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Vosoughi AR, Hashemipour B, Khademi S, Akbarzadeh A, Shayan Z. Clinical Outcomes Following Suturing of Sheath of Peroneal Tendons to the Calcaneal Plate as an Innovative Technique for Reduction of Peroneal Tendon Instability Accompanying Calcaneal Fracture. Foot Ankle Spec 2022:19386400221125373. [PMID: 36181273 DOI: 10.1177/19386400221125373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the clinical and functional outcomes following suturing of sheath of peroneal tendons to the calcaneal plate as an innovative technique for reduction of peroneal tendon instability (PTI) accompanying calcaneal fracture surgically treated via extensile lateral approach (ELA). METHODS In a retrospective comparative study, among 245 operatively treated calcaneal fractures through ELA, we had 33 cases with PTI who underwent relocation of the peroneal tendons with ethibond suture in a figure-of-8 shape, passed through 2 parts of sheath of peroneal tendons and stitched to the calcaneal plate. Of the 33 cases, 12 were evaluated in the experimental group. Twelve surgically treated calcaneal fractures without PTI were matched as the control group. The outcome of the patients was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI) percentage, Visual Analog Scale (VAS) pain, changes in Tegner activity level, maximal peroneal muscles strength testing, modified Star Excursion Balance Test (mSEBT), and triple hop for distance (THD) test. For the last 3 tests, the difference between operated and normal feet was calculated for each patient and this difference was compared between the 2 groups. RESULTS There was no statistically significant difference between the 2 groups for AOFAS Ankle-Hindfoot Scale (P = .09), FFI percentage (P = .12), VAS pain (P = .73), changes in Tegner activity level (P = .87), maximal peroneal muscles strength testing (P = .45), mSEBT (P > .05), and THD (P = .87) tests. We had a case with point tenderness on retromalleolar groove and 4 cases with paresthesia in the territory of the sural nerve in the experimental group in contrary to one case of sural nerve paresthesia in the control group (P = .31). CONCLUSIONS Relocation of peroneal tendons in PTI accompanying calcaneal fractures by fixing sheath of peroneal tendons to the calcaneal plate could be an acceptable procedure with good outcomes but may have increased chance of sural nerve injury. LEVELS OF EVIDENCE Therapeutic, Level III: Retrospective.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Hashemipour
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Khademi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Akbarzadeh
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shayan
- Trauma Research Center, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Shazadeh Safavi K, Ratnasingam S, Janney CF. Chronic Peroneal Tendon Dislocation: A Case Report. Mil Med 2020; 185:e1882-e1886. [PMID: 32501507 DOI: 10.1093/milmed/usaa093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present a unique case of chronic peroneal tendon dislocation in a 47-year-old active duty military member with a 2-mo history of acute onset lateral ankle pain due to sports injury. Magnetic resonance imaging revealed superficial peroneal retinaculum (SPR) disruption, a flattened retrofibular groove, dislocation of the peroneus longus tendon, and a tear of the peroneus brevis tendon. The patient was managed operatively with fibular groove deepening, SPR reconstruction, peroneus brevis debridement, and peroneus longus tubulurization. No complications were observed during the intra- or perioperative periods. At their 3-mo follow-up, the patient reported near complete resolution of pain and the ability to ambulate without any brace or support. He returned to running and was able to deploy fit for full duty 4.5 mo from injury.
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Affiliation(s)
- Kiya Shazadeh Safavi
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Saruthija Ratnasingam
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Cory F Janney
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
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Gorbachova T, Chang EY, Ha AS, Amini B, Dorfman SR, Fox MG, Khurana B, Klitzke A, Lee KS, Mooar PA, Shah KH, Shah NA, Singer AD, Smith SE, Taljanovic MS, Thomas JM, Kransdorf MJ. ACR Appropriateness Criteria® Acute Trauma to the Foot. J Am Coll Radiol 2020; 17:S2-S11. [PMID: 32370964 DOI: 10.1016/j.jacr.2020.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 12/26/2022]
Abstract
Acute injuries to the foot are frequently encountered in the emergency room and in general practice settings. This publication defines best practices for imaging evaluations for several variants of patients presenting with acute foot trauma. The variants include scenarios when the Ottawa rules can be evaluated, when there are exclusionary criteria, and when suspected pathology is in anatomic areas not addressed by the Ottawa rules. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | - Behrang Amini
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Pekka A Mooar
- Temple University Hospital, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Kaushal H Shah
- Icahn School of Medicine at Mt Sinai, New York, New York; American College of Emergency Physicians
| | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Adam D Singer
- Emory University School of Medicine, Atlanta, Georgia
| | - Stacy E Smith
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Jonelle M Thomas
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Peroneal groove deepening as the treatment of peroneal tendon subluxation: A case report. Int J Surg Case Rep 2019; 65:333-338. [PMID: 31770709 PMCID: PMC6879996 DOI: 10.1016/j.ijscr.2019.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 11/21/2022] Open
Abstract
Subluxation of the peroneal tendon is relatively infrequent. Subluxation of the peroneal tendon often misdiagnosed as ankle sprain. Avulsion of the superior peroneal retinaculum from is the main cause of peroneal tendon subluxation. Good outcomes can be achieved by peroneal groove deepening and retinaculum ligament repair.
Introduction Peroneal tendon subluxation is a relatively rare disorder that is often misdiagnosed as an ankle sprain. It affects mainly young adults, usually during sports activities. It is mostly caused by avulsion of the superior peroneal retinaculum (SPR) from its fibular insertion, which requires surgical intervention, especially for cases of symptomatic chronic peroneal tendon subluxation and/or dislocation. We reported a case of peroneal tendon subluxation of left ankle treated with peroneal groove deepening and retinaculum ligament repair, the objective of which is to illustrate the effectiveness of this procedure. Case presentation We present a case of a thirty-four-year old male with peroneal tendon subluxation of left ankle. The patient was injured while exercising two years prior to admission. He now reported pain and instability on the left ankle. We performed peroneal groove deepening and retinaculum ligament repair to treat this patient. Discussion Peroneal groove deepening and retinaculum ligament repair shows an excellent clinical outcome; after the procedure, there are no major complications such as infections, wound problems or permanent discomfort. Overall, the result of surgery had been considered satisfactory. Postoperatively, the ankle was placed in a below-knee, non–weight-bearing temporary cast in semi-equinus position for two weeks. Conclusion The incidence rate of peroneal tendon subluxation is relatively low, and surgery is the primary treatment of this type of injury, with various available surgical methods available for the performing surgeon. Peroneal groove deepening and retinaculum ligament repair offers a satisfactory outcome.
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Lateral ankle anatomical variants predisposing to peroneal tendon impingement. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Suh JW, Lee JW, Park JY, Choi WJ, Han SH. Posterior Fibular Groove Deepening Procedure With Low-Profile Screw Fixation of Fibrocartilaginous Flap for Chronic Peroneal Tendon Dislocation. J Foot Ankle Surg 2018; 57:478-483. [PMID: 29269024 DOI: 10.1053/j.jfas.2017.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Indexed: 02/03/2023]
Abstract
Chronic peroneal tendon dislocation is an uncommon disorder that frequently presents with concomitant pathology. Posterior fibular groove deepening and retinaculum repair have been increasing in popularity for treatment of peroneal tendon dislocations. The purpose of the present study was to introduce a posterior fibular groove deepening procedure using low-profile snap-off screws to securely and simply fix the fibrocartilaginous flap to facilitate faster rehabilitation and to assess the clinical outcomes of patients with chronic peroneal tendon dislocation and associated pathologic features. In the present retrospective case series, 34 ankles in 34 patients underwent the fibular groove deepening procedure using low-profile screws with superior peroneal retinaculum repair. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and patient subjective satisfaction rate. The time of return to recreational and sports activities was also assessed. Weightbearing ankle radiographs were evaluated to assess the stability of the flap by checking the screws. The mean follow-up period was 47.96 (range 12 to 142) months. The mean AOFAS scale score for all patients improved from 69.96 ± 13.14 to 87.72 ± 10.13 at the last follow-up examination (p < .001). Overall, 85.3% of patients subjectively rated their operative outcomes as excellent or good. The 18 (52.9%) patients with an isolated peroneal tendon dislocation had a faster return to recreational or sports activities than the 16 (47.1%) patients with concomitant pathologic features (2.95 ± 0.19 versus 4.14 ± 1.34 months; p = .002). No patient experienced residual dislocation, screw loosening, or irritation from the screws. The fibular groove deepening procedure using low-profile screws is be a simple procedure that offers rigid fixation. This leads to relatively fast rehabilitation and resumption of recreational or sports activities.
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Affiliation(s)
- Jae Wan Suh
- Assistant Professor, Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, Republic of Korea; Graduate Student, Department of Orthopaedic Surgery, Graduate School of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jin Woo Lee
- Professor, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Young Park
- Resident, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Choi
- Associate Professor, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Han
- Associate Professor, Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2018. [PMID: 29767272 DOI: 10.1007/s00167-018-4971-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
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The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surg Sports Traumatol Arthrosc 2018; 26:3096-3107. [PMID: 29767272 PMCID: PMC6154028 DOI: 10.1007/s00167-018-4971-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
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Koutserimpas C, Magarakis G, Kastanis G, Kontakis G, Alpantaki K. Complications of Intra-articular Calcaneal Fractures in Adults: Key Points for Diagnosis, Prevention, and Treatment. Foot Ankle Spec 2016; 9:534-542. [PMID: 27613810 DOI: 10.1177/1938640016668030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Calcaneal fractures are complex injuries with high complication rates and they can lead to serious disability. The proper management remains controversial and complications may occur regardless of the chosen type of treatment (operative or nonoperative). The present article reviews the studies that are related to the complications of calcaneal fractures. The incidence, the diagnosis, the prevention and the treatment of these complications were researched and analyzed, with the use of PubMed database, abstracts and original articles in English than investigate the etiology. The aim of the article is to discuss the most suitable management of the complications of calcaneal fractures and recommend a specific treatment as well as prevention methods. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopedics and Traumatology, University Hospital of Heraklion, Crete, Greece
| | - George Magarakis
- Department of Orthopedics and Traumatology, University Hospital of Heraklion, Crete, Greece
| | - Grigoris Kastanis
- Department of Orthopedics and Traumatology, University Hospital of Heraklion, Crete, Greece
| | - George Kontakis
- Department of Orthopedics and Traumatology, University Hospital of Heraklion, Crete, Greece
| | - Kalliopi Alpantaki
- Department of Orthopedics and Traumatology, University Hospital of Heraklion, Crete, Greece
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Bancroft LW, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, Bruno MA, Dempsey ME, Fries IB, Khoury V, Khurana B, Mosher TJ, Roberts CC, Tuite MJ, Ward RJ, Zoga AC, Weissman BN. ACR Appropriateness Criteria Acute Trauma to the Foot. J Am Coll Radiol 2015; 12:575-81. [DOI: 10.1016/j.jacr.2015.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 12/23/2022]
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Zhenbo Z, Jin W, Haifeng G, Huanting L, Feng C, Ming L. Sliding fibular graft repair for the treatment of recurrent peroneal subluxation. Foot Ankle Int 2014; 35:496-503. [PMID: 24637656 DOI: 10.1177/1071100714523271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Because recurrent peroneal subluxation can produce functional impairment in athletes, most authors suggest operative intervention for patients who fail nonoperative treatment. The present report introduces the modified sliding fibular graft repair for this pathology. METHODS This retrospective study was conducted to analyze the clinical results for 26 patients with recurrent peroneal subluxation who underwent this procedure with a follow-up of a minimum of 3 years. RESULTS Intraoperative observations revealed 15 convex grooves and 11 shallow sulci with a low-lying peroneus brevis muscle belly in 6 patients and a peroneus quartus muscle in 4 patients. All underwent the procedure plus excision of redundant muscle and tendon repair, with an improvement rate of 88.5% according to American Orthopaedic Foot & Ankle Society (AOFAS) score at the final visit. All but 3 patients returned to normal function in 4.4 months with no infection, nonunion, or intra-articular screw placement. A total of 8 patients had minor complications including neurapraxia, synovitis, stress fracture, and delayed union. CONCLUSION We found that an anomalous fibular groove plus tendon variants could lead to a further decrease in the volume of the osteofibrous tunnel and might be the reason for recurrent peroneal dislocation; thus, our modified procedure may be a reasonable treatment for this pathological malposition. We found less functional recovery in aged patients due to a higher incidence of tendon tear and postoperative complications. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Zuo Zhenbo
- Department of Trauma, Affiliated Hospital of Qingdao University, Qingdao, PR China
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Staresinic M, Bakota B, Japjec M, Culjak V, Zgaljardic I, Sebecic B. Isolated inferior peroneal retinculum tear in professional soccer players. Injury 2013; 44 Suppl 3:S67-70. [PMID: 24060023 DOI: 10.1016/s0020-1383(13)70202-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Peroneal tendon dislocations are rare injuries that can easily be misdiagnosed. Up to date literature mostly describes proximal peroneal tendon dislocations due to superior peroneal retinaculum (SPR) tear. In this article, we present the assessment, diagnostic algorithm and a new therapeutic option for the distal dislocation of the long peroneal tendon due to isolated inferior peroneal retinaculum (IPR) tear. PATIENTS AND METHODS Between 2001 and 2011 three patients with distal peroneal tendon dislocation were operated. All of them were competitive athletes in the national soccer league. They presented with an ankle sprain and prolonged problems on the lateral side of the foot with no improvement after conservative therapy measures. Coleman block test was performed; ultrasound and MRI showed a tendon dislocation under the IPR. The patients underwent surgical repair that consisted of peroneal tubercle excision, a new lateral calcanear groove formation for both peroneal tendons and IPR plasty. RESULTS At the two year follow up the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score showed a significant increase. The decrease of painful stimuli assessed by a Visual Analogue Scale (VAS) was significant as well. At an average of 12 weeks after the surgery, the patients returned to their level of sport activity before injury and didn't report similar problems later. CONCLUSION Description of distal peroneal tendon dislocations is limited in the literature. This topic should be considered in differential diagnostics of an acute and chronic ankle sprain which leads to chronic ankle pain and instability. The authors recommend surgical treatment as a method of choice especially in professional athletes.
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Affiliation(s)
- Mario Staresinic
- Surgery Clinic, Department of Traumatology, University Hospital Merkur, Zagreb, Croatia
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Abstract
Peroneal tendon injuries are recognized with increasing frequency to be the cause of persistent lateral ankle symptoms. The lesions are frequently found in patients with concomitant anatomical or biomechanical abnormalities, such as chronic lateral instability or cavovarus deformity. The most common mechanism involves a sudden inversion injury or repetitive activities. Three categories of injuries can be distinguished: (1) tendinitis and tenosynovitis, (2) tendon subluxation and dislocation and (3) tendon tears and ruptures. Many of these conditions respond to conservative therapy. However, when left untreated, the disorders can lead to persistent lateral ankle pain and substantial functional deficits. This is particularly true in patients with an underlying anatomical predisposition to lesions.
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Gaulke R, Hildebrand F, Panzica M, Hüfner T, Krettek C. Modified rerouting procedure for failed peroneal tendon dislocation surgery. Clin Orthop Relat Res 2010; 468:1018-24. [PMID: 19548043 PMCID: PMC2835608 DOI: 10.1007/s11999-009-0918-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Accepted: 05/18/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Recurrent dislocation of the peroneal tendons following operative treatment is relatively uncommon, but can be difficult to treat. We asked whether subligamental transposition of the peroneus brevis tendon, fibular grooving, and reattachment of the superior peroneal retinaculum for failed peroneal tendon dislocation surgery would achieve a stable fixation of the peroneal tendons and whether there would be restrictions of ROM or instability of the hindfoot. We reviewed six female patients (mean age, 24.5 years) with general laxity of joints preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. Within 1 year postoperatively no recurrence was found. In two ankles the extension was restricted 5 degrees to 10 degrees . In another pronation and supination was restricted 5 degrees each. Stability of the ankle increased in four patients and stayed unchanged in two. AOFAS score increased from a mean value of 36 +/- 20.6 preoperatively to 90 +/- 7 postoperatively at 1 year. We conclude transposition of the peroneus brevis tendon is a reasonable treatment for failed peroneal tendon dislocation surgery. LEVEL OF EVIDENCE Level IV, therapeutic study (prospective case series). See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- R Gaulke
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
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Saxena A, Ewen B. Peroneal subluxation: surgical results in 31 athletic patients. J Foot Ankle Surg 2010; 49:238-41. [PMID: 20350818 DOI: 10.1053/j.jfas.2010.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Indexed: 02/03/2023]
Abstract
Few studies describe the results of surgical treatment of peroneal retinaculum in athletic populations. Thirty-one athletic patients with symptomatic subluxating peroneal tendons were treated surgically by one surgeon with isolated subluxation repair, subluxation repair plus peroneus brevis tendon repair, or subluxation repair plus lateral ankle stabilization. As a group, the average time to return to activity was 3.2 +/- 0.8 months with a postoperative AOFAS score of 97.0 +/- 5.3. Patients with tendon tears were older in age (P < .01) and took longer to return to activity than the rest of the cohort (P = .02). There were a total of 4 patients with postoperative complications, although all were able to return to sports. The patients with peroneal subluxation in this study were able to return to their sport in approximately 3 months. Those with concomitant tendon tears took longer. Further study is needed to see if this is associated with longer-standing symptoms.
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Affiliation(s)
- Amol Saxena
- Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA 94301, USA.
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