Tendoscopy

What is tendoscopy?

Tendoscopy is a procedure that allows an orthopaedic surgeon to see the inside of a tendon sheath. It can be used to treat
Image_Cerrato_Tendoscopy_1.jpgPeroneal tendoscopy: A skin portal is created along the course of the peroneal tendons. Then an arthroscope is introduced into the tendon sheath.
tendon disorders of the foot and ankle. Tendoscopy is very similar to arthroscopy. A small camera and special instruments are placed through small incisions along the course of a tendon. Sterile fluid is used to expand the sheath and helps provide direct exposure to the tendon.
 

What is the goal of tendoscopy?

The goal of tendoscopy is to treat tendon disorders without using large incisions. Patients have less pain and smaller scars than with traditional open surgery. Patients also can get back to work and exercise quicker with this procedure versus open surgery.
 

When might tendoscopy be used?

Surgery such as tendoscopy should only be considered if non-surgical treatment has failed. Tendoscopy may be used on many of the tendons of the feet and ankles. Some examples include:
 
Posterior tibial tendon (PTT): The PTT runs along the inside of the ankle and helps to pull the foot inward and hold up the arch of the foot. Inflammation of the lining of the PTT is often associated with flat feet. It can also occur in patients with rheumatoid or psoriatic arthritis. Tendoscopy allows an orthopaedic surgeon to remove the inflamed tissue from within the tendon sheath. If a tear in the tendon is found, a small incision can be made over the tear to repair it.
 
Peroneal tendons: The peroneal tendons run along the outside of the ankle and help push the foot outward. Sometimes these tendons can be scarred from surgery or a fracture of the fibula, the bone these tendons run along. Scarring can lead to abnormal tendon motion. Releasing the individual tendon sheaths via tendoscopy can relive pain. Also, when small tears are identified with the scope, an incision can be made over the location of the tear and the tendon can be repaired.
 
Flexor Hallucis Longus Tendon (FHL): This tendon runs behind the ankle and attaches to the bottom of the big toe. The
Image_Cerrato_Tendoscopy_2.pngScope picture from the back of the ankle taken during tendoscopy. The FHL tendon is shown.
  FHL helps to pull the big toe downward. Patients with inflammation of the FHL typically have ankle pain and occasional locking of the big toe when they walk. In the past, this problem was fixed with an open surgery that involved opening the tendon sheath and cleaning the tendon. Today this procedure is now commonly done using a scope.
 
Achilles Tendon: Achilles paratendinitis is inflammation of the lining of the tendon. Paratendinitis causes swelling of the tendon. Removal of the thickened paratenon can be performed with a scope. Some orthopaedic surgeons also use a scope to repair tears in the Achilles tendon.
 

When should I avoid tendoscopy?

Patients with large tears or other severe tendon problems may require traditional open surgery.  Patients with active infections, poor circulation, severe leg swelling and other conditions such as poorly controlled diabetes should not have this procedure.
 

General Details of Procedure

This surgery is typically an outpatient procedure. General anesthesia is often used. An alternative may be sedation and numbing medication for the leg. Two small skin incisions are made directly over the course of the tendon. These incisions are called portals. They are entry points into the tendon sheath. The incisions are created with a surgical scalpel.
 
The arthroscope is placed through one portal and into the tendon sheath. Sterile fluid flows through the arthroscope to expand the tendon sheath. The second portal is used to pass instruments for the surgery. Often the camera and instruments are alternated between the portals. The skin portals are closed with sutures once the surgery is complete. A sterile dressing is applied and the foot is placed in a splint or boot.
 

What happens after tendoscopy?

Recovery varies depending on the specific procedure. Pain and swelling are common, and elevating the leg can help decrease swelling. You may be allowed to put weight on the foot right away, or you may be required to be non-weightbearing for several weeks. Some patients need rehab with progressive strengthening, range-of-motion and balancing exercises. Others need physical therapy.
 

Potential Complications

There are complications that can occur with any surgery. These include the risks associated with anesthesia, infection, and bleeding or blood clots.
 
Potential complications following a tendoscopy procedure can include scarring and infection, nerve or tendon injury, and ongoing pain.
 

Frequently Asked Questions

When can I expect to return to work and sports?
The type of procedure performed will determine the length of recovery. Some patients may begin placing weight on their foot right away and can return to work within several days. Other patients may require a longer recovery and period of rest. The length of recovery time should be discussed with your surgeon. Athletes can typically return to play after four to six weeks.
 
Who performs tendoscopy?
Tendoscopy is much less commonly performed than other scoping procedures such as for knee or shoulder conditions. Orthopaedic surgeons trained in foot and ankle arthroscopy techniques have the skills and equipment to perform this procedure. You should ask your orthopaedic surgeon about his or her overall experience with arthroscopy and specifically with tendoscopy.
 
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