The Cobb procedure for stage II posterior tibial tendon dysfunction.

Flexor digitorum longus transfer or augmentation is currently the most popular adjunctive procedure for the repair of an attenuated or ruptured tibialis posterior tendon. Although the procedure is efficacious, an important functional muscle is sacrificed. Results show that similar results can be achieved with a tenodesis procedure by way of a split anterior tibial tendon repair. The authors have modified the Cobb procedure, and do not create a hole through the medial cuneiform or navicular. The thick, fibrous periosteal tissue at the medial aspect of the cuneiform is a sufficient tunnel for securing and positioning the tibialis anterior tendon. An additional site of healing and potential complications are avoided. The Cobb procedure is a useful and successful treatment option for PTTD, provides strong autograft augmentation to the posterior tibial tendon without sacrificing function of other tendons, and offers the surgeon and patient predictable outcomes with long-term satisfaction.