RESUMO
BACKGROUND: Although tenotomy and tenodesis are frequently used for long head of the biceps tendon lesions, controversies remain as to which technique is superior regarding pain, functionality, complications, and cosmetic appearance. QUESTIONS/PURPOSES: (1) For long head of biceps tendon lesions, does tenotomy or tenodesis result in greater improvements in VAS score for pain? (2) Which approach has superior results when evaluating function outcome (Constant) scores? (3) Does tenotomy or tenodesis have fewer complications? (4) Does tenotomy or tenodesis result in better cosmesis (Popeye sign)? METHODS: A systematic review was performed in the Cochrane Library, Embase, PubMed, and Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) using the keywords "long head of the biceps tendon," "biceps tenodesis," and "tenotomy." We completed the search in June 2020. The inclusion criteria were randomized controlled trials and quasirandomized controlled trials that investigated tenodesis and tenotomy with no language restriction and evaluation of adult patients who presented with a long head of the biceps tendon lesion, associated with other lesions or not, without previous shoulder surgeries and who had no response to nonoperative treatment. The initial search yielded 239 studies, 40 of which were duplicates. We assessed the titles and abstracts of 199 articles and excluded all studies that were not randomized controlled trials (literature reviews) or that compared different techniques. We assessed the full text of 14 articles and excluded the ones that were protocols and cohort studies. We evaluated the risk of bias using the Cochrane Collaboration tool. We included eight studies in this systematic review and meta-analysis, with a total of 615 participants, 306 of whom were treated with tenotomy and 309 with tenodesis. The median duration of follow-up was 2 years. Overall, the included studies had a low risk of bias. The complications evaluated were adhesive capsulitis, biceps brachii tear, cramps, and a subsequent second surgical procedure. We used a random model in this meta-analysis so that we could generalize the results beyond the included studies. In this study, we only reported differences between the groups if they were both statistically valid and larger than the minimum clinically important difference (MCID). RESULTS: Comparing tenotomy and tenodesis, we observed no difference between the groups regarding pain in the long term (mean difference 0.25 [95% confidence interval -0.29 to 0.80]; p = 0.36). There was no difference in Constant score in the long-term (mean difference -1.45 [95% CI -2.96 to 0.06]; p = 0.06). There were no differences when evaluating for major complications (odds ratio 1.37 [95% CI 0.29 to 6.56]; p = 0.70). There were not enough papers evaluating adhesive capsulitis, cramping, and risk of revision surgery. Popeye sign was more frequent in the tenotomy group than in the tenodesis group (OR 4.70 [95% CI 2.71 to 8.17]; p < 0.001). CONCLUSION: This systematic review demonstrated that tenotomy and tenodesis offer satisfactory treatment for long head of the biceps tendon lesions. In terms of pain improvement and Constant score, there was no difference between the techniques, but patients undergoing tenotomy have worse cosmetic results. Therefore, surgeons should choose the technique based on their skills and the patient's expectations of surgery, such as cosmesis and time to recovery. More studies are needed to evaluate complications such as adhesive capsulitis and cramping, as well as to compare duration of surgery and recovery time for each technique. LEVEL OF EVIDENCE: Level I, therapeutic study.
Assuntos
Ombro/cirurgia , Tendinopatia/cirurgia , Tendões/cirurgia , Tenodese/estatística & dados numéricos , Tenotomia/estatística & dados numéricos , Braço/cirurgia , Humanos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Resultado do TratamentoRESUMO
Long-segment disease involving the insertional region of the Achilles tendon can be a challenging problem. These patients often have significant disability and functional problems. Surgical management requires some type of tissue replacement, regional tissue rearrangement or tendon transfer. Various types of allograft tissue as well as synthetic materials have been described. Patients often have residual weakness and functional deficits following surgery. We have utilized an Achilles tendon-bone block allograft in combination with a flexor hallucis longus tendon transfer for long-segment Achilles tendon deficits involving the insertion. A retrospective review was performed on this group of patients to assess complication rates. A chart review was performed on 14 patients who underwent this procedure. The average postoperative follow-up duration was 24.7 months (range 6-48). Postoperatively, all patients exhibited grade 5 muscle strength with manual muscle testing and 12 of 14 patients were able to perform a single limb heel rise. This case series reviews the surgical technique as well as the patient demographics and complication rates. This procedure has been reliable for those patients with long-segment Achilles tendon deficits involving the insertion who desire to resume a high demand occupation or active lifestyle. The complication rate is relatively low.
Assuntos
Tendão do Calcâneo , Tendinopatia , Tendão do Calcâneo/cirurgia , Aloenxertos , Humanos , Estudos Retrospectivos , Ruptura , Tendinopatia/cirurgia , Transferência TendinosaRESUMO
OBJETIVO Presentación de un inusual caso de xantomatosis cerebrotendinosa en un paciente de edad cuya primera manifestación fueron xantomas bilaterales del tendón de Aquiles. MATERIAL Y MÉTODOS Mujer de 62 años, que presenta tumoraciones, que presenta tumoraciones sólidas y polilobuladas, en la cara posterior de ambos tendones de Aquiles de 8 años de evolución. El diagnóstico se realizó mediante el hallazgo de hiperlipidemia y estudio genético. Se realió la exóresis quirúrgica parcial de las tumoraciones. RESULTADOS A los 5 años de la cirugía del pie izquierdo y 4 años del pie derecho la paciente estaba asintomática. Presentaba una fuerza para la flexión plantar bilateral de 5/5, pudiendo caminar y subir escaleras sin molestias. Presentaba una escala AOFAS de 85 y 90 puntos en el pie izquierdo y derecho, respectivamente. No hubo recidivas. DISCUSIÓN Los xantomas son depósitos de colesterol en el tejido conectivo de la piel, tendones o fascia, como resultado de una hiperlipoproteinemia. La importancia del caso radica en su sospecha diagnóstica, ya que la xantomatosis cerebrotendinosa suele manifestarse en pacientes de menos de 30 años de edad y en los que se ha recomendado la resección radical de las tumoraciones, e incluso del tendón, debido a las frecuentes recidivas. CONCLUSIÓN En pacientes de mayor edad con lesiones que infiltran el tendón, se puede optar por un tratamiento menos agresivo con un buen resultado clínico.
OBJETIVE Presentation of an unusual case of cerebrotendinous xanthomatosis in an elderly patient whose first manifestation was bilateral Achilles tendon xanthomas. MATERIAL AND METHODS 62-year-old woman presenting solid and polylobed tumors on the posterior aspect of both Achilles tendons for eight years. The diagnosis was made by means of hyperlipidemia and a genetic study. Surgical partial excision of the tumors was performed. RESULTS Five years after surgery on the left foot and four years after the right foot, the patient was asymptomatic. Bilateral plantar flexion force was 5/5, The patient was able to walk and climb stairs without discomfort. AOFAS score was 85 and 90 on the left and right feet, respectively. There were no recurrences. DISCUSSION Xanthomatosis is a genetic alteration with deposits of cholesterol in connective tissue of the skin, tendons or fascia, because of hyperlipoproteinemia. The importance of the present case lies in its diagnostic suspicion, since cerebrotendinous xanthomatosis manifests usually in patients under 30 years of age and in whom radical resection of tumors, and even of the tendon, has been recommended due to frequent recurrences . CONCLUSION In older patients with tumors that infiltrate the tendon, a less aggressive treatment can be chosen with a good clinical result.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Tendão do Calcâneo , Xantomatose/cirurgia , Xantomatose/diagnóstico , Xantomatose Cerebrotendinosa/complicações , Tendinopatia/cirurgia , Tendinopatia/diagnóstico , Imageamento por Ressonância Magnética , Xantomatose/etiologia , Xantomatose/diagnóstico por imagem , Tendinopatia/etiologia , Tendinopatia/diagnóstico por imagem , HiperlipidemiasRESUMO
Calcific insertional Achilles tendinopathy (CIAT) is a relatively common musculoskeletal entity that results in significant pain and disability, as well as posterior muscle group weakness. There is a lack of evidence criteria to support the timing of operative intervention, choice of procedures, or whether equinus requires treatment. The purpose of this study was to retrospectively review 45 patients (48 feet) who have undergone surgical management of CIAT with concomitant posterior muscle group weakness with the single heel rise testing. All patients underwent debridement and repair of the Achilles tendon with reattachment of the Achilles tendon to the calcaneus, ostectomy of the calcaneus, and flexor hallucis longus tendon transfer. Those patients with equinus also underwent gastrocnemius recession. The focus includes patient-reported satisfaction, time to return to normal shoe gear, and the incidence of revision surgery. The overall average of time to weightbearing was 4.3 weeks. After surgery, 73.3% (nâ¯=â¯33) of the 45 patients responded to the following question: "Would you have this surgery done again?" Of these patients, 93.9% (nâ¯=â¯31) responded "Yes" and 6.1% (nâ¯=â¯2) responded "Unsure." Of the same 33 patients, 84.8% (nâ¯=â¯28) responded that they were "Very Satisfied" with the procedure and 15.2% (nâ¯=â¯5) responded that they were "Satisfied." Twelve patients (26.7%) did not respond to either question. One of the 12 patients (8.3%) who did not respond had bilateral procedures. None of the patients experienced tendon rupture, deep vein thrombosis, or the need for revision surgery. Four patients (8%) experienced a superficial infection, whereas 1 patient (2%) had development of a deep infection. No correlations were found when looking at the relationship between body mass index and return to weightbearing/normal shoe gear with Spearman analysis.
Assuntos
Tendão do Calcâneo/cirurgia , Calcinose/cirurgia , Imageamento por Ressonância Magnética/métodos , Satisfação do Paciente , Tendinopatia/cirurgia , Transferência Tendinosa/métodos , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/fisiopatologia , Adulto , Idoso , Calcâneo/cirurgia , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Estudos de Coortes , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Osteotomia/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Tendinopatia/diagnóstico por imagem , Tendinopatia/fisiopatologia , Resistência à Tração , Resultado do TratamentoRESUMO
BACKGROUND: The purpose of this study is to translate, culturally adapt, and validate the VISA-A questionnaire for Chilean Spanish speakers with Achilles tendinopathy (AT), which has been originally developed for English-speaking population. METHODS: According to the guidelines published by Beaton et al., the questionnaire was translated and culturally adapted to Chilean patients in six steps: initial translation, synthesis of the translation, back translation, expert committee review, test of the pre-final version (cohort n = 35), and development of VISA-A-CH. The resulting Chilean version was tested for validity on 60 patients: 20 healthy individuals (group 1), 20 patients with a recently diagnosed AT (group 2), and 20 with a severe AT that already initiated conservative treatment with no clinical improvement (group 3). The questionnaire was completed three times by each participant: at the time of study enrollment, after an hour, and after a week of the initial test. RESULTS: All six steps were successfully completed for the translation and cultural adaptation of the VISA-A-CH. VISA-A-CH final mean scores in the healthy group was significantly higher than those in the other groups. Group 3 had the lowest scores. Validity showed excellent test-retest reliability (rho c = 0.999; Pearson's r = 1.000) within an hour and within a week (rho c = 0.837; Pearson's r = 0.840). CONCLUSIONS: VISA-A was translated and validated to Chilean Spanish speakers successfully, being comparable to the original version. We believe that VISA-A-CH can be recommended as an important tool for clinical and research settings in Chilean and probably Latin-American Spanish speakers.
Assuntos
Comparação Transcultural , Tendinopatia , Humanos , Psicometria , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e Questionários , Tendinopatia/diagnóstico , Tendinopatia/cirurgiaRESUMO
Introducción: la tendinitis calcificada es una afección frecuente en la articulación del hombro, sus principales síntomas y signos son el dolor y la pérdida del movimiento articular, el tratamiento conservador es el pilar fundamental, sin embargo la vía artroscópica es de gran utilidad en caso de fallo del primero. Objetivo: el objetivo de este trabajo es profundizar en aspectos como: síntomas y signos, clasificaciones, modalidades de tratamiento conservador y por último en la perspectiva quirúrgica a través de la vía artroscópica. Método: la búsqueda de la información se realizó en un periodo de tres meses (1ro. de marzo de 2016 al 31 de mayo de 2016) y se emplearon las siguientes palabras: calcific tendinitis y subacromial impingment. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 311 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 51 citas seleccionadas para realizar la revisión, 49 de ellas de los últimos 5 años donde se incluyeron 4 libros. Se presentan los síntomas y signos más importantes de esta entidad, así como las clasificaciones basadas en diferentes parámetros, apoyadas fundamentalmente por medios imaginológicos como la radiografía simple, ultrasonido de alta definición y la imagen de resonancia magnética. Conclusiones: la tendinitis calcificada es una entidad frecuente; aunque el tratamiento más empleado es el conservador, la cirugía por la vía artroscópica ofrece múltiples ventajas(AU)
Background: Calcific tendinitis is a common condition in the shoulder joint, its main symptoms and signs are pain and loss of joint movement, conservative treatment is the fundamental pillar, however the arthroscopic course is very useful in case of the first course fails. Objective: The objective of this work is to delve into aspects such as symptoms and signs, classifications, modalities of conservative treatment and finally in the surgical perspective through the arthroscopic course. Method: the search for the information was carried out in a period of three months (from March 1, 2016 to May 31, 2016) and we used the following words: calcific tendinitis and subacromial impingment. A bibliographic review was conducted for 311 articles published in PubMed, Hinari, SciELO and Medline databases, using EndNote search manager and reference manager. Fifty-one selected citations were used to perform those articles reviewed, 49 of them from the last five years. Four books were included. The most important symptoms and signs of this entity are presented, as well as classifications based on different parameters, mainly supported by imaging such as simple radiography, high definition ultrasound and magnetic resonance imaging. Conclusions: Calcific tendinitis is a common entity; although the conservative treatment is most commonly, arthroscopic surgery offers multiple advantages(AU)
Fondement: La tendinite calcifiante est une affection fréquente de l'articulation de l'épaule. Elle est caractérisée par la douleur et la perte du mouvement articulaire. Son pilier fondamental est le traitement conservateur. Cependant, la voie arthroscopique s'avère très utile en cas d'échec du traitement conservateur. Objectif: Le but de ce travail est d'approfondir des aspects tels que les symptômes et signes, les classifications, les modalités de traitement conservateur, et finalement, du point de vue chirurgical, le traitement par voie arthroscopique. Méthodes: La recherche de l'information a été effectuée dans une période de trois mois (du 1er mars 2016 au 31 mai 2016) et on a utilisé les mots-clés : calcific tendinitis et subacromial impingment. À l'aide du logiciel de gestion des références EndNote, on a réalisé une révision bibliographique d'un total de 311 articles publiés dans les bases de données PubMed, Hinari, SciELO et Medline. Sur 51 citations sélectionnées pour faire la révision, on a utilisé 49 de ces cinq dernières années, y compris quatre livres. Les symptômes et signes les plus importants de cette maladie, ainsi que les classifications basées sur différents paramètres, prouvées notamment par imagerie (radiographie simple, échographie haute définition et IRM), sont présentés. Conclusions: La tendinite calcifiante est une affection fréquente; quoique le traitement conservateur soit le plus souvent employé, la chirurgie par voie arthroscopique offre plusieurs bénéfices(AU)
Assuntos
Humanos , Artroscopia/métodos , Articulação do Ombro , Tendinopatia/cirurgia , Tendinopatia/classificação , Tendinopatia/tratamento farmacológico , Tendinopatia/diagnóstico por imagemRESUMO
Fundamento: La ruptura traumática aguda del tendón del cuádriceps es una entidad poco frecuente con una incidencia de 1,37/100 000 pacientes por año. Los hombres son los más afectados y la edad media de aparición ronda los 50 años. La cirugía ofrece los mejores resultados. Objetivo: Presentar un paciente con ruptura traumática aguda del tendón del cuádriceps derecho, con evolución favorable luego de una reparación primaria precoz con sutura transpatelar de alambre. Reporte de caso: Paciente masculino de 58 años de edad, con antecedentes de diabetes mellitus tipo II, que sufrió caída de sus pies. Acudió al servicio de urgencias con dolor intenso a nivel de la rodilla derecha, e imposibilidad para la marcha. A la exploración física se encontró impotencia absoluta para la extensión de la pierna derecha y signo del surco en la zona del tendón del cuádriceps. En la ultrasonografía de la rodilla derecha se apreció una solución de continuidad total del tendón del cuádriceps, a nivel del polo superior de la rótula lo que corroboró el diagnóstico de una ruptura traumática aguda del tendón del cuádriceps derecho. Se decidió tratamiento quirúrgico que consistió en perforaciones en la rótula y reinserción del tendón mediante alambres de acero, con buena evolución clínica Conclusiones: La reparación primaria precoz con sutura transpatelar de alambre en la ruptura traumática aguda del tendón del cuádriceps es un proceder quirúrgico efectivo cuando se realiza en los primeros diez días de la lesión.
Background: The acute traumatic rupture of the quadriceps tendon is a rare diseases with an incidence of 1.37 / 100 000 patients per year. Men are the most affected and the average age of appearance is around 50 years old. Surgery offers the best results. Objective: to present a patient with acute traumatic rupture of the right quadriceps tendon, with a favorable evolution after an early primary repair with transpatellar wire suture. Case report: a 58-year-old male patient with a personal history of type II diabetes mellitus, who suffered a fall in his feet. He arrived to the emergency room with severe pain in the right knee and impossibility to walk. At physical examination showed an absolute impotence for the extension of the right leg and a depression sign in the area of the quadriceps tendon. In the right knee ultrasonography, a complete continuity solution of the quadriceps tendon was observed at the level of the superior pole of the patella, which corroborated the diagnosis of an acute traumatic rupture of the right quadriceps tendon. Surgical treatment consisted of perforations in the patella and reinsertion of the tendon through steel wires, with good clinical evolution Conclusions: early primary repair with transpatellar wire suture in acute traumatic rupture of the quadriceps tendon is an effective surgical procedure when it is done in the first ten days of the lesion.
Assuntos
Enxertos Osso-Tendão Patelar-Osso/cirurgia , Músculo Quadríceps/cirurgia , Fios Ortopédicos , Diabetes Mellitus Tipo 2 , Tendinopatia/cirurgiaRESUMO
Las calcificaciones del manguito rotador afectan mayormente al tendón del supraespinoso. El compromiso del tendón del subescapular es menos frecuente y sólo unos pocos casos han sido reportados. Presentamos un caso de una calcificación del subescapular en un paciente sin respuesta al tratamiento conservador, que fue tratado con la remoción completa de la misma y la posterior reparación del defecto residual con un arpón de doble sutura reforzada. Un año luego de la cirugía el paciente se presentaba sin dolor, con movilidad completa y sin restos de calcio en los estudios postoperatorios. La combinación de la remoción completa de la calcificación y la subsecuente reparación del defecto con arpones en forma artroscópica puede resultar en excelentes resultados funcionales, sin comprometer la integridad del manguito rotador en pacientes con calcificaciones del subescapular. Nivel de Evidencia: V...
The supraspinatus tendon is the most common tendon associated with the calcific tendinosis of the rotator cuff. The subscapularis tendon is rarely affected, and only a few prior cases have been reported. We present a case of a subscapularis tendon calcification in a patient with a failed conservative treatment that was treated arthroscopically with complete removal of the calcific deposit and posterior repair of the defect with suture anchors. One year after surgery the patient had no pain, he had full range of motion and there were not residual calcium deposits in the postoperative studies. The combination of complete calcium removal and posterior repair with suture anchors can led to excellent functional outcomes without compromising the integrity of the rotator cuff in patients with calcifications of the subscapularis tendon. Level Of Evidence: V...
Assuntos
Adulto , Articulação do Ombro/cirurgia , Articulação do Ombro/patologia , Artroscopia/métodos , Calcinose/cirurgia , Escápula/cirurgia , Tendinopatia/cirurgia , Tendinopatia/patologia , Tendões/cirurgia , Tendões/patologia , Resultado do TratamentoRESUMO
Introdução: A tendinopatia patelar é uma afecção frequente entre esportistas. Objetivo: Investigar as evidências científicas no tratamento fisioterapêutico da tendinopatia patelar. Métodos: Foram incluídos ensaios clínicos randomizados controlados, nas línguas portuguesa, inglesa e espanhola publicados de 2004 a 2014, sendo utilizados para a busca os descritores tendinopatia, tendinopatia patelar e patela nas bases: Medline, PubMed, Lilacs e PEDro. Os artigos foram analisados de forma independente e cega, por dois pesquisadores. Para avaliar a qualidade metodológica dos estudos foi aplicada a escala PEDro. Resultados: Na busca inicial foram encontrados 37.155 artigos. Após a leitura dos títulos e resumos, permaneceram dez estudos, sendo todos com uma boa qualidade metodológica segundo a escala PEDro. Conclusões: A abordagem fisioterapêutica mediante utilização de exercícios excêntricos foi a que mostrou maior eficácia no tratamento da tendinopatia patelar, sendo superior a outras formas de intervenções fisioterapêuticas e outros tipos de tratamentos como o medicamentoso e cirúrgico.
Introduction: Patellar tendinopathy is a common condition among athletes. Objective: To investigate the scientific data on physiotherapy for patellar tendinopathy. Methods: Randomized controlled trials related to physiotherapy in patellar tendinopathy written in Portuguese, English and Spanish in the period 2004 to 2014 were included. The descriptors tendinopathy, patella and patellar tendinopathy were used for searching in Medline, PubMed, Lilacs and PEDro databases. The articles were reviewed independently and blindly by two researchers. To assess the methodological quality of the studies PEDro scale was applied. Results: The initial search identified 37.155 articles. After reading the titles and abstracts ten studies remained for analysis and all with a good methodological quality according the PEDro Scale. Conclusions: The physiotherapy approach through the use of eccentric exercises showed the greatest efficacy in the treatment of patellar tendinopathy, being superior to other forms of physiotherapy interventions and other treatments such as medication and surgery.
Assuntos
Humanos , Patela/lesões , Tendinopatia/reabilitação , Modalidades de Fisioterapia , Tendinopatia/cirurgia , Tendinopatia/tratamento farmacológico , Terapia por Exercício , AtletasRESUMO
La tendinitis del tibial posterior se presenta comúnmente en pacientes con actividades deportivas. Se puede originar ya sea por exceso de uso o una sobrecarga brusca sobre el tendón. Esta tendinitis también se puede presentar en pacientes con enfermedades inflamatorias sistémicas, y se clasifica como el estadio I en la disfunción del tendón tibial posterior. El tratamiento inicial, con el que se han presentado buenos resultados, se basa en la inmovilización y rehabilitación. En los casos que no presentan mejoría del cuadro clínico o la tendinitis se asocia a una ruptura parcial del tendón, existen técnicas abiertas para realizar tenosinovectomías y revisiones del tendón para mejorar la sintomatología dolorosa. Con el advenimiento de las técnicas miniinvasivas se pueden realizar revisiones amplias del tendón con una mínima agresión o combinarlas con técnicas tradicionales si se asocian con roturas parciales. En este artículo se describe el caso clínico de un paciente femenino de 35 años con patología y dolor crónico a nivel de tibial posterior, la cual fue manejada mediante tenoscopía del tibial posterior y su evolución postquirúrgica a 24 meses. El tratamiento endoscópico y/o tenoscópico es una técnica simple y reproducible. En esta paciente encontramos excelentes resultados funcionales y cosméticos. Es necesario aumentar nuestra casuística sobre este método de tratamiento...
Posterior tibial tendinitis occurs commonly in patients involved in sports activities. It may result from either excessive use or sudden overload of the tendon. This tendinitis may also occur in patients with systemic inflammatory conditions and is classified as posterior tibial tendon dysfunction stage I. Initial treatment, which has produced good results, is based on immobilization and rehabilitation. In cases without clinical improvement or in which tendinitis is associated with partial tendon rupture, open techniques may be used to perform tenosynovectomy and tendon revisions to improve painful symptoms. With the advent of minimally invasive techniques broad tendon revisions may be done that cause minimal damage or they may be combined with traditional techniques in cases of partial rupture. This paper describes the clinical case of a 35 year-old female patient with posterior tibial pathology and chronic pain. She underwent posterior tibial tenoscopy and was followed-up postoperatively for 24 months. Endoscopic and/or tenoscopic treatment is a simple and reproducible technique. We obtained excellent functional and cosmetic results in this patient. We need larger case series of patients subjected to this treatment...