Table 2.

Pearls and Pitfalls of the Proposed Technique

Pearls	Pitfalls
Ensure proper support for the patient’s head and nonoperative extremity to limit movement during the procedure.	Incorrect placement of inferior and superior portal may cause tibial nerve injury.
Inject lidocaine at both portal sites and just posterior to the medial malleolus	Too inferior and anterior placement of the inferior portal may lead to difficulties in assessing the retromalleolar and proximal TPT
Use a mixture of lidocaine with epinephrine and bupivacaine for injection into the tendon sheath to limit bleeding.	Debridement before a full diagnostic evaluation may lead to iatrogenic injury.
“Walk” step-wise with the 18-gauge spinal needle posterior to the medial malleolus to identify the proper location for the inferior portal.	Maintain constant visualization of the shaver to limit iatrogenic injury to the TPT.
Identifying the “glistening tendon” with right-angle forceps assists with correct cannula placement
Injection of 5 cc of normal saline into the tendon sheath allows for easier cannula introduction.
Instruct patient to actively range his or her ankle to assess TPT gliding and identify any missed adhesions.