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Diagnostic and Therapeutic Ankle Tenography

Outcomes and Complications

Noah W. Jaffee1, Louis A. Gilula2, Robert D. Wissman3 and Jeffrey E. Johnson4

1 Southwest Radiology Associates, 1200 Postoak Blvd., Ste. 426, Houston, TX 77056.
2 Mallinkckrodt Institute of Radiology, Washington University School of Medicine, 520 S. Kingshighway Blvd., St. Louis, MO 63110.
3 Diagnostic Clinic, P. O. Box 2901, Largo, FL 33779-2901.
4 Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Ste. 11300 W. Pavilion, St. Louis, MO 63110.



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  		Fig. 1. —Tenogram shows mild peroneal tenosynovitis (one to five sacculations [arrowheads]). Large bulge (arrow) is normal enlargement of sheath between two extrinsic retinacular bands pressing on peroneal tendons.

 


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  		Fig. 2. —Tenogram shows moderate tenosynovitis (six to 10 sacculations [arrowheads]) of posterior tibial tendon sheath. Normal narrowing of tendon sheath (between arrows) overlies tibial plafond.

 


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  		Fig. 3. —Tenogram shows severe tenosynovitis (>10 sacculations) along posterior tibial tendon sheath margins. Distal posterior tibial capsule defect allows contrast material to pass into distal subtalar facet and talonavicular joint (arrowheads).

 


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  		Fig. 4. —Tenogram shows flexor retinaculum (between arrows), which commonly produces extrinsic compression on posterior tibial tenograms at level of tibial plafond. Care should be taken not to mistake this normal finding for pathologic stenosis or adhesion. Obliquity on this image explains why this narrowing projects below tibial plafond.

 


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  		Fig. 5. —Tenogram shows two retinacula (between arrowheads and between arrows) creating pressure effects on peroneal tendons, which commonly overlie calcaneus. This normal finding can be mistaken for stenosis or adhesion.

 


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  		Fig. 6A. —Mass representing torn peroneal tendon. Tenogram in anteroposterior view shows large mass effect (arrows) of peroneal tendons inferior to lateral malleolus.

 


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  		Fig. 6B. —Mass representing torn peroneal tendon. Tenogram in lateral view shows same mass (arrows). In retrospect, this mass represented a partially or completely torn tendon that correlated with area of rupture found at surgery.

 


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  		Fig. 7A. —Mass representing torn posterior tibial tendon. Tenogram in lateral view shows mass effect (arrows) of posterior tibial tendon. This mass correlates with tear found at surgery.

 


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  		Fig. 7B. —Mass representing torn posterior tibial tendon. Tenogram in lateral view with more contrast material than in A shows contrast material filling both posterior tibial and flexor digitorum longus (arrowheads) tendon sheaths. Arrows outline mass.

 

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