Reattachment of tibialis posterior tendon using suture anchors
1. General considerations
Goal of surgery
The main goal of the surgery is to restore the tibialis posterior tendon function.
2. Technique options
A suture anchor or the tibialis tendon pull-through technique may be used for this procedure.
3. Excision of a small bony fragment
Excise any small avascular bone fragment.
4. Suture anchor technique
Drill a hole in the navicular tubercle using a drill bit corresponding to the suture anchor’s size.
Insert the anchor. The anchors need to be placed sufficiently deep so that the metal part does not protrude above the bone surface.
Remove the applicator and use the sutures to anchor the posterior tibialis tendon to the navicular tubercle.
5. Pull through technique
Drill a 5 mm deep hole in the navicular tubercle using a drill bit corresponding to the tibialis tendon’s diameter.
Two small drill holes are drilled from the navicular’s dorsal aspect to the distal end of the first drill hole.
Two non-resorbable sutures are woven into the tendon, passed through the larger-diameter hole, and then through the smaller diameter hole with a suture passer or a free needle.
Use the sutures to pull the tendon into the larger-diameter hole and then secure the tendon by tying the suture ends together.
Care must be taken not to overtighten the sutures to prevent them from cutting into/through the bone.
