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Fig 2 - uploaded by Panagiotis Symeonidis

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A. Skin incision for the distal portal B. "Nick and spread"

technique using two haemostats C. Introduction of the 2.7
mm arthroscope

Source publication

+3

Peroneal tendoscopy. A pictorial essay

Article Full-text available
Jan 2018
St Luke's Hospital · Thessaloniki · Panayiotis
Greece · Panagiotis Symeonidis
Tendoscopy of the peroneal tendons is gaining
popularity in the diagnosis and treatment of
retromalleolar pain as a result of tenosynovitis,
impingement and tendon tear. Further indications for
the technique include tendon subluxation or
dislocation, a low riding muscle belly and symptomatic
vinculae. The method combines the advantages of
minimally...

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Contexts in source publication

Context 1

... is to be combined with a lateral ankle reconstruction

procedure. [9] Portal placement Typically a two portal
technique is used. The dis- tal portal is made first. A number
11 blade is used for the skin incision which is located
around 2 cm distal to the tip of the lateral malleolus and is 3
to 5 mm long and parallel to the tendons' direction. (Fig. 2a)
By using a "nick and spread" technique, the surgeon
develops the space between the sub- cutaneous tissue and
the tendon sheath with one or two small haemostats [3].
(Fig. 2b) This allows for identification and protection of
branches of the sural nerve crossing the surgical site and
visu- alization of the external surface of the sheath. ...

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Context 2

... 11 blade is used for the skin incision which is located

around 2 cm distal to the tip of the lateral malleolus and is 3
to 5 mm long and parallel to the tendons' direction. (Fig. 2a)
By using a "nick and spread" technique, the surgeon
develops the space between the sub- cutaneous tissue and
the tendon sheath with one or two small haemostats [3].
(Fig. 2b) This allows for identification and protection of
branches of the sural nerve crossing the surgical site and
visu- alization of the external surface of the sheath. [14] The
tendon sheath is raised with a curved Kelly clamp and a
blunt trocar is introduced under di- rect vision. Another
helpful step is to inject 20 cc of saline solution ...

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Context 3

... sheath throughout its length, facilitating the easier

passage of the arthroscope. [10,16] A useful maneuver is to
plantar flex the ankle while the arthroscope is being
introduced. This causes the course of the peroneal tendons
to straighten and with a gentle push the scope can be driven
in a cephalad direction to the retrom- alleolar zone [10].
(Fig. 2c) An 18 gauge needle is introduced with
transillumination approximate- ly 2.5 cm proximal to the
posterior edge of the lateral malleolus. (Fig. 3) The superior
portal is then created with an 11 blade and a small probe is
introduced. Care is being taken not to injure the tendons
when creating portals with the knife ...

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