CONTRIBUTION OF TENDINOSCOPY IN ANKLE TENDON DISEASE: PRELIMINARY ANALYSIS OF 22 CASES

Abstract

Purpose: Endoscopy provides an attractive alternative to open surgery for diagnostic and therapeutic purposes in patients with ankle tendon disease. Early work was published by Van Dijk in 1994.

Material and methods: Twenty patients (mean age 34.7 years, range 20–59 years), 16 with posttraumatic lesions, underwent 22 tendinoscopy procedures using a slightly modified technique with a 4.5 optical. The procedures, conducted under general anaesthesia, were performed to explore fibular (n=15), posterior tibial (n=6), and anterior tibial (n=1) tendons. Prospective follow-up was at least six months (6 – 30). Preoperatively, all patients presented more or less localised pain with signs of tendon suffering. Fifteen had undergone prior explorations (ultrasound=4, MRI=7, CT scan=1, MRI+ultrasound=3) which had not revealed any anomaly in seven.

Results: Peritendinous adherences were observed intra-operatively in 18 cases with inflammatory reactions requiring resection in 13. A lesion of the tendon itself was found in seven cases-fissure (n=2), superficial dilaceration (n=2), induration (n=2), strangulation (n=1)-which required specific cure with forceps or motorised instrumentation. No explanation of the pain could be identified in one patient. Postoperatively, 17 patient achieved complete pain relief which persisted for at least six months. At last follow-up, one patient had not been reviewed, twelve were totally pain free and five had developed associated symptoms (cracking, swelling). Overall, four patients were very satisfied, eight were satisfied, four were disappointed, and three were dissatisfied (no improvement). There were no signs of worsening and no complications directly related to the method.

Conclusion: These results of early experience in France are less satisfactory than those reported by Van Dijk who had 80% good results for 85 tendinoscopic procedures in 70 patients. They do however confirm the usefulness of this technique for the management of patients with tenosynovitis, adherences, and partial ruptures of the ankle tendons which cannot always be identified with classical imaging techniques. Definitive evaluation will require analysis of a larger series of well selected patients.