An anatomic cadaver study was performed and subsequently, in a prospec
tive study, diagnostic and therapeutic tendoscopy (tendon sheath endos
copy) was performed in 16 consecutive patients with a history of persi
stent posteromedial ankle pain for at least 6 months. All patients had
pain on palpation over the posterior tibial tendon, a positive tibial
tendon resistance test, and local swelling. The indications were diag
nostic procedure after surgery in 5 patients, diagnostic procedure aft
er fracture in 5, diagnostic after trauma in 1, chronic tenosynovitis
in 2, screw removal in 1, and posterior ankle arthrotomy in 2 patients
. Inspection and surgery of the complete tendon and its tendon sheath
can be performed by a standard two-portal technique. A new finding is
the vincula that was consistently present in all our autopsy specimens
as well as all our patients. At 1-year follow-up, 3 of the 4 patients
in whom resection of a pathological thickened vincula, and 2 patients
in whom tenosynovectomy and tendon sheath release were performed, wer
e free of symptoms. Other procedures such as removal of adhesions and
screw removal could well be performed. In 2 patients with a posteromed
ially located loose body, successful removal took place by means of a
posterior tibial tendoscopic approach. There were no complications.