Table 1.

Step-by-step Guide to Performing In-Office Needle Tendoscopy

Step 1. Inject proximal and distal tendoscopy portal sites. After 5 to 10 minutes, inject deeper into soft tissues, retrofibular groove and posterior fibula, and any other desired sites (e.g., peroneal tubercle)

Step 2. Make 2 mm incision in distal portal. Use blunt trocar to enter peroneal sheath. Before incision, can localize with 25-gauge needle if desired.

Step 3. Perform diagnostic tendoscopy, examining all three zones of pathology. Ask patient to perform provocative maneuvers and also manually circumduct ankle to identify instability

Step 4. Perform debridement or groove deepening as indicated. Be aware of anatomic variants that can contribute to retrofibular groove overcrowding. Actively engage patient during procedure.

Step 5. Ask patient to plantarflex, dorsiflex, and circumduct ankle, and re-examine tendon sliding and stability.

Step 6. Apply Steri-Strips for portals and soft dressing or splint as indicated.