Endoscopic assisted posterior tibial tendon reconstruction for stage 2 posterior tibial tendon insufficiency

Posterior tibial tendon insufficiency is the commonest cause of adult onset flatfoot deformity. The treatment of stage 2 posterior tibial tendon insufficiency is still controversial. Different combination of open procedures of tendon transfer, calcaneal osteotomy and hindfoot arthrodesis has been described. We describe an endoscopic approach of posterior tibial tendon reconstruction. By means of anterior and posterior tibial tendon tendoscopies, the medial half of the anterior tibial tendon is then transferred to the posterior tibial tendon. The construct is then augmented by side-to-side anastomosis with flexor digitorum longus tendon. This is supplemented with subtalar arthroereisis with a bioresorbable arthroereisis implant.