[Postinfectious dislocation of the tibialis posterior tendon in a prima ballerina : A 13-year case report].

Abstract

Background: The most frequent side effect of local corticosteroid injections in athletes is the rupture of collagenic tissues, such as fascia and tendons.

Objective: 1. Warning against cortisone injections in the vicinity of tendons, fascia and retinacula. 2. Presentation of the anatomical restoration of the osteofibrous quiver of the tibialis posterior tendon. 3. Introduction of a pathogenetic classification of tibialis posterior tendon dislocation.

Material and method: A 23-year-old female ballet dancer suffered from pain and significant loss of strength despite stiff taping while dancing en pointe 8 months after radical debridement for a putrid infection with Klebsiella pneumoniae of the left tibialis posterior tendon with a sonographically detectable dislocation. After debridement and reduction of the partially ruptured, scarred and split tendon, an anatomical restoration of the osteofibrous tendon quiver was performed with local tissue and transosseous sutures. The targeted perioperative administration of antibiotics, a postoperative lower leg cast for 6 weeks with thrombosis prophylaxis and subsequent intensive rehabilitation measures resulted in the complete ability to work after 8 weeks.

Result: There were no recurrences over the 13-year period. With pain-free dancing en pointe without taping, the now 36-year-old soloist is still the lead female dancer at a renowned German opera house, is the mother of two children and believes that she dances better today than before.

Discussion: Whether the initial local corticosteroid injection caused a pathological retinaculum rupture with dislocation of the tibialis posterior tendon or whether it was originally caused by the putrid infection after tendon revision surgery or whether a necrotic retinaculum was ultimately subjected to radical debridement, must remain an open question.