for 4-6 weeks, then changed to plaster splint fixing at neutral position for 4 weeks. Functions of ankle and foot were evaluated before and after operation. Results All patients were followed up for an average of 28 months(range, 12 to 40 months). According to Maryland foot score, 2 were fair and 6 were failure in preoperative, 4 were excellent, 3 were good and 1 was fair in postoperative. The total excellent and good rate was 87.5%. The specific index of X-ray improve obviously(P

Acquired Flat Foot due to Rupture of Posterior Tibial Tendon: Two case reports

The posterior tibial muscle is considered a plantar flexor as well as an invertor of the foot, which acts as a key muscle to the medial longitudinal arch by locking the talar joints in normal gait. Rupture of the posterior tibial tendon can cause a valgus deformity of the hindfoot and an abduction deformity of the forefoot which produces a typical flat foot and a talar dislocation in severe cases. The tendon of posterior tibial muscle can be ruptured spontaneously after the age of 40 from chronic stress at the ankle joint, or by sports injury and trauma. Severe foot deformity which can be prevented by early diagnosis and appropriate treatment often occurs from misdiagnosis as a chronic ankle sprain or a congenital flat foot. We report two cases of foot deformities caused by spontaneous and traumatic rupture of posterior tibial tendons with their clinical manifestations and MRI findings.