1
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Cerezal A, Ocampo R, Llopis E, Cerezal L. Ankle Instability Update. Semin Musculoskelet Radiol 2023; 27:231-244. [PMID: 37230124 DOI: 10.1055/s-0043-1767767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.
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Affiliation(s)
- Alvaro Cerezal
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Ronald Ocampo
- Department of Radiology, Hospital de Trauma del Instituto Nacional de Seguros, San Jose, Costa Rica
| | - Eva Llopis
- Department of Radiology, Hospital IMSKE, Hospital de la Ribera, Valencia, Spain
| | - Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Santander, Spain
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2
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Zannoni S, Bonifacini C, Albano D, Messina C, Sconfienza LM. Posterior Tibial Tendon Dislocation: A Case Report. J Foot Ankle Surg 2022; 61:417-420. [PMID: 34670676 DOI: 10.1053/j.jfas.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/27/2020] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
Isolated posterior tibial tendon dislocation is a rare condition. Diagnosis can be challenging, especially in the acute clinical setting. Predisposing factors include shallow posterior tibial tendon groove and tear of the flexor retinaculum. We report the case of traumatic subluxation of the posterior tibial tendon, illustrating imaging findings and surgical technique. Posterior tibial tendon dislocation was detected using dynamic ultrasound, while magnetic resonance was essential for a comprehensive evaluation that included underlying predisposing anatomic abnormalities and associated pathologic conditions. Conservative treatment is often unsuccessful thus surgical approach was needed. Under ampliscopic guidance, a bone tunnel was created behind the retromalleolar groove. The posterior tibial tendon was located into the new groove and the retinaculum was re-attached and tightened by anchors and absorbable sutures at the anterior margin of the sulcus. At 12-month follow-up, the patient did not complain any residual pain and he was able to perform normal daily activities without any limitations and with no further tendon dislocations.
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Affiliation(s)
- Stefania Zannoni
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - Carlo Bonifacini
- IRCCS Istituto Ortopedico Galeazzi, Foot and Ankle Surgery, Milano, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy; Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy.
| | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
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3
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Teixeira da Mota P, Sapage R, Branco C, Sousa R, Sousa D, Pintado C. Tibialis Posterior Tendon Dislocation: A Case Report. JBJS Case Connect 2020; 10:e1900590. [PMID: 32649149 DOI: 10.2106/jbjs.cc.19.00590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 37-year-old man presented after a sudden snap followed by pain in the medial side of the ankle while playing football. Physical examination showed edema and pain posteriorly to the medial malleolus, and a longitudinal structure was palpable anteriorly. Ultrasound confirmed a dislocated tibialis posterior tendon (TPT). The patient underwent surgery, and the flexor retinaculum was repaired. Six months after the surgery, he was asymptomatic and had resumed his usual physical activity, with an AOFAS score of 100. CONCLUSION TPT dislocation is rare and orthopaedic surgeons should be aware of this condition in patients with a sudden traumatic medial ankle pain.
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Traumatic Dislocation of the Tibialis Posterior Tendon. Am J Phys Med Rehabil 2019; 99:e30-e31. [PMID: 31135463 DOI: 10.1097/phm.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Soliman SB, Spicer PJ, van Holsbeeck MT. Sonographic and radiographic findings of posterior tibial tendon dysfunction: a practical step forward. Skeletal Radiol 2019; 48:11-27. [PMID: 29802532 DOI: 10.1007/s00256-018-2976-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/22/2018] [Accepted: 05/08/2018] [Indexed: 02/08/2023]
Abstract
The purpose of this article is to describe the sonographic and radiographic findings in the diagnosis and treatment of posterior tibial tendon dysfunction. Ultrasound and radiographs play a crucial role in the diagnosis of posterior tibial tendon dysfunction and in imaging the postoperative changes related to posterior tibial tendon dysfunction. Early detection and diagnosis of posterior tibial tendon dysfunction is important in helping to prevent further progression of disease, obviating the need for more invasive and complex procedures.
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Affiliation(s)
- Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
| | - Paul J Spicer
- Division of Musculoskeletal Radiology, Department of Radiology, University of Kentucky Healthcare, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Marnix T van Holsbeeck
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
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Strydom A, Saragas NP, Tladi M, Ferrao PNF. Tibialis Posterior Tendon Dislocation: A Review and Suggested Classification. J Foot Ankle Surg 2017; 56:656-665. [PMID: 28237568 DOI: 10.1053/j.jfas.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Indexed: 02/03/2023]
Abstract
Tibialis posterior tendon dislocation is a rarely described entity that is easily missed, resulting in delayed diagnosis and treatment. A review of the English published data on the topic showed inconsistency in the reporting of injuries and surgical management techniques, leading us to describe a novel classification system to guide treatment and future reporting. We also describe a case of tibialis posterior tendon dislocation in a professional volleyball player and our surgical technique for correction, including retromalleolar groove deepening.
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Affiliation(s)
- Andrew Strydom
- Fellow, The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, South Africa; Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa.
| | - Nikiforos Pandelis Saragas
- Director, The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, South Africa; Honorary Adjunct Professor, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Makgabo Tladi
- Fellow, The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, South Africa; Consultant Orthopaedic Surgeon, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Science University, Ga-Rankuwa, South Africa
| | - Paulo Norberto Farria Ferrao
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa; Assistant Director, The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, South Africa
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Waldron JE, Bernhardson AS, Fellars TA. Unilateral Dislocation of the Posterior Tibialis Tendon (PTT) and Flexor Digitorum Longus Tendon With Contralateral PTT Subluxation in a Patient With Congenitally Shallow Flexor Groove. Foot Ankle Spec 2017; 10:480-483. [PMID: 28920487 DOI: 10.1177/1938640017699062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Flexor tendon dislocation from the flexor tendon groove posterior of the medial malleolus has been previously described, and may be difficult to diagnose initially, but is amendable to surgical treatment with good outcomes. We present a unique case of unilateral dislocation of the posterior tibialis and flexor digitorum longus tendons with contralateral flexor digitorum longus subluxation that was treated surgically with a good outcome. CASE PRESENTATION A 37-year-old active duty male sustained a dislocation and subluxation of the flexor tendons bilaterally after a forced dorsiflexion injury. Bilateral ankle magnetic resonance imaging revealed the injuries that this patient sustained and aided in surgical planning. Surgical Treatment. Bilateral flexor tendon groove deepening with periosteal flap elevation and retinacular repair. DISCUSSION/CONCLUSION This injury has not been previously described in the literature after a forced dorsiflexion mechanism. Advanced imaging is helpful as this injury may be initially misdiagnosed. This case shows that delayed bilateral reconstruction of the flexor tendon grooves and retinacula are reliable methods for pain relief to allow a patient to return to a physically demanding level of function. LEVELS OF EVIDENCE Level V.
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Affiliation(s)
- Jacob E Waldron
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, California
| | - Andrew S Bernhardson
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, California
| | - Todd A Fellars
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, California
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Wong GNL, Tan TJ. MR imaging as a problem solving tool in posterior ankle pain: A review. Eur J Radiol 2016; 85:2238-2256. [PMID: 27842673 DOI: 10.1016/j.ejrad.2016.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 12/12/2022]
Abstract
Posterior ankle pain is a cause of chronic pain and disability, afflicting a wide range of individuals. While proper identification of the cause is essential for timely and adequate treatment, identifying the cause and excluding mimickers is often challenging for the physician due to the complex nature of the joint. In addition, pathology that can cause posterior ankle pain may occur on their own or in co-existence. Clinical conditions that can present as posterior ankle pain include: posterior ankle impingement, Achilles tendon pathology, medial flexor tendon pathology, peroneal pathology, retrocalcaneal bursitis, posterior subtalar tarsal coalition, sinus tarsi, and tarsal tunnel syndrome. In this review we introduce current concepts of pathophysiology in the main conditions involved in posterior ankle pain, and review the role of MR in the diagnosis and management of each condition. When pathology can be detected earlier and with more specificity, appropriate and time-sensitive treatment can be commenced, thus improving clinical outcomes.
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Affiliation(s)
- Gloria N L Wong
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
| | - Tien Jin Tan
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
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9
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Mullens J, Whiteside W, Nilssen E, Kennedy C. Dislocated Posterior Tibial Tendon Treated With Plate Buttress Fixation in a Collegiate Gymnast: A Case Report and Review of the Literature. Foot Ankle Spec 2016; 9:361-6. [PMID: 26446101 DOI: 10.1177/1938640015609985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Dislocation of the posterior tibial tendon (PTT) is a rare pathological process that occurs most often as a result of acute trauma. The injury involves forced dorsiflexion and eversion of the foot against a contracted posterior tibialis. Diagnosis of the injury is often difficult secondary to the rarity of the injury and its similarity with other benign injuries of the medial ankle. Routine diagnostic imaging often does not reveal the injury, and advanced imaging with magnetic resonance imaging or ultrasound to confirm the diagnosis is often required. The injury can be a result of an abnormal retromalleolar groove or a tear of the flexor retinaculum. Because nonoperative treatment frequently results in poor outcomes with continuing pain and progressive flat foot, operative treatment with repair of the flexor retinaculum with correction of the retromalleolar groove is the most described intervention. We report an acute case of PTT dislocation in a collegiate gymnast during competition and offer our technique for surgical correction in the setting of a partially torn, attenuated flexor retinaculum with plate buttressing of the PTT into its native uncorrected groove. LEVELS OF EVIDENCE Therapeutic, Level IV: Case study.
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Affiliation(s)
- Jess Mullens
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
| | - William Whiteside
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
| | - Erik Nilssen
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
| | - Chad Kennedy
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
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10
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Godino M, Vides M, Guerado E. Traumatic dislocation of posterior tibial tendon by avulsion of flexor retinacular release. Reconstruction with suture anchors. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Godino M, Vides M, Guerado E. Traumatic dislocation of posterior tibial tendon by avulsion of flexor retinacular release. Reconstruction with suture anchors. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 59:211-4. [PMID: 24882612 DOI: 10.1016/j.recot.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/28/2014] [Accepted: 04/01/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Traumatic dislocation of the posterior tibial tendon (PTT) has a very low prevalence. It presents with pain and recurrent snapping on the posterior side of the medial malleolus after an ankle sprain while practicing sports. The diagnosis is based on clinical examination, supported by imaging techniques. The treatment must be always surgical. CASE REPORT A 28 year old man sprained ankle his ankle while jogging. He was treated in an emergency department with an elastic bandage. Once he recovered, he went back to running, noticing a projection with ankle pain. In the physical examination the PTT was reproduced with inversion maneuvers and forced dorsiflexion. Ultrasound and MRI were performed on the ankle. The patient was operated on, leaving a stable ankle with no projection. Three months later he had no pain and restarted his physical activities. CONCLUSION Surgical treatment of PTT dislocation by re-anchoring the flexor retinacula provides an excellent functional outcome.
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Affiliation(s)
- M Godino
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Costa del Sol, Universidad de Málaga, Marbella, Málaga, España.
| | - M Vides
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Costa del Sol, Universidad de Málaga, Marbella, Málaga, España
| | - E Guerado
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Costa del Sol, Universidad de Málaga, Marbella, Málaga, España
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12
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Gambardella GV, Donegan R, Caminear DS. Isolated dislocation of the posterior tibial tendon in an amateur snowboarder: a case report. J Foot Ankle Surg 2013; 53:203-7. [PMID: 24361009 DOI: 10.1053/j.jfas.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Indexed: 02/03/2023]
Abstract
Isolated dislocation of the posterior tibial tendon is an uncommon pathologic entity that typically occurs in the setting of acute trauma. The diagnosis remains challenging and is often delayed second to the rarity of the injury and symptoms similar to that of medial ankle sprains and other routinely diagnosed injuries about the ankle. The factors that predispose this tendon to dislocation include a hypoplastic retromalleolar groove, flexor retinaculum insufficiency, chronic repetitive trauma, and a structural abnormality from a previous medial malleolar fracture, or a combination thereof. Dislocation has also been cited as a complication of multiple local steroid injections and tarsal tunnel release. The mechanism of injury appears to involve forced dorsiflexion and eversion of the ankle when the posterior tibial tendon is contracted. Most cases do not respond well to conservative treatment and will require surgery to restore function and eliminate symptoms. We report a case of posterior tibial tendon dislocation related to a snowboarding injury and offer our technique for surgical correction.
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Affiliation(s)
- Gabriel V Gambardella
- New Haven Foot Surgeons/Milford Podiatry Associates, New Haven, CT; and Attending Podiatric Surgeon, Yale-New Haven Hospital, New Haven, CT
| | - Ryan Donegan
- Postgraduate Year 2 Resident, Department of Podiatric Medicine and Surgery, Yale-New Haven Hospital/DVA Healthcare System, Hamden, CT
| | - David S Caminear
- Connecticut Orthopaedic Specialists, Hamden, CT; Section Chief, Department of Podiatric Surgery, Yale-New Haven Hospital, Saint Raphael Campus, New Haven, CT; and Assistant Clinical Professor, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
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13
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Al Khudairy A, Zafar MM, Padinjarathala BA. The unexpected with ankle fracture: traumatic tibialis posterior tendon dislocation: a case report and literature review. Foot Ankle Spec 2013; 6:482-9. [PMID: 24026087 DOI: 10.1177/1938640013502726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traumatic dislocation of tibialis posterior is infrequently reported in the literature. It is rare but potential cause of persistent pain that can be easily missed. Concomitant ankle fracture may obscure the clinical picture and if unsuspected, consequences such as iatrogenic injury to tibialis posterior tendon while fixing the medial malleolus may occur. We report our experience in the management of a tibialis posterior tendon dislocation associated with ankle fracture. A review of all English literature had been carried with a focus on treatment options.
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Affiliation(s)
- A Al Khudairy
- Waterford Regional Hospital, Waterford City, Ireland
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14
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Ribbans WJ, Garde A. Tibialis posterior tendon and deltoid and spring ligament injuries in the elite athlete. Foot Ankle Clin 2013; 18:255-91. [PMID: 23707177 DOI: 10.1016/j.fcl.2013.02.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The tibialis posterior tendon and the spring and deltoid ligament complexes combine to provide dynamic and passive stabilization on the medial side of the ankle and hindfoot. Some of the injuries will involve acute injury to previous healthy structures, but many will develop insidiously. The clinician must be aware of new treatment strategies and the level of accompanying scientific evidence regarding injuries sustained by athletes in these areas, while acknowledging that more traditional management applied to nonathletic patients is still likely to be appropriate in the setting of treatment for elite athletes.
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Affiliation(s)
- William John Ribbans
- The University of Northampton, School of Health, Park Campus, Northampton NN2 7AL, UK.
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15
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Jain NB, Omar I, Kelikian AS, van Holsbeeck L, Grant TH. Prevalence of and factors associated with posterior tibial tendon pathology on sonographic assessment. PM R 2012; 3:998-1004. [PMID: 22108227 DOI: 10.1016/j.pmrj.2011.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 05/03/2011] [Accepted: 05/15/2011] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the frequency of and factors associated with supramalleolar posterior tibial tendon (PTT) pathology that often may be missed on sonography because of the limited field of view of ultrasound. DESIGN Retrospective cross-sectional study. SETTING Large academic center. PATIENTS Patients with medial ankle pain and tenderness and with normal radiographs who presented for sonographic assessment (n = 217). METHODS Two experienced musculoskeletal radiologists interpreted the studies by consensus. MAIN OUTCOME MEASUREMENT PTT pathology. RESULTS Of the 217 patients, 33.2% had grade 1 PTT pathology (n = 72), 14.3% had grade 2 pathology (n = 31), and 2.8% had grade 3 pathology (n = 6). When stratified by location, 29.0% of patients (n = 63) had inframalleolar abnormalities, 11.5% had retromalleolar pathology (n = 25), and 11 patients had supramalleolar pathology (5.1%). Four patients had PTT subluxation or dislocation. Age was significantly associated with PTT pathology (P = .02). A higher proportion of patients with supramalleolar (81.8%) and retromalleolar (72.0%) PTT pathology were women compared with patients who had inframalleolar (57.1%) PTT pathology. A higher proportion of patients with supramalleolar and retromalleolar PTT pathology had grade 2 tears compared with those with inframalleolar PTT pathology (36.4% for supramalleolar, 44.0% for retromalleolar, and 22.2% for inframalleolar pathology). CONCLUSIONS We present one of the largest studies on PTT pathology. PTT pathology can occur in the supramalleolar area, a region that often is not assessed on imaging. Although data are unavailable with regard to whether the natural history of supramalleolar PTT is different from that of other regions, patients with supramalleolar PTT pathology had more severe grades of tear and increased prevalence of tenosynovitis and were more often women. It is essential to recognize supramalleolar PTT pathology so that consequences of nontreatment such as medial arch collapse can be prevented.
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Affiliation(s)
- Nitin B Jain
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
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16
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Mitchell K, Mencia MM, Hoford R. Tibialis posterior tendon dislocation: a case report. Foot (Edinb) 2011; 21:154-6. [PMID: 21106362 DOI: 10.1016/j.foot.2010.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/24/2010] [Accepted: 10/25/2010] [Indexed: 02/04/2023]
Abstract
Dislocation of the posterior tibial tendon is a rare event, which may occur after trauma particularly sporting accidents. These injuries are frequently misdiagnosed at the initial presentation leading to a delay in treatment. We describe a case of delayed presentation of an atraumatic dislocation of the posterior tibial tendon which was diagnosed accurately and managed with primary repair of the flexor retinaculum.
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Affiliation(s)
- Karlene Mitchell
- The Orthopaedic Department, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
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17
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Lee K, Byun WJ, Ha JK, Lee WC. Dislocation of the tibialis posterior tendon treated with autogenous bone block: a case report. Foot Ankle Int 2010; 31:254-7. [PMID: 20230706 DOI: 10.3113/fai.2010.0254] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: V, Expert Opinion
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Affiliation(s)
- Kang Lee
- Inje University Seoul Paik Hospital, Department of Orthopaedic Surgery, Seoul, Republic of Korea
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18
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Collins MS, Felmlee JP. 3T magnetic resonance imaging of ankle and hindfoot tendon pathology. Top Magn Reson Imaging 2009; 20:175-188. [PMID: 20410804 DOI: 10.1097/rmr.0b013e3181d47fbd] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Ankle tendon pathology is relatively common in the active adult population. Magnetic resonance imaging is often the preferred advanced imaging option for the evaluation of tendon pathology of the hindfoot and ankle. The almost linear increase in signal-to-noise ratio provided by higher field strength imaging allows for improved image resolution and decreased scan times. Newer systems with faster gradients allow for optimal fast spin-echo imaging with lower echo spacing for longer echo train lengths and minimal image blurring. The ability to comfortably scan the ankle within the magnet isocenter using high-field strength-compatible extremity coils further maximizes the image resolution. It is imperative for the radiologist to be aware of necessary protocol adjustments and potential imaging artifacts unique to high-field strength imaging of the ankle. Our review outlines high-field strength magnetic resonance imaging technique and artifacts and also details the specifics of our own methods of ankle imaging.
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Affiliation(s)
- Mark S Collins
- Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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19
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Boss AP, Hintermann B. Tibialis posterior tendon dislocation in combination with achilles tendon rupture: a case report. Foot Ankle Int 2008; 29:633-6. [PMID: 18549765 DOI: 10.3113/fai.2008.0633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Andreas P Boss
- SRO AG, Orthopaedics and Traumatology, St Urbanstrasse 67, Langenthal, BE 4900, Switzerland.
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20
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Aguiar ROC, Cabral MVG, Moura BB, Marchiori E. Dislocation of the flexor digitorum longus and posterior tibial tendons without fracture dislocation of the ankle: a case report. Foot Ankle Int 2007; 28:1187-9. [PMID: 18021589 DOI: 10.3113/fai.2007.1187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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21
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Wong YS. Recurrent dislocation of the posterior tibial tendon secondary to detachment of a retinacular-periosteal sleeve: a case report. Foot Ankle Int 2004; 25:602-4. [PMID: 15363384 DOI: 10.1177/107110070402500815] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Yue Shuen Wong
- Department of Orthopaedic Surgery, Alexandra Hospital, 378 Alexandra Road, Singapore 159964.
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Prato N, Abello E, Martinoli C, Derchi L, Bianchi S. Sonography of posterior tibialis tendon dislocation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:701-705. [PMID: 15154538 DOI: 10.7863/jum.2004.23.5.701] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Nicoló Prato
- Servizio di Radiologia, Ospedale La Colletta, Genoa, Italy
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23
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Leffler S, Disler DG. MR imaging of tendon, ligament, and osseous abnormalities of the ankle and hindfoot. Radiol Clin North Am 2002; 40:1147-70. [PMID: 12462474 DOI: 10.1016/s0033-8389(02)00052-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article serves as an overview of the pathologic processes that are seen in the foot and ankle. MRI can play a pivotal role in making precise diagnoses and then guiding treatment decisions. MRI can be extremely helpful in determining response to therapy.
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Affiliation(s)
- Susan Leffler
- Commonwealth Radiology, PC, 5801 Bremo Road, Richmond, VA 23226, USA.
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24
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Farooki S, Sokoloff RM, Theodorou DJ, Trudell DJ, Clopton P, Feng SAK, Resnick D. Visualization of ankle tendons and ligaments with MR imaging: influence of passive positioning. Foot Ankle Int 2002; 23:554-9. [PMID: 12095125 DOI: 10.1177/107110070202300613] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To determine if passive positioning of the ankle influences the MR imaging appearance of ankle tendons and ligaments. METHODS A positioning device was used during imaging of 10 volunteers. Axial and coronal T1-weighted images were acquired in six positions of the ankle, and the appearance of the tendons and lateral ligaments was subjectively evaluated. RESULTS The peroneus longus (PL), peroneus brevis (PB), anterior tibialis (AT), extensor digitorum longus (EDL), and extensor hallucis longus (EHL) tendons were best visualized in 20 degrees of plantarflexion and 20 degrees of inversion (p < 0.0001). The anterior talofibular (ATF) and calcaneofibular (CF) ligaments were best seen in 20 degrees of plantarflexion (p < 0.0001). Ten degrees of dorsiflexion was the least useful imaging plane for all of the aforementioned structures. CONCLUSION When there is clinical concern regarding pathology of a specific structure about the ankle, passive positioning may allow optimal evaluation.
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Affiliation(s)
- Shella Farooki
- Department of Radiology, Veterans Affairs San Diego Healthcare System, CA 92161, USA.
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25
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Bencardino JT, Rosenberg ZS, Serrano LF. MR IMAGING OF TENDON ABNORMALITIES OF THE FOOT AND ANKLE. Magn Reson Imaging Clin N Am 2001. [DOI: 10.1016/s1064-9689(21)00533-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Rosenberg ZS, Beltran J, Bencardino JT. From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot. Radiographics 2000; 20 Spec No:S153-79. [PMID: 11046169 DOI: 10.1148/radiographics.20.suppl_1.g00oc26s153] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance (MR) imaging has opened new horizons in the diagnosis and treatment of many musculoskeletal diseases of the ankle and foot. It demonstrates abnormalities in the bones and soft tissues before they become evident at other imaging modalities. The exquisite soft-tissue contrast resolution, noninvasive nature, and multiplanar capabilities of MR imaging make it especially valuable for the detection and assessment of a variety of soft-tissue disorders of the ligaments (eg, sprain), tendons (tendinosis, peritendinosis, tenosynovitis, entrapment, rupture, dislocation), and other soft-tissue structures (eg, anterolateral impingement syndrome, sinus tarsi syndrome, compressive neuropathies [eg, tarsal tunnel syndrome, Morton neuroma], synovial disorders). MR imaging has also been shown to be highly sensitive in the detection and staging of a number of musculoskeletal infections including cellulitis, soft-tissue abscesses, and osteomyelitis. In addition, MR imaging is excellent for the early detection and assessment of a number of osseous abnormalities such as bone contusions, stress and insufficiency fractures, osteochondral fractures, osteonecrosis, and transient bone marrow edema. MR imaging is increasingly being recognized as the modality of choice for assessment of pathologic conditions of the ankle and foot.
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Affiliation(s)
- Z S Rosenberg
- Department of Radiology, Hospital for Joint Diseases, NYU Medical Center, 305 E 17th St, New York, NY 10003, USA.
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27
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Affiliation(s)
- M E Schweitzer
- Both authors: Department of Radiology, Thomas Jefferson University Hospital, 111 S. 11th St., 3390 Gibbon, Philadelphia, PA 19107, USA
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28
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Abstract
Sonography of the foot and ankle offers many advantages. Currently, sonographic evaluation rivals or exceeds MR imaging for evaluation of tendons, joint and bursal pathology, and specific soft tissue pathology. The advantages of sonographic evaluation provide a strong impetus for applying this modality to imaging of foot and ankle pathology. Those who accept the challenge will have an expanded repertoire to offer in the pursuit of efficient and effective patient care.
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Affiliation(s)
- D P Fessell
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, USA
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29
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Bencardino J, Rosenberg ZS, Delfaut E. MR IMAGING IN SPORTS INJURIES OF THE FOOT AND ANKLE. Magn Reson Imaging Clin N Am 1999. [DOI: 10.1016/s1064-9689(21)00504-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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