AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-Tendoscopy_ Posterior Tibial and Peroneal Tendon Pathology-Phinit Phisitkul, M.D.

Tendoscopy_ Posterior Tibial and Peroneal Tendon Pathology-Phinit Phisitkul, M.D.

Pdf Summary

This document summarizes evidence and clinical experiences regarding tendoscopy for peroneal tendon dysfunction, authored by Dr. Phinit Phisitkul. Tendoscopy is utilized both diagnostically and therapeutically for conditions such as tendon tears, tenosynovitis, subluxation, snapping sensations, and adhesions of the peroneal tendons.<br /><br />Several retrospective and prospective case series (Level IV evidence) report good clinical outcomes:<br /><br />- Marmotti et al. (2012) found 100% subjective improvement in lateral ankle pain in patients with thickened vincula lesions.<br />- Scholten et al. (2006) reported no recurrence after tendoscopic treatment of longitudinal peroneal brevis tendon ruptures and tenosynovitis, with some cases requiring open suturing.<br />- Van Dijk et al. (1998) successfully performed adhesiolysis, exostosis removal, and tendon repair, with 75–100% success rates.<br />- Guillo et al. (2013) observed a 100% return to activity in recurrent peroneal tendon subluxation cases, with minimal complications.<br />- Vega et al. (2013) achieved excellent results in intrasheath subluxation and adhesions; tendon rupture repairs were variably successful (62.5% symptom-free).<br />- Lui (2012) and Jerosch et al. (2007) similarly demonstrated high rates of symptom resolution and return to activity, though some cases needed open repair for instability or complex tears.<br /><br />Indications for tendoscopy include diagnostic evaluation, synovectomy, excision of accessory muscles (peroneus quartus), adhesion lysis, tendon stabilization, and groove deepening to prevent or treat subluxation or dislocation. Technical pearls emphasize use of a 2.7mm scope and a 2-portal technique, careful management of fluid pressure to avoid extravasation, and protection of the sural nerve. Tendoscopy may be combined with subtalar arthroscopy.<br /><br />Overall, tendoscopy is a minimally invasive, effective option for managing peroneal tendon disorders, though complex tears or instabilities sometimes require open repair. It offers high patient satisfaction, improvement in pain and function, and quick return to activity.

Keywords

tendoscopy

peroneal tendon dysfunction

peroneal tendon tears

tenosynovitis

peroneal tendon subluxation

adhesions

minimally invasive surgery

lateral ankle pain

peroneus quartus excision

sural nerve protection