Post-operative care

In case of mini-open repair of a longitudinal rupture, cast immobilisation for a week is advocated, after which a functional brace is applied for 3-5 weeks.

Post-operative rehabilitation

Aftertreatment after endoscopic synovectomy is functional. A pressure bandage is apllied for 2-3 days and weight-bearing is allowed as tolerated. In case of repair of a longitudinal rupture, cast immobilisation for a week is advocated, after which a functional brace is applied for 3-5 weeks.

Pearls

It is important to identify the location of the posterior tibial tendon before creating the portals. Ask the patient to actively invert the foot, identify the tendon, and mark the location of the portals on the skin.

In cases where you have entered the tendon sheath of the flexor digitorum longus, you can easily see tendons move up and down when you passively flex and extend the toes.

Pitfalls

The tendon sheath between the posterior tibial tendon and the flexor digitorum longus is quite thin. Always check to ensure that you are inspecting the correct tendon.

Remaining in the tendon sheath of the posterior tibial tendon keeps the neurovascular bundle out of danger.

Surgeons not familiar with endoscopic surgery are advised to train themselves in a cadaveric setting.