What Is Tendoscopy?
Tendoscopy is a procedure that allows an orthopaedic surgeon to see a tendon from the inside of its sheath to treat tendon disorders of the foot and ankle. Tendoscopy is very similar to arthroscopy, in which a camera goes into a joint. In tendoscopy, a small camera and special instruments are placed through small incisions along the tendon. Sterile fluid is used to expand the sheath and provide direct exposure to the tendon.
The goal of tendoscopy is to treat tendon disorders without using large incisions. Patients often have less pain and smaller scars than with traditional open surgery. Patients also can return to work and exercise sooner with this procedure versus open surgery.
Tendoscopy can be considered if non-surgical treatment has failed. It 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 functions to pull the foot inward and hold up the arch of the foot. Inflammation of the lining of the PTT often is associated with flat feet. It also can occur in patients with rheumatoid or other inflammatory 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.
The peroneal tendons run along the outside of the ankle and help push the foot outward. Sometimes these tendons can be scarred from prior injuries or surgery. 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 FHL helps to flex the big toe downward. Patients with inflammation of the FHL typically have pain in the back of the ankle 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 can be done using a scope.
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.
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.
Tendoscopy is performed by a foot and ankle orthopaedic surgeon. It typically is an outpatient procedure, meaning you can go home the same day as treatment. You may be put under general anesthesia or a milder forms of anesthesia such as sedation or nerve block. Your surgeon will make two small skin incisions called "portals" directly over the course of the tendon. They will place the scope through one portal and into the tendon sheath. Sterile fluid flows through the scope 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. Once the surgery is complete, your surgeon will close the skin portals with sutures, apply a sterile dressing, and place your foot in a splint or boot.
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 require physical therapy with progressive strengthening, range-of-motion, and balancing exercises. Others can perform rehab exercises at home.
Risks and Complications
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Potential complications following a tendoscopy procedure include scarring and infection, nerve or tendon injury, and ongoing pain.
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 4-6 weeks.
Who performs tendoscopy?
Tendoscopy is much less common 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 foot and ankle orthopaedic surgeon about his or her overall experience with arthroscopy and specifically with tendoscopy.
Original article by Rebecca Cerrato, MD
Contributors/Reviewers: Jeffrey Feinblatt, MD; Jason Tartaglione, MD; Patrick Maloney, MD
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