(Visualizing Tendons With Miniature Cameras)
By Robert H. Sheinberg, D.P.M., F.A.C.F.A.S., D.A.B.F.A.S.
What is it?
A procedure that is utilized to visualize tendons in a minimally invasive approach. We are able to see injuries of the tendon and its covering using small instruments. Two incisions 1/6” in length along the tendon allows us to not only visualize the tendon but place small shavers in the sheath to remove abnormal tissue during the procedure.
What is it useful for?
- Inflammation or synovitis of the tendon sheath that occurs due to injury, overuse, abnormal biomechanics or connective tissue disease.
- Adhesions of the tendon to its surrounding covering or sheath.
- Partial tears of the tendon that can occur through injury or chronic repetitive stress.
- The release of the tendon that is tethered and unable to move in its sheath.
- Biopsy of the tendon sheath to help with diagnosing an inflammatory condition.
- Removal of small bone spurs that may be impinging or irritating a tendon.
Why is it better than traditional open surgery?
- Small incisions (2-3) 1/6” in length avoiding long incisions over tendons that may cause adhesions.
- Minimally invasive.
- Faster recovery.
- Much less pain.
- Less swelling.
- Easier to diagnose pathology instead of an open surgical procedure.
- Fewer wound complications.
- Less scarring.
What tendons can endoscopy be performed on?
- Posterior tibial tendon.
- Peroneal tendon.
- Anterior tibial tendon.
- Achilles tendon.
How is it performed?
- It is an outpatient procedure performed under a local, twilight or general anesthetic according to the patient’s needs.
- A small tourniquet may be utilized to allow better visualization and minimize bleeding.
- Incisions 1/6” are utilized in different areas of the tendon to allow a miniature camera inside the tendon sheath to visualize the tendon and its associated injuries.
- Incisions 1/6” are utilized over the tendon to remove any existing abnormal tissue or tendon tears when the tears are small and will not interfere with the long-term tendon function.
- 2-3 total stitches are used to close the very small incisions.
What occurs after surgery?
- Patients go home that day and rest with their foot and extremity elevated.
- Ice is utilized for 48 hours to reduce inflammation, swelling, and pain.
- Bandages are usually removed within 24 hours to allow the foot and ankle to begin to move and prevent adhesions.
- Weight bearing is usually allowed within 1-3 days either in a sandal or a walking boot.
- Surgery is usually performed on Friday, allowing the patient to return to school or work on Monday.
- Physical therapy is necessary in most cases postoperatively to return a range of motion, diminish adhesions, improve muscle strength and coordination.
What is usually the prognosis?
- If we are releasing adhesions, the range of motion can be restored very quickly and the prognosis is excellent.
- If we are removing a small piece of tendon that has been split or frayed off, the prognosis is excellent.
- If the tendon is split in a 50-50 fashion, we usually revert the mini procedure to an open procedure to repair the tendon. The recovery may be longer but the prognosis is still good.
- Although advances in tendon scopes have been made, repairing ligaments and deepening the fibular groove for peroneal dislocations may be difficult and open procedures usually provide a much better long-term outcome.
- Removing inflamed tissue (synovitis) may be a great long-term benefit as the inflamed tissue can cause a tendon to disease very quickly. If we get to these problems early, the prognosis is much better for the long-term health of the tendon and the extremity.