Posterior Tibial Tendon Endoscopic Debridement for Stage I and II Posterior Tibial Tendon Dysfunction 2LT Jeffrey Wake, B.S., A.T.C., MAJ Kevin Martin,

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Presentation transcript:

Posterior Tibial Tendon Endoscopic Debridement for Stage I and II Posterior Tibial Tendon Dysfunction 2LT Jeffrey Wake, B.S., A.T.C., MAJ Kevin Martin, D.O. Arthroscopy Techniques Volume 6, Issue 5, Pages e2019-e2022 (October 2017) DOI: 10.1016/j.eats.2017.07.023 Copyright © 2017 Terms and Conditions

Fig 1 (A) A taped thigh bump allows for easy removal by a nonsterile assistant when ready to proceed to posterior tibial tendon endoscopy after the medial calcaneal and Cotton osteotomy. (B) The thigh bump is placed under the ipsilateral hip to assist in internal rotation of the leg when performing the calcaneal and Cotton osteotomy. Removal of the thigh bump allows for external rotation of the lower extremity and access to the posterior tibial tendon. Arthroscopy Techniques 2017 6, e2019-e2022DOI: (10.1016/j.eats.2017.07.023) Copyright © 2017 Terms and Conditions

Fig 2 The proximal portal is made approximately 4 cm proximal to the medial malleolus. By use of a straight hemostat, the nick-and-spread technique is performed to achieve blunt dissection to the tendon sheath. Once the tendon sheath is visualized, it is incised with a scalpel to allow for insertion of the arthroscope. Arthroscopy Techniques 2017 6, e2019-e2022DOI: (10.1016/j.eats.2017.07.023) Copyright © 2017 Terms and Conditions

Fig 3 The distal port is made approximately 2 cm distal to the medial malleolus. By use of a straight hemostat, the nick-and-spread technique is performed to achieve blunt dissection to the tendon sheath. Once the tendon sheath is visualized, it is incised with a scalpel to allow for insertion of the arthroscopic shaver. Arthroscopy Techniques 2017 6, e2019-e2022DOI: (10.1016/j.eats.2017.07.023) Copyright © 2017 Terms and Conditions

Fig 4 The arthroscope is in the distal portal, and the arthroscopic shaver is in the proximal portal. (A) The surgeon's hands are positioned close to the patient's foot and leg to help limit excessive motion and assist in instrumentation positioning. (B) The labeled structure (A) is the posterior tibial tendon. Arthroscopy Techniques 2017 6, e2019-e2022DOI: (10.1016/j.eats.2017.07.023) Copyright © 2017 Terms and Conditions

Fig 5 The arthroscope hand and arthroscopic shaver hand (surgeon's left hand and right hand, respectively) are positioned as close as possible to the patient's lower extremity to facilitate proper positioning within the tendon sheath. Arthroscopy Techniques 2017 6, e2019-e2022DOI: (10.1016/j.eats.2017.07.023) Copyright © 2017 Terms and Conditions