IS THERE ANY ROOM FOR TENDOSCOPY IN THE SURGICAL TREATMENT OF POSTERIOR TIBIAL TENDON INSUFFICIENCY?
Autori:
Ivan Bojanić, Damjan Dimnjaković, Alan Mahnik, Tomislav Smoljanović
Sažetak
Nedostatnost funkcije tetive tibijalis posteriora (engl. posterior tibial tendon insufficiency – PTTI) danas se smatra glavnim uzrokom nastanka spuštenoga medijalnog uzdužnog svoda stopala u odraslih osoba (engl. adult-acquired flatfoot deformity – AAFD). Cilj je ovog istraživanja pokazati rezultate tendoskopskog liječenja tetive tibijalis posteriora (TP) kod 11 bolesnika s 1. ili 2. stadijem PTTI-a nakon neuspješnoga neoperacijskog liječenja. Tendoskopija kao samostalan kirurški zahvat provedena je kod 8 bolesnika, dok je kod 3 bolesnika bio potreban i dodatni zahvat poput mini-open tubularizacije TP-a ili artroskopske toalete prednjeg dijela gležnja. U jednog je bolesnika s kompletnom rupturom TP-a u drugom aktu načinjen transfer tetive fleksora digitorum longusa. Nisu zabilježene komplikacije tendoskopskih zahvata ni kod jednog bolesnika. Tendoskopija TP-a djelotvorna je i minimalno invazivna operacijska tehnika u liječenju ozljeda i oštećenja TP-a u početnim stadijima PTTI-a. Ta tehnički zahtjevna endoskopska tehnika iziskuje veliko iskustvo operatera u artroskopiji malih zglobova i odlično poznavanje regionalne anatomije.
Summary
Posterior tibial tendon insufficiency (PTTI) is nowadays considered to be the main cause of adult-acquired flatfoot deformity (AAFD). The purpose of this study is to report the outcomes of tendoscopic treatment of tibialis posterior tendon (TP) in eleven patients with stage 1 or 2 PTTI and failed prior conservative treatment. Tendoscopy was carried out as a solitary procedure in 8 patients, while in 3 patients additional procedures such as „mini-open” tubularization of TP or anterior ankle arthroscopy were necessary. In a single patient transfer of flexor digitorum longus tendon was performed as a second stage surgery due to complete rupture of TP. Related with tendoscopic procedure, no complications were reported. TP tendoscopy is a useful and beneficial minimally invasive procedure to treat TP pathology at earlier stages of PTTI. It is a technically demanding procedure that requires extensive experience in arthroscopic management of small joints and excellent knowledge of regional anatomy.
