Ima li tendoskopija mjesto u kirurškom liječenju nedostatnosti funkcije tetive tibijalis posteriora? [Is there any room for tendoscopy in the surgical treatment of posteriortibial tendon insufficiency]

Bojanić, Ivan and Dimnjaković, Damjan and Mahnik, Alan and Smoljanović, Tomislav (2016) Ima li tendoskopija mjesto u kirurškom liječenju nedostatnosti funkcije tetive tibijalis posteriora? [Is there any room for tendoscopy in the surgical treatment of posteriortibial tendon insufficiency]. Liječnički vjesnik, 138 (5-6). pp. 144-151. ISSN 0024-3477

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Abstract

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 poste- rior 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 re- ported. 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 ioints and excellent knowledge of repional anatomy.

Abstract in Croatian

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.

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