Early surgical management of traumatic dislocation of the tibialis posterior tendon: a case report and review of the literature

Abstract

BackgroundTraumatic dislocation of the tibialis posterior tendon at the ankle is a rare injury. Some of these cases are misdiagnosed as ankle sprains and are not treated properly. In addition, because the conservative treatment is not as effective as the surgical treatment, it is essential that patients be diagnosed early so that proper surgical treatment can be performed. We report the early surgical management of traumatic dislocation of the tibialis posterior tendon.Case presentationA 44-year-old Japanese man, who was a karate coach, was injured while acting as an umpire in a karate competition. On the same day of his injury, he came to our hospital. He complained of swelling and pain in the medial malleolus. Anterior dislocation of the tibialis posterior tendon was detected upon palpation. Magnetic resonance imaging showed the presence of anterior dislocation of the tibialis posterior tendon with retinaculum injury. Four days after the injury, we performed the Das De procedure as the surgical treatment. Three months after the surgery, the patient was able to participate in karate again.ConclusionsDislocation of the tibialis posterior tendon is likely to be misdiagnosed, thus delaying the start of proper treatment. It is essential to diagnose the patient accurately by carefully assessing the physical symptoms manifested. Moreover, magnetic resonance imaging can also be used for better diagnosis, thereby leading to an early and proper surgical treatment.

Traumatic Dislocation of Tibialis Posterior Tendon: A Case Report and Literature Review

“…Furthermore, a delay in the diagnosis and definitive management in athletes prolongs their recovery time and ability to return to sports [4]. Traumatic TPT dislocation is caused by different mechanisms of injury, including plantar flexion with inversion, falling in a varus position of the foot, from a recurrent forced inversion from twisting injuries, or as a result of a motor vehicle accident [4]. Dislocation in our patient was due to plantar flexion and inversion while he landed from a jump.…”

“…These include chronicity and recurrence, rupture of the TPT leading to an adult-onset flatfoot, valgus deformity, and chronic pain. To avoid or minimize these problems, surgical intervention should be considered even in the acute setting [4]. Furthermore, a delay in the diagnosis and definitive management in athletes prolongs their recovery time and ability to return to sports [4].…”

“…To avoid or minimize these problems, surgical intervention should be considered even in the acute setting [4]. Furthermore, a delay in the diagnosis and definitive management in athletes prolongs their recovery time and ability to return to sports [4]. Traumatic TPT dislocation is caused by different mechanisms of injury, including plantar flexion with inversion, falling in a varus position of the foot, from a recurrent forced inversion from twisting injuries, or as a result of a motor vehicle accident [4].…”

“…It is important to rule out bony injuries by standard radiographs. When suspected, an additional internal rotation (Mortise) view can help to find any bony avulsion from the insertion of the flexor retinaculum [4]. Ultrasonography is rarely used to diagnose the TPT dislocation, and there is only one literature has been reported the appearance and the integrity of the TPT [5].…”

Posterior Tibialis Tendon Dislocation: Case Report and Review of Literature

“…In type I, the flexor retinaculum is ruptured, thus allowing the PTT to freely move over the medial malleolus in the subcutaneous tissue. In type II, flexor retinaculum and periosteum are detached from the tibia, leading to the formation of a pseudopouch in which the PTT can settle (Figure 10) [9]. PTT: Posterior Tibialis Tendon…”