Abstract
Objective
To examine the effectiveness of a new technique for reattaching the posterior tibial tendon (PTT) using a bone tunnel and interference screw after resection of the accessory navicular for painful accessory navicular (type II) in adult athletes.
Methods
Ten adult athletes (7 male, 3 female; mean age 30 years, range 23–45) underwent reconstruction using a bone tunnel with an interference screw for a painful accessory navicular. All patients complained of pain on the medial aspect of the foot after eversion sprain during sports activities and radiographs revealed type II accessory navicular. Clinical evaluation with the American Orthopaedic Foot and Ankle Society Ankle–Hindfoot Scale (AOFAS) and visual analogue scale (VAS) before surgery was compared with that at most recent follow up (mean 30 months, range 24–39).
Results
Mean AOFAS score improved from a preoperative 62.8 ± 2.9 points (range 61–82) to a postoperative 92.1 ± 7.0 points (range 83–100; p < 0.01). Furthermore, mean VAS score improved from a preoperative 92.5 ± 5.4 points (range 85–100) to a postoperative 4.5 ± 3.8 points (range 0–10; p < 0.01). All patients could return to full sports activity at a mean of 14 weeks (range 12–18) after surgery.
Conclusions
The presented technique reconstructs the bone-tendon interface of the PTT at the primary navicular with sufficient fixation after resection of the accessory navicular, which preserves the strength of the PTT in adult athletes with an intractably painful accessory navicular.
Similar content being viewed by others
References
Coughlin MJ (2007) Sesamoids and accessory bones of the foot, in Coughlin MJ, Mann RA, Saltzman CL (ed) Surgery of the Foot and Ankle, vol 1, pp 531- 610
Geist E (1925) The accessory scaphoid bone. J Bone Joint Surg Am 7:570–574
Veitch JM (1978) Evaluation of the Kidner procedure in treatment of symptomatic accessory tarsal scaphoid. Clin Orthop 131:210–213
Seltzer SE, Weissman BN, Braunstein EM, Adams DF, Thomas WH (1984) Computed tomography of the hindfoot. J Comput Assist Tomogr 8:488–497
Sella EJ, Lawson JP, Ogden JA (1986) The accessory synchondrosis. Clin Orthop 209:280–285
Chung JW, Chu IT (2009) Outcome of fusion of a painful accessory navicular to the primary navicular. Foot Ankle Int 30:106–109
Macnicol MF, Voutsinas S (1984) Surgical treatment of the symptomatic accessory navicular. J Bone Joint Surg Br 66:218–226
Gluck GS, Heckman DS, Parekh SG (2010) Tendon disorders of the foot and ankle, part 3. The posterior tibial tendon. Am J Sports Med 38:2133–2144
Kidner FC (1929) The pre-hallux (accessory scaphoid) in its relation to flatfoot. J Bone Joint Surg 11:831–837
Clark GC (1988) A modified Kidner procedure for symptomatic flat feet. Clin Orthop 228:258–260
Dawson DM, Julsrud ME, Erdmann BB, Jacobs PM, Ringstrom JB (1988) Modified KIdner procedure utilizing a Mitek bone Anchor. J Foot Ankle Surg 37:115–121
Nakayama S, Sugimoto K, Takakura Y, Tanaka Y, Kasanami R (2005) Percutaneous drilling of symptomatic accessory navicular in young athletes. Am J Sports Med 33:531–535
Shurnas PS, Sanders A (2007) A novel approach to the symptomatic accessory navicular. Techniques in Foot and Ankle Surgery 6:195–200
Scott AT, Sabesan VJ, Saluta JR, Wilson MA, Easley ME (2009) Fusion versus excision of the symptomatic type II accessory navicular: a prospective study. Foot Ankle Int 30:10–15
Takao M, Oae K, Uchio Y, Ochi M, Yamamoto H (2005) Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft. A new technique using an interference fit anchoring system. Am J Sports Med 33:814–823
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Miyamoto, W., Takao, M., Yamada, K. et al. Reconstructive surgery using interference screw fixation for painful accessory navicular in adult athletes. Arch Orthop Trauma Surg 132, 1423–1427 (2012). https://doi.org/10.1007/s00402-012-1574-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-012-1574-8