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Melville DM, Taljanovic MS, Gimber LH, Miller M, Ahmad A, Sepich D, Latt LD. Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation. J Clin Med 2024; 13:740. [PMID: 38337434 PMCID: PMC10856550 DOI: 10.3390/jcm13030740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Suspected peroneal tendinopathy, tears, and subluxation are often confirmed preoperatively using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). No study has directly compared the accuracy of these tests for the diagnosis of peroneal tendon pathology. The purpose of this study is to directly compare MRI and US to intraoperative findings in patients who underwent surgery for suspected peroneal pathology to determine the imaging diagnostic accuracy. Operative records and diagnostic images for 21 consecutive patients who had both MRI and US prior to surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. The results of this review are compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality. For the diagnosis of peroneal tendon tears, US was found to have a sensitivity of 88% and specificity of 100%, compared to 100% sensitivity and specificity for MRI. In the diagnosis of peroneal tendinopathy, both US and MRI had a sensitivity and specificity of 100%. In diagnosing peroneal subluxation, US was 100% sensitive compared to 66% for MRI, and both were 100% specific. In conclusion, US was found to be more effective in diagnosing peroneal subluxation and MRI was slightly more accurate in the diagnosis of peroneal tendon tears.
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Affiliation(s)
- David M. Melville
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85259, USA;
| | - Mihra S. Taljanovic
- Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA;
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Lana H. Gimber
- Kaiser Permanente Moanalua Medical Center, Honolulu, HI 96819, USA;
| | - Matthew Miller
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA;
| | - Aamir Ahmad
- Department of Orthopaedic Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA;
| | | | - L. Daniel Latt
- Kaiser Permanente Moanalua Medical Center, Honolulu, HI 96819, USA;
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2
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Singh K, Hosseini N, Pooyan A, Zadeh FS, Chalian M. Imaging Tendon Disorders in Athletes. Clin Podiatr Med Surg 2023; 40:223-238. [PMID: 36368845 DOI: 10.1016/j.cpm.2022.07.015] [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: 11/30/2022]
Abstract
Imaging plays a critical role in evaluating pathology affecting athletes from various fields. Tendon pathology manifests in terms of mechanical, degenerative, enthesitis, neoplastic, and overuse diseases. Tendon pathologies in athletes usually involve injuries to commonly injured tendons such as the tendons involving the ankle, elbow, rotator cuff, hip abductors, patellar tendon, and Achilles tendon. For the purposes of this article, the focus will be on the tendons involving the ankle such as the tibialis posterior and peroneal tendons. The 2 most common imaging modalities used for the evaluation of tendons are ultrasound (US) and magnetic resonance imaging (MRI). There are several emerging imaging techniques such as T2 mapping, ultra-short echo time MRI, and sonoelastography. These novel imaging techniques are all in research phase and have not been adapted to routine clinical practice.
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Affiliation(s)
- Kanwardeep Singh
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA
| | - Nastaran Hosseini
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/Nas_Hosseini
| | - Atefe Pooyan
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/AtefePooyan
| | - Firoozeh Shomal Zadeh
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/FiroozehShomal
| | - Majid Chalian
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA.
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3
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Soltanolkotabi M, Mills MK, Nixon DC, Zadeh FS, Chalian M. Postoperative Imaging of the Ankle Tendons. Semin Ultrasound CT MR 2023. [DOI: 10.1053/j.sult.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abou Diwan R, Badr S, Boulil Y, Demondion X, Maynou C, Cotten A. Presurgical Perspective and Postsurgical Evaluation of Non-Achilles Tendons of the Ankle and Retinaculum. Semin Musculoskelet Radiol 2022; 26:670-683. [PMID: 36791736 DOI: 10.1055/s-0042-1760121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The vast majority of non-Achilles ankle tendinopathies are related to overuse. This article discusses the clinical aspect, imaging appearance, and management of tendinopathies of the lateral, medial, and the anterior compartments with a focus on presurgical perspective and postsurgical evaluation.
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Ayanoglu T, Arikan E, Kurtbogan M, Yilmaz OF, Kaya YE, Ozturan KE. Anatomical Factors Which Influence the Formation of Peroneal Tendon Tears: A Retrospective Comparative Study. J Foot Ankle Surg 2022; 61:1299-1302. [PMID: 35606277 DOI: 10.1053/j.jfas.2022.04.006] [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] [Received: 04/02/2021] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 02/03/2023]
Abstract
This study aims to investigate the anatomical factors that are effective in the formation of peroneal tendon tears comparing with the control group. The patients with ankle magnetic resonance imaging (MRI) due to pain on the lateral side of the ankle were retrospectively analyzed using the clinical archive between July 2015 and January 2020. Peroneal tendon tears, peroneal tubercle type and size, presence of peroneal quartus, presence and type of retromalleolar groove, retromalleolar groove area, lateral malleolus type, presence of os peroneum, peroneus brevis-lateral malleolus distance (PBLMD), and accompanying pathologies in coronal, axial, and sagittal planes MRI were evaluated. PBLMD was measured as 27.1 ± 12.3 mm in Group 1. With PBLMD, it was measured as 39.6 ± 11.68 mm in Group 2. There was a significant relationship between low-lying peroneus brevis muscle and peroneal tear (p < .001). Peroneal tendon tear was more common in patients with peroneal quartus muscle (p < .001). There was a relationship between the retromalleolar groove type and the presence of peroneal tear (p = .004). More peroneal tears were observed in the concave retromalleolar groove type. The presence of concave type retromalleolar groove, peroneus quartus, and low-lying peroneus brevis muscle was found to be associated with peroneal tendon tears.
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Affiliation(s)
- Tacettin Ayanoglu
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
| | - Emre Arikan
- Department of Orthopaedics and Traumatology, Çanakkale State Hospital, Çanakkale, Turkey.
| | - Mahmut Kurtbogan
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
| | - Omer Faruk Yilmaz
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
| | - Yasin Emre Kaya
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
| | - Kutay Engin Ozturan
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
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Fifth Metatarsal Base Fracture Combined With Fracture of the Os Peroneum. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202210000-00001. [PMID: 36201675 PMCID: PMC9542830 DOI: 10.5435/jaaosglobal-d-22-00172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/29/2022] [Indexed: 11/15/2022]
Abstract
Fracture of the os peroneum is rare, and displacement of the fracture can be indicative of a tear in the peroneal longus tendon. A fifth metatarsal base fracture is a common injury caused by sudden inversion and plantar flexion of the hindfoot. We observed a rare case of a fifth metatarsal base zone I fracture combined with a displaced os peroneum fracture in a 34-year-old woman. The patient was treated with resection of the os peroneum and repair of the peroneal longus tendon, as well as open reduction and internal fixation of the fifth metatarsal base. After exposing the fragment of the fifth metatarsal base, the distal part of the fractured os peroneum was found to be located just under the fracture site. There were no complications or discomfort of the foot or ankle at 2 years postoperatively. Resection of the os peroneum and direct repair of the peroneal longus tendon were easily performed after the fifth metatarsal base fragment was exposed. This was an innovative method for performing peroneal longus tendon repair in the deep portion of the midfoot.
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Davies JP, Smith WB. Management of Peroneal Tendon Complications. Foot Ankle Clin 2022; 27:401-413. [PMID: 35680296 DOI: 10.1016/j.fcl.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Peronealsehnenverletzungen. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00519-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund
Verletzungen der Peronealsehnen gelten als häufig unterdiagnostizierte Ursache lateraler Rückfußschmerzen. Prädisponierende Ursachen sind u. a. eine chronische laterale Instabilität sowie ein Rückfußvarus, da dies zu einer Überbelastung der Peronealsehnen führt. Klinisch äußern sich Peronealsehnenverletzungen meist unspezifisch mit lateralen Rückfußschmerzen.
Material und Methoden
In der Untersuchung zeigen sich Schmerzen bei Aktivierung der Sehnen gegen Widerstand. Die Sonographie zur Diagnostik bietet die Möglichkeit einer dynamischen Untersuchung, in der Magnetresonanztomographie (MRT) können gleichzeitig weitere Strukturen beurteilt werden. Zu unterscheiden sind eine Tendinopathie der Sehnen, eine Instabilität mit Luxation oder Subluxation verbunden mit Pathologien des superioren Peronealsehnenretinakulums sowie Längssplit und komplette Sehnenruptur. Bei Tendinopathien und Längsrissen erfolgt die Therapie primär konservativ. Ein kompletter Riss und eine Läsion über 50 % sollten operativ versorgt und, falls möglich, direkt genäht werden. Alternativ sind eine Tenodese oder ein Sehnenersatz mit einem Graft zu evaluieren.
Ergebnisse
Bei Patienten mit einer Peronealsehneninstabilität führen die Naht oder Rekonstruktion des superioren Peronealsehnenretinakulums zu guten Resultaten. Eine frühe Therapie zeigt eine bessere Heilungschance und kann somit zu einem besseren Outcome führen.
Schlussfolgerung
Zusammenfassend kann gesagt werden, dass bei chronischen lateralen Rückfußschmerzen an eine Peronealsehnenverletzung gedacht und bei Verdacht auf eine Läsion eine MRT oder eine Sonographie zur Bestätigung respektive Ausschluss der Diagnose durchgeführt werden sollte.
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Willegger M, Hirtler L, Schwarz GM, Windhager RH, Chiari C. [Peroneal tendon pathologies : From the diagnosis to treatment]. DER ORTHOPADE 2021; 50:589-604. [PMID: 34160639 PMCID: PMC8241798 DOI: 10.1007/s00132-021-04116-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 02/03/2023]
Abstract
Peronealsehnenpathologien sind selten, jedoch häufig unterdiagnostiziert. Eine Assoziation mit einer chronisch lateralen Sprunggelenkinstabilität sowie mit einer varischen Rückfußachse kann bestehen. Pathologien der Sehnen lassen sich in 3 Kategorien einteilen: Tendinitis und Tenosynovitis, Sehnenrisse und Rupturen sowie Sehnensubluxation und Sehnenluxation. Die Magnetresonanztomographie ist die Standardmethode zur radiologischen Beurteilung. Die Diagnose und Behandlung basieren jedoch in erster Linie auf Anamnese und klinischer Untersuchung. Eine primär konservative Therapie kann versucht werden, ausgenommen bei Peronealsehnenluxationen des professionellen Sportlers. Die chirurgische Therapie sollte gezielt auf die zugrunde liegende Pathologie abgestimmt werden und kann dementsprechend divers von der tendoskopischen Synovektomie bis zur anatomischen Reparatur des superioren peronealen Retinakulums mit Vertiefung der retromalleolären Rinne ausfallen. Die postoperativen Ergebnisse zeigen eine hohe Patientenzufriedenheit und niedrige Reluxationsraten.
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Affiliation(s)
- Madeleine Willegger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Lena Hirtler
- Zentrum für Anatomie und Zellbiologie, Abteilung für Anatomie, Medizinische Universität Wien, Wien, Österreich
| | - Gilbert M Schwarz
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Zentrum für Anatomie und Zellbiologie, Abteilung für Anatomie, Medizinische Universität Wien, Wien, Österreich
| | - Rein Hard Windhager
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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10
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Taniguchi A, Alejandro SF, Kane JM, Daoud Y, Tanaka Y, Ford SE, Brodsky JW. Association of Cavovarus Foot Alignment With Peroneal Tendon Tears. Foot Ankle Int 2021; 42:750-756. [PMID: 33847151 DOI: 10.1177/1071100721990348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although it is a widely accepted clinical principle that cavovarus deformity predisposes to peroneal tendon problems, there are limited data to support that assumption. This study tested the hypothesis that cavovarus is associated with peroneal tendon tears and evaluated which radiographic measures correlated with that association. METHODS A retrospective comparison of radiographic measures of cavovarus in 234 consecutive patients operatively treated for chronically symptomatic peroneal tendon tears was compared to a matched control group. Measures included calcaneal pitch, anteroposterior (AP) talometatarsal and talocalcaneal angles, and talonavicular coverage angle. A novel coordinate system analyzed midfoot and hindfoot components of cavovarus. Analysis of variance was used to compare cohorts, and a Tukey-Kramer test used to analyze 3 subgroups of brevis and longus tears, and concomitant tears. RESULTS The distribution of tears was 73% peroneus brevis, 8% longus, and 19% both tendons. Compared with controls, the study group, and subgroups, had multiple measures of increased cavovarus, including greater calcaneal pitch (P = .0001), decreased AP talo-first metatarsal angle (P = .0001), and increased talonavicular coverage angle (P = .0001). Elevated medial longitudinal arch, and rotational changes in the radiographic profiles of the hindfoot were found with the coordinate system described by Yokokura. CONCLUSION This study found a statistically significant association of increased cavovarus deformity with peroneal tendon tears, compared to controls. It documented the relative incidence of tears of peroneus brevis, peroneus longus, and concomitant tears in a large surgical series. It demonstrated which simple radiographic angles and complex coordinate measurements of cavovarus deformity were significantly associated with peroneal tendon tears. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.
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Affiliation(s)
- Akira Taniguchi
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | | | - Justin M Kane
- Orthopedic Associates of Dallas, Baylor University Medical Center, Dallas, TX, USA
| | - Yahya Daoud
- Orthopedic Associates of Dallas, Baylor University Medical Center, Dallas, TX, USA
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Samuel E Ford
- Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - James W Brodsky
- Orthopedic Associates of Dallas, Baylor University Medical Center, Dallas, TX, USA
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11
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Abstract
Peroneal tendon disorders remain an often overlooked source of lateral hindfoot pain and tenderness. Medical professionals who specialize in foot and ankle care are still far more likely to diagnose a peroneal tendon disorder as an ankle injury. In fact, acute peroneal dislocations are misdiagnosed in up to 40% of cases. The major subsets of peroneal disorders include peroneal tendonitis and tenosynovitis, painful os peroneum syndrome, subluxation, and tearing of the peroneal tendons. Proper history and physical exam maneuvers must be performed to help identify the source of the injury and differentiate these categories. Detailed imaging through X-ray and magnetic resonance imaging must also be used to diagnose the etiology of the patient's condition in order to direct management. Currently, there is very limited knowledge on peroneal pathologies, and treatment protocol is highly variable and limited to expert opinion. Despite the individual preferences and nuances held by each surgeon when it comes to operating, the overarching principles that guide appropriate management of tendonitis, subluxation, and tendon tear should maintain a higher level of consistency. Therefore, the authors of this review aim to elucidate the most current methods to diagnose these disorders as well as evidence-based practices for optimal management.Levels of Evidence: Level V.
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Affiliation(s)
- Akhil Sharma
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
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12
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Nishikawa DRC, Duarte FA, Saito GH, de Cesar Netto C, Fonseca FCP, Miranda BRD, Monteiro AC, Prado MP. Minimally invasive tenodesis for peroneus longus tendon rupture: A case report and review of literature. World J Orthop 2020; 11:137-144. [PMID: 32190558 PMCID: PMC7063456 DOI: 10.5312/wjo.v11.i2.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/21/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Peroneal tendon disorders are common causes of lateral hindfoot pain. However, total rupture of the peroneal longus tendon is rare. Surgical treatment for this condition is usually a side-to-side tenodesis of the peroneal longus tendon to the peroneal brevis tendon. While the traditional procedure involves a long lateral curved incision, this approach is associated with damage to the lateral soft tissues (up to 24% incidence).
CASE SUMMARY A 50-year-old female had developed pain at the lateral aspect of the hindfoot 1 mo after an ankle sprain while walking in the street. Previous treatments were anti-inflammatory drugs, ice, rest and Cam-walker boot. At physical exam, there was pain and swelling over the course of the peroneal tendons. Ankle instability and cavovarus foot deformity were ruled out. Eversion strength was weak (4/5). Imaging showed complete rupture of the peroneal longus tendon associated with a sharp hypertrophic peroneal tubercle. Surgical repair was indicated after failure of conservative treatment (physiotherapy, rest, analgesics, and ankle stabilizer). A less invasive approach was performed for peroneal longus tendon debridement and side-to-side tenodesis to the adjacent peroneal brevis tendon, with successful clinical and functional outcomes.
CONCLUSION Peroneus longus tendon tenodesis can be performed through a less invasive approach with preservation of the lateral soft tissue integrity.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopedics, Foot and Ankle Surgery, Hospital of the Municipal Public Servant of São Paulo (HSPM), Aclimação 01532-000, São Paulo, Brazil
| | | | - Guilherme Honda Saito
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital Israelita Albert Einstein, Jardim Leonor 05652-900, São Paulo, Brazil
| | - Cesar de Cesar Netto
- Department of Orthopedics, Foot and Ankle Surgery, University of Iowa, Iowa City, IA 52242, United States
| | - Fábio Correia Paiva Fonseca
- Department of Orthopedics, Foot and Ankle Surgery, Hospital of the Municipal Public Servant of São Paulo (HSPM), Aclimação 01532-000, São Paulo, Brazil
| | - Bruno Rodrigues de Miranda
- Department of Orthopedics, Foot and Ankle Surgery, Hospital of the Municipal Public Servant of São Paulo (HSPM), Aclimação 01532-000, São Paulo, Brazil
| | - Augusto César Monteiro
- Department of Orthopedics, Foot and Ankle Surgery, Hospital of the Municipal Public Servant of São Paulo (HSPM), Aclimação 01532-000, São Paulo, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital Israelita Albert Einstein, Jardim Leonor 05652-900, São Paulo, Brazil
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13
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Sherman TI, Koury K, Orapin J, Schon LC. Lateral Transfer of the Flexor Digitorum Longus for Peroneal Tendinopathy. Foot Ankle Int 2019; 40:1012-1017. [PMID: 31203651 DOI: 10.1177/1071100719853297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have reported midterm outcomes after single-stage flexor digitorum longus (FDL) tendon transfer to the lateral foot for irreparable rupture of the peroneal tendons. METHODS Over a 7-year period (2008-2015), 25 consecutive patients underwent transfer of the FDL to the fifth metatarsal for irreparable peroneal tendon tears. Of these, 15 patients were available for inclusion with a mean follow-up of 53.7 ± 23.3 months, mean age at surgery of 48.4 years, and mean body mass index (BMI) of 29.8 kg/m2. Patients completed the pain visual analog scale (VAS), Foot Function Index (FFI), Short Musculoskeletal Function Assessment (SMFA), and Foot and Ankle Ability Measure (FAAM) and participated in range of motion, peak force, and peak power testing. RESULTS All 15 patients were satisfied with their surgery and reported a reduction in their pain level with a decreased VAS of 5.6 ± 2.5. The mean FFI was 12.8 ± 9.2, the SMFA Function Index was 12.4 ± 8, and the mean SMFA Bothersome Index was 11.5 ± 11. The mean FAAM was 86.4 ± 9.7. Patients had on average 58% less eversion and 28% less inversion compared with the nonoperative side. Isometric peak torque and isotonic peak velocity were 38.4% and 28.8% less compared with the contralateral side, respectively. The average power in the operative limb was diminished by 56% compared with the nonoperative limb. CONCLUSION In this small case series with midterm follow-up, FDL transfer to the lateral foot for significant, irreparable peroneal tendinopathy was an effective and durable treatment option. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Thomas I Sherman
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Kimberly Koury
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Jakrapong Orapin
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lew C Schon
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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14
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Abstract
CLINICAL ISSUE Injuries of the peroneal tendons are rare and often overlooked. Typical pathologies are tendinitis, tears and dislocation. Accompanying injuries are fractures. They are often associated with instability in the ankle and rearfoot deformities; therefore, these pathologies should be excluded or taken into consideration in the treatment. The clinical examination is crucial for the diagnosis. DIAGNOSTIC WORK-UP Ultrasound and magnetic resonance imaging (MRI) examinations are very helpful; however, the true extent of the tendon pathology is often first seen during surgery. Bony injuries and deformities are assessed radiographically and by computed tomography (CT). PERFORMANCE Although conservative treatment is generally used at the beginning of therapy, progression is more likely to occur in the case of tears; therefore, the correct timing for an operative therapy should not be missed. Dislocations are the domain of operative therapy. Acute tendinitis, on the other hand, is usually accessible to conservative therapy if it is not the result of a gross deformity. ACHIEVEMENTS Rehabilitation after operative treatment is demanding and prolonged especially after operative therapy of peroneal tendon tears. The results to be expected appear promising.
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15
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Wagner E, Wagner P, Ortiz C, Radkievich R, Palma F, Guzmán-Venegas R. Biomechanical Cadaveric Evaluation of Partial Acute Peroneal Tendon Tears. Foot Ankle Int 2018. [PMID: 29519147 DOI: 10.1177/1071100718760256] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND No clear guideline or solid evidence exists for peroneal tendon tears to determine when to repair, resect, or perform a tenodesis on the damaged tendon. The objective of this study was to analyze the mechanical behavior of cadaveric peroneal tendons artificially damaged and tested in a cyclic and failure mode. The hypothesis was that no failure would be observed in the cyclic phase. METHODS Eight cadaveric long leg specimens were tested on a specially designed frame. A longitudinal full thickness tendon defect was created, 3 cm in length, behind the tip of the fibula, compromising 66% of the visible width of the peroneal tendons. Cyclic testing was initially performed between 50 and 200 N, followed by a load-to-failure test. Tendon elongation and load to rupture were measured. RESULTS No tendon failed or lengthened during cyclic testing. The mean load to failure for peroneus brevis was 416 N (95% confidence interval, 351-481 N) and for the peroneus longus was 723 N (95% confidence interval, 578-868 N). All failures were at the level of the defect created. CONCLUSION In a cadaveric model of peroneal tendon tears, 33% of remaining peroneal tendon could resist high tensile forces, above the physiologic threshold. CLINICAL RELEVANCE Some peroneal tendon tears can be treated conservatively without risking spontaneous ruptures. When surgically treating a symptomatic peroneal tendon tear, increased efforts may be undertaken to repair tears previously considered irreparable.
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Affiliation(s)
- Emilio Wagner
- 1 Orthopedic Department, Clinica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Pablo Wagner
- 1 Orthopedic Department, Clinica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Cristian Ortiz
- 1 Orthopedic Department, Clinica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Ruben Radkievich
- 1 Orthopedic Department, Clinica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Felipe Palma
- 2 Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Chile
| | - Rodrigo Guzmán-Venegas
- 2 Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Chile
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16
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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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17
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Guelfi M, Vega J, Malagelada F, Baduell A, Dalmau-Pastor M. Tendoscopic Treatment of Peroneal Intrasheath Subluxation: A New Subgroup With Superior Peroneal Retinaculum Injury. Foot Ankle Int 2018; 39:542-550. [PMID: 29595062 DOI: 10.1177/1071100718764674] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Snapping peroneal tendons is a rare cause of lateral ankle pain. Two subgroups have been described: chronic subluxation with superior peroneal retinaculum (SPR) injury and intrasheath subluxation with SPR intact. The aim of the study was to report the tendoscopic findings and results in patients affected by snapping peroneal tendons without evident dislocation. METHODS Between 2010 and 2015, a total of 18 patients with a retromalleolar "click" sensation and no clinical signs of peroneal tendon dislocation underwent tendoscopy. Mean age was 29 years (range, 18-47). Mean follow-up was 45 months (range, 18-72). RESULTS Tendoscopic examination revealed an intact SPR in 12 patients. Of these 12, a space-occupying lesion was present in 7, a superficial tear of peroneus brevis in 4, and a shallow fibular groove in 7. An SPR injury without peroneal tendon dislocation was observed in the remaining 6 patients. All these 6 patients presented a shallow fibular groove. Although the SPR was injured, they had been diagnosed as intrasheath subluxation. Patients with intrasheath subluxation and intact SPR underwent debridement of a space-occupying lesion in 11 cases and fibular groove deepening in 5 cases. Patients with intrasheath subluxation and SPR injury underwent fibular groove deepening without addressing the SPR. At follow-up, the mean American Orthopaedic Foot & Ankle Society score increased from 76 (range, 69-85) preoperatively to 97 (range, 84-100). No recurrence or major complications were reported. Conclusion Intrasheath subluxation of peroneal tendons was successfully treated tendoscopically. A new subgroup of intrasheath subluxation with SPR injury but no clinically evident peroneal tendon dislocation is reported. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Matteo Guelfi
- 1 Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Chieti, Italy
| | - Jordi Vega
- 2 Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain.,3 Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
| | - Francesc Malagelada
- 4 Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Albert Baduell
- 2 Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain.,5 Department of Orthopaedic and Traumatology, Hospital of Figueres-Funcació Salut Empordà, Figueres, Girona, Spain
| | - Miki Dalmau-Pastor
- 3 Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.,6 Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain
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18
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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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19
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Abstract
Chronic rupture of the peroneal tendons can be a functionally limiting condition with a multitude of causes. Conservative and operative interventions are heterogenous and tailored to the functional demands of the patient. Surgical plans are based on muscle viability, patient preference, and surgeon expertise. Clinical outcomes evidence remains limited in this domain, and further well-designed studies are warranted to guide treatment.
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Affiliation(s)
- Kamran S Hamid
- Rush University Medical Center, 1611 West Harrison Street, Chicago, Illinois 60612, USA.
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20
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Wilson KJ, Surowiec RK, Johnson NS, Lockard CA, Clanton TO, Ho CP. T2* Mapping of Peroneal Tendons Using Clinically Relevant Subregions in an Asymptomatic Population. Foot Ankle Int 2017; 38:677-683. [PMID: 28552042 DOI: 10.1177/1071100717693208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneal tendon evaluation is particularly demanding using current magnetic resonance imaging (MRI) techniques because of their curving path around the lateral malleolus. Quantifiable, objective data on the health of the peroneal tendons could be useful for improving diagnosis of tendon pathology and tracking post-treatment responses. The purpose of this study was to establish a method and normative T2-star (T2*) values for the peroneal tendons in a screened asymptomatic cohort using clinically reproducible subregions, providing a baseline for comparison with peroneal tendon pathology. METHODS Unilateral ankle scans were acquired for 26 asymptomatic volunteers with a 3-Tesla MRI system using a T2* mapping sequence in the axial and sagittal planes. The peroneus brevis and peroneus longus tendons were manually segmented and subregions were isolated in the proximity of the lateral malleolus. Summary statistics for T2* values were calculated. RESULTS The peroneus brevis tendon exhibited a mean T2* value of 12 ms and the peroneus longus tendon was 11 ms. Subregions distal to the lateral malleolus had significantly higher T2* values ( P < .05) than the subregions proximal in both tendons, in both the axial and sagittal planes. CONCLUSION Peroneal tendon regions distal to the inferior tip of the lateral malleolus had significantly higher T2* values than those regions proximal, which could be related to anatomical differences along the tendon. CLINICAL RELEVANCE This study provides a quantitative method and normative baseline T2* mapping values for comparison with symptomatic clinically compromised peroneal tendon patients.
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Affiliation(s)
| | | | | | | | | | - Charles P Ho
- 1 Steadman Philippon Research Institute, Vail, CO, USA
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21
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Kumar Y, Alian A, Ahlawat S, Wukich DK, Chhabra A. Peroneal tendon pathology: Pre- and post-operative high resolution US and MR imaging. Eur J Radiol 2017. [PMID: 28624011 DOI: 10.1016/j.ejrad.2017.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Peroneal tendon pathology is an important cause of lateral ankle pain and instability. Typical peroneal tendon disorders include tendinitis, tenosynovitis, partial and full thickness tendon tears, peroneal retinacular injuries, and tendon subluxations and dislocations. Surgery is usually indicated when conservative treatment fails. Familiarity with the peroneal tendon surgeries and expected postoperative imaging findings is essential for accurate assessment and to avoid diagnostic pitfalls. Cross-sectional imaging, especially ultrasound and MRI provide accurate pre-operative and post-operative evaluation of the peroneal tendon pathology. In this review article, the normal anatomy, clinical presentation, imaging features, pitfalls and commonly performed surgical treatments for peroneal tendon abnormalities will be reviewed. The role of dynamic ultrasound and kinematic MRI for the evaluation of peroneal tendons will be discussed. Normal and abnormal postsurgical imaging appearances will be illustrated.
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Affiliation(s)
- Yogesh Kumar
- Radiology, Yale New Haven Health at Bridgeport Hospital, CT, USA.
| | - Ali Alian
- Musculoskeletal Radiology, UT Southwestern Medical Center, TX, USA
| | - Shivani Ahlawat
- Musculoskeletal Radiology, Johns Hopkins University, MD, USA
| | - Dane K Wukich
- Orthopaedic Surgery, UT Southwestern Medical Center, TX, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology, UT Southwestern Medical Center, TX, USA; Orthopaedic Surgery, UT Southwestern Medical Center, TX, USA.
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22
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Chinzei N, Kanzaki N, Takakura Y, Takakura Y, Toda A, Fujishiro T, Hayashi S, Hashimoto S, Kuroda R, Kurosaka M. Surgical management of the peroneus quartus muscle for bilateral ankle pain: a case report. J Am Podiatr Med Assoc 2016; 105:85-91. [PMID: 25675231 DOI: 10.7547/8750-7315-105.1.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The peroneus quartus muscle is an accessory muscle seen in the lateral compartment of the lower leg. Although the peroneus quartus muscle is asymptomatic in general, it sometimes becomes pathologic. We present the rare case of bilateral ankle pain with crepitation caused by the peroneus quartus muscle. Magnetic resonance imaging should be considered to assist with diagnosing this condition. Foot and ankle surgeons should consider it in the preoperative differential diagnosis when patients present with posterior ankle pain.
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Affiliation(s)
- Nobuaki Chinzei
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshinori Takakura
- Department of Orthopaedic Surgery, Takakura Orthopedic and Sports Clinic, Kobe, Japan
| | - Yoshiyuki Takakura
- Department of Orthopaedic Surgery, Takakura Orthopedic and Sports Clinic, Kobe, Japan
| | - Akihiko Toda
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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23
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Pellegrini MJ, Glisson RR, Matsumoto T, Schiff A, Laver L, Easley ME, Nunley JA. Effectiveness of Allograft Reconstruction vs Tenodesis for Irreparable Peroneus Brevis Tears: A Cadaveric Model. Foot Ankle Int 2016; 37:803-8. [PMID: 27480963 DOI: 10.1177/1071100716658469] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Irreparable peroneus brevis tendon tears are uncommon, and there is scant evidence on which to base operative treatment. Options include tendon transfer, segmental resection with tenodesis to the peroneus longus tendon, and allograft reconstruction. However, the relative effectiveness of the latter 2 procedures in restoring peroneus brevis function has not been established. METHODS Custom-made strain gage-based tension transducers were implanted into the peroneus longus and brevis tendons near their distal insertions in 10 fresh-frozen cadaver feet. Axial load was applied to the foot, and the peroneal tendons and antagonistic tibialis anterior and posterior tendons were tensioned to 50% and 100% of physiologic load. Distal tendon tension was recorded in this normal condition and after sequential peroneus brevis-to-longus tenodesis and peroneus brevis allograft reconstruction. Measurements were made in 5 foot inversion/eversion and plantarflexion/dorsiflexion positions. RESULTS Distal peroneus brevis tendon tension after allograft reconstruction significantly exceeded that measured after tenodesis in all tested loading conditions (P ≤ 0.022). With 50% of physiologic load applied, peroneus brevis tension was 1% to 28% of normal (depending on foot position) after tenodesis and 73% to 101% of normal after allograft reconstruction. Under the 100% loading condition, peroneus brevis tension was 6% to 43% of normal after tenodesis and 88% to 99% of normal after reconstruction with allograft. Distal peroneus longus tension remained within 20% of normal under all operative and loading conditions. CONCLUSION Allograft reconstruction of a peroneus brevis tendon tear in this model substantially restored distal tension when the peroneal tendons and their antagonists were loaded to 50% and 100% of physiologic load. Tenodesis to the peroneus longus tendon did not effectively restore peroneus brevis tension under the tested conditions. CLINICAL RELEVANCE Because tenodesis was demonstrated to be ineffective for restoration of peroneus brevis function, this procedure may result in an imbalanced foot clinically.
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Affiliation(s)
- Manuel J Pellegrini
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Richard R Glisson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Takumi Matsumoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Adam Schiff
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Lior Laver
- Department of Orthopaedics, Tel-Aviv University Hospital, Tel-Aviv, Israel
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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24
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Mullens J, Whiteside W, Nilssen E, Kennedy C. Dislocated Posterior Tibial Tendon Treated With Plate Buttress Fixation in a Collegiate Gymnast: A Case Report and Review of the Literature. Foot Ankle Spec 2016; 9:361-6. [PMID: 26446101 DOI: 10.1177/1938640015609985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Dislocation of the posterior tibial tendon (PTT) is a rare pathological process that occurs most often as a result of acute trauma. The injury involves forced dorsiflexion and eversion of the foot against a contracted posterior tibialis. Diagnosis of the injury is often difficult secondary to the rarity of the injury and its similarity with other benign injuries of the medial ankle. Routine diagnostic imaging often does not reveal the injury, and advanced imaging with magnetic resonance imaging or ultrasound to confirm the diagnosis is often required. The injury can be a result of an abnormal retromalleolar groove or a tear of the flexor retinaculum. Because nonoperative treatment frequently results in poor outcomes with continuing pain and progressive flat foot, operative treatment with repair of the flexor retinaculum with correction of the retromalleolar groove is the most described intervention. We report an acute case of PTT dislocation in a collegiate gymnast during competition and offer our technique for surgical correction in the setting of a partially torn, attenuated flexor retinaculum with plate buttressing of the PTT into its native uncorrected groove. LEVELS OF EVIDENCE Therapeutic, Level IV: Case study.
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Affiliation(s)
- Jess Mullens
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
| | - William Whiteside
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
| | - Erik Nilssen
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
| | - Chad Kennedy
- Department of Orthopedic Surgery, University of South Alabama, Mobile, Alabama (JM)Andrews Research and Education Institute, Foot and Ankle Center, Gulf Breeze, Florida (WW, EN, CK)
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25
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Gupta YS, Ali S, Ling S. Tendon pathology in trauma CT imaging: an under-recognized entity. Emerg Radiol 2016; 23:513-20. [DOI: 10.1007/s10140-016-1426-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/14/2016] [Indexed: 11/28/2022]
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26
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Ballal MS, Pearce CJ, Calder JDF. Management of sports injuries of the foot and ankle. Bone Joint J 2016; 98-B:874-83. [DOI: 10.1302/0301-620x.98b7.36588] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 12/02/2015] [Indexed: 12/14/2022]
Abstract
Sporting injuries around the ankle vary from simple sprains that will resolve spontaneously within a few days to severe injuries which may never fully recover and may threaten the career of a professional athlete. Some of these injuries can be easily overlooked altogether or misdiagnosed with potentially devastating effects on future performance. In this review article, we cover some of the common and important sporting injuries involving the ankle including updates on their management and outcomes. Cite this article: Bone Joint J 2016;98-B:874–83.
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Affiliation(s)
- M. S. Ballal
- Fortius Clinic, 17
Fitzhardinge Street, London, W1H
6EQ, UK
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27
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Seybold JD, Campbell JT, Jeng CL, Short KW, Myerson MS. Outcome of Lateral Transfer of the FHL or FDL for Concomitant Peroneal Tendon Tears. Foot Ankle Int 2016; 37:576-81. [PMID: 26912032 DOI: 10.1177/1071100716634762] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Concomitant tears of the peroneus longus and brevis tendons are rare injuries, with literature limited to case reports and small patient series. Only 1 recent study directly compared the results of single-stage lateral deep flexor transfer, and no previous series objectively evaluated power and balance following transfer. The purpose of this study was to evaluate clinical outcomes, patient satisfaction, and objective power and balance data following single-stage flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon transfers for treatment of concomitant peroneus longus and brevis tears. METHODS Over an 8-year period (2005-2012), 9 patients underwent lateral transfer of the FHL or FDL tendon for treatment of concomitant peroneus longus and brevis tears. All but 1 patient underwent additional procedures to address hindfoot malalignment or other contributing deformity at the time of surgery. Mean age was 56.9 years, and average body mass index was 27.9. Lateral transfer of the FHL was performed in 5 patients, and FDL transfer performed in 4 with mean follow-up 35.7 months (range: 11-94). Eight of 9 patients completed SF-12 and Foot Function Index (FFI) scores, and 7 returned for range of motion (ROM) and manual strength testing of the involved and normal extremities. These 7 patients also completed force plate balance tests, in addition to peak force and power testing on a PrimusRS machine with a certified physical therapist. RESULTS All patients were satisfied with the results of the procedure. Mean SF-12 physical and mental scores were 32 and 55, respectively; mean FFI total score was 56.7. No postoperative infections were noted. Two patients continued to utilize orthotics or braces, and 2 patients reported occasional pain with weightbearing activity. Three patients noted mild paresthesias in the distribution of the sural nerve and 2 demonstrated tibial neuritis. All patients demonstrated 4/5 eversion strength in the involved extremity. Average loss of inversion and eversion ROM were 24.7% and 27.2% of normal, respectively. Mean postoperative eversion peak force and power were decreased greater than 55% relative to the normal extremity. Patients demonstrated nearly 50% increases in both center-of-pressure tracing length and velocity during balance testing. There were no statistically significant differences between the FHL and FDL transfer groups with regards to clinical examination or objective power and balance tests. CONCLUSION The FHL and FDL tendons were both successful options for lateral transfer in cases of concomitant peroneus longus and brevis tears. Objective measurements of strength and balance demonstrated significant deficits in the operative extremity, even years following the procedure. These differences, however, did not appear to alter or inhibit patient activity levels or high satisfaction rates with the procedure. Although anatomic studies have demonstrated benefits of FHL transfer over the FDL tendon, further studies with increased patient numbers are needed to determine if these differences are clinically significant. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - John T Campbell
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - Clifford L Jeng
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - Kelly W Short
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - Mark S Myerson
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
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28
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Grice J, Watura C, Elliot R. Audit of foot and ankle surgeons' management of acute peroneal tendon tears and review of management protocols. Foot (Edinb) 2016; 26:1-3. [PMID: 26794007 DOI: 10.1016/j.foot.2015.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 09/25/2015] [Accepted: 11/11/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this audit was to identify whether there is consistent and successful management of acute peroneal tendon tears within orthopaedic foot and ankle consultants in the Wessex area of the UK. It was suspected that there was an absence of consistency between surgeons' practices and a more evidenced based management protocol could be developed. MATERIALS AND METHODS A questionnaire of the orthopaedic surgeons in Wessex investigated whether there was consistency in surgical management of peroneal tears. RESULTS Our results demonstrate that each of the nine surgeons' management of acute peroneal tendon tears varied greatly. CONCLUSION The evidence in the literature was examined in an attempt to produce a protocol to aid surgical decision-making. A randomised controlled trial is required for consistent evidenced based surgical management of peroneal tendon tears.
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Affiliation(s)
- John Grice
- Trauma and Orthopaedic Department, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke RG249NA, UK.
| | - Christopher Watura
- Surgical Department Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke RG249NA, UK.
| | - Robin Elliot
- Trauma and Orthopaedic Department, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke RG249NA, UK.
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29
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Abstract
Insertion of the peroneus brevis tendon normally occurs at the lateral aspect of the fifth metatarsal base. However, there is new evidence that congenital variant insertion of the tendon on the calcaneal peroneal tubercle occurs in a small segment of the population. We report a case of 24-year old male presenting with non-traumatic ankle pain who underwent ankle magnetic resonance imaging. Imaging demonstrated insertion of the peroneus brevis tendon on the calcaneal peroneal tubercle with absence of the tendon distal to the calcaneus. Furthermore, in reviewing 200 consecutive ankle magnetic resonance examinations, the authors discovered one additional case of this variant. We discuss the magnetic resonance imaging characteristics of this anatomic variant, the implications for clinical management, and review the literature on peroneal anatomic variations.
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Affiliation(s)
- Nathan D Cecava
- Department of Radiology, Mike O'Callaghan Federal Medical Center, Nellis AFB, NV, USA
| | - Scot E Campbell
- Department of Radiology, Landstuhl Regional Medical Center, Landstuhl, Germany
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30
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Abstract
Peroneal tendon pathology is often found in patients complaining of lateral ankle pain and instability. Conditions encountered include tendinosis; tendinopathy; tenosynovitis; tears of the peroneus brevis, peroneus longus, and both tendons; subluxation and dislocation; and painful os peroneum syndrome. Injuries can be acute as a result of trauma or present as chronic problems, often in patients with predisposing structural components such as hindfoot varus, lateral ligamentous instability, an enlarged peroneal tubercle, and a symptomatic os peroneum. Treatment begins with nonoperative care, but when surgery is required, reported results and return to sport are in general very good.
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Affiliation(s)
- Brent Roster
- Missoula Bone & Joint, 2360 Mullan Road, Suite C, Missoula, MT 59808, USA.
| | - Patrick Michelier
- University of California Davis School of Medicine, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
| | - Eric Giza
- Department of Orthopaedic Surgery, University of California Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
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31
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Abstract
Chronic lateral ankle instability is a condition frequently encountered by orthopedic surgeons treating highly active patient populations, particularly military service members. Providers treating military service members must have a high index of suspicion for this condition when signs and symptoms of functional or mechanical instability exist. Stress testing and ankle MRI, although not definitive in sensitivity for detecting instability or other concomitant injuries, should be considered during the treatment decision-making process. Appropriate nonoperative treatment should be attempted initially; however, when nonoperative treatment fails, surgical management is warranted to prevent untoward long-term sequelae. Proper surgical treatment and subsequent postoperative management are at the discretion of the individual surgeon but must account for the concomitant diseases frequently associated with chronic lateral ankle instability. Low recurrence of lateral instability can be achieved even in high-demand military patient populations with a focused treatment plan.
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32
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Pellegrini MJ, Adams SB, Parekh SG. Reversal of Peroneal Tenodesis With Allograft Reconstruction of the Peroneus Brevis and Longus: Case Report and Surgical Technique. Foot Ankle Spec 2014; 7:327-331. [PMID: 24962697 DOI: 10.1177/1938640014537299] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic peroneal tendinopathy and tears represent a challenging clinical situation. Traditionally, tenodesis of the torn tendon to the remaining healthy tendon has been advocated if more than half of the tendon is compromised. Allograft reconstructions have been reserved for patients with functional muscles and both peroneal tendons extensively compromised. We report a unique case of a peroneal tenodesis takedown and reconstruction of both peroneal tendons using semitendinosus allograft. A description of the surgical technique and tips are provided. Peroneal tendon function is crucial to maintain a balanced hindfoot. To the best of our knowledge, reconstruction of both peroneal tendons after a tenodesis has not been previously reported. Allograft reconstruction of the peroneal tendons arises as a feasible alternative in patients with residual pain and weakness after a failed tenodesis surgery LEVELS OF EVIDENCE: Therapeutic Level IV, case study.
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Affiliation(s)
- Manuel J Pellegrini
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (MJP, SBA)Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic Adjunct Faculty, Durham, North Carolina (SGP)
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (MJP, SBA)Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic Adjunct Faculty, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (MJP, SBA)Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic Adjunct Faculty, Durham, North Carolina (SGP)
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Gambardella GV, Donegan R, Caminear DS. Isolated dislocation of the posterior tibial tendon in an amateur snowboarder: a case report. J Foot Ankle Surg 2013; 53:203-7. [PMID: 24361009 DOI: 10.1053/j.jfas.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Indexed: 02/03/2023]
Abstract
Isolated dislocation of the posterior tibial tendon is an uncommon pathologic entity that typically occurs in the setting of acute trauma. The diagnosis remains challenging and is often delayed second to the rarity of the injury and symptoms similar to that of medial ankle sprains and other routinely diagnosed injuries about the ankle. The factors that predispose this tendon to dislocation include a hypoplastic retromalleolar groove, flexor retinaculum insufficiency, chronic repetitive trauma, and a structural abnormality from a previous medial malleolar fracture, or a combination thereof. Dislocation has also been cited as a complication of multiple local steroid injections and tarsal tunnel release. The mechanism of injury appears to involve forced dorsiflexion and eversion of the ankle when the posterior tibial tendon is contracted. Most cases do not respond well to conservative treatment and will require surgery to restore function and eliminate symptoms. We report a case of posterior tibial tendon dislocation related to a snowboarding injury and offer our technique for surgical correction.
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Affiliation(s)
- Gabriel V Gambardella
- New Haven Foot Surgeons/Milford Podiatry Associates, New Haven, CT; and Attending Podiatric Surgeon, Yale-New Haven Hospital, New Haven, CT
| | - Ryan Donegan
- Postgraduate Year 2 Resident, Department of Podiatric Medicine and Surgery, Yale-New Haven Hospital/DVA Healthcare System, Hamden, CT
| | - David S Caminear
- Connecticut Orthopaedic Specialists, Hamden, CT; Section Chief, Department of Podiatric Surgery, Yale-New Haven Hospital, Saint Raphael Campus, New Haven, CT; and Assistant Clinical Professor, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
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Seybold JD, Campbell JT, Jeng CL, Myerson MS. Anatomic comparison of lateral transfer of the long flexors for concomitant peroneal tears. Foot Ankle Int 2013; 34:1718-23. [PMID: 24025943 DOI: 10.1177/1071100713503817] [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: 02/01/2023]
Abstract
BACKGROUND Lateral transfers of the flexor hallucis longus (FHL) or flexor digitorum longus (FDL) tendons have been described for treatment of concomitant, irreparable peroneal tears. This study evaluated the anatomic benefits and constraints of lateral FHL and FDL tendon transfers with regard to available tendon length, diameter, and proximity to the posterior neurovascular bundle. METHODS In 9 cadaveric specimens, the FHL and FDL tendons were transected through a medial approach distal to the knot of Henry. Each tendon was transferred into a lateral incision, passing the FDL tendon both posterior and anterior to the tibial neurovascular bundle. The tendons were individually secured to the base of the fifth metatarsal with the foot in maximal eversion and dorsiflexion. The length of donor tendon available for fixation at the fifth metatarsal was measured. After the FDL tendon transfer was secured, the posterior neurovascular bundle was examined for signs of compression. RESULTS Average FHL tendon diameter measured 5.1 mm; the FDL measured 4.5 mm. After passage through a bone tunnel, an additional 4.9 cm of FHL tendon remained to suture to itself; only 0.5 cm remained for the posterior and anterior FDL transfers. Transfer of the FHL did not increase muscle bulk within the retrofibular groove. Every FDL transfer posterior to the neurovascular bundle produced obvious visual compression of the tibial nerve with plantar flexion and inversion of the foot. CONCLUSION Use of the FHL tendon for lateral transfer consistently provided sufficient length of tendon for multiple fixation options and a stronger muscle for transfer. Fixation options for the FDL were limited due to its shorter length. Lateral transfer of the FDL tendon posterior to the neurovascular bundle caused visible compression on the tibial nerve with ankle and hindfoot range of motion. CLINICAL RELEVANCE This anatomic study confirmed several advantages for the use of the FHL tendon transfer in cases of concomitant peroneal tears.
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Affiliation(s)
- Jeffrey D Seybold
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
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Ho KK, Chan KB, Lui TH, Chow YY. Tendoscopic-assisted repair of complete rupture of the peroneus longus associated with displaced fracture of the os peroneum--case report. Foot Ankle Int 2013; 34:1600-4. [PMID: 23847274 DOI: 10.1177/1071100713496769] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Ka Ki Ho
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong SAR, China
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Henrie AM, Oberg P, Willick S. Partial peroneus longus tendon rupture at its distal insertion in a runner: a case presentation. PM R 2013; 5:155-8. [PMID: 23415252 DOI: 10.1016/j.pmrj.2012.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 10/17/2012] [Accepted: 10/19/2012] [Indexed: 11/25/2022]
Affiliation(s)
- A Michael Henrie
- Physical Medicine and Rehabilitation, University of Utah Orthopedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Influence of ankle injury on muscle activation and postural control during ballet grand plié. J Appl Biomech 2013; 30:37-49. [PMID: 23677907 DOI: 10.1123/jab.2012-0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ballet deep squat with legs rotated externally (grand plié) is a fundamental movement for dancers. However, performing this task is a challenge to ankle control, particularly for those with ankle injury. Thus, the purpose of this study was to investigate how ankle sprains affect the ability of postural and muscular control during grand plié in ballet dancers. Thirteen injured dancers and 20 uninjured dancers performed a 15 second grand plié consisting of lowering, squatting, and rising phases. The lower extremity motion patterns and muscle activities, pelvic orientation, and center of pressure (COP) excursion were measured. In addition, a principal component analysis was applied to analyze waveforms of muscle activity in bilateral medial gastrocnemius, peroneus longus, and tibialis anterior. Our findings showed that the injured dancers had smaller pelvic motions and COP excursions, greater maximum angles of knee flexion and ankle dorsiflexion as well as different temporal activation patterns of the medial gastrocnemius and tibialis anterior. These findings suggested that the injured dancers coped with postural challenges by changing lower extremity motions and temporal muscle activation patterns.
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Treatment of longitudinal mid-substance tears of the peroneal tendons. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e318249f992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maurer M, Lehrman J. Significance of sesamoid ossification in peroneus longus tendon ruptures. J Foot Ankle Surg 2011; 51:352-5. [PMID: 22188903 DOI: 10.1053/j.jfas.2011.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Indexed: 02/03/2023]
Abstract
Ruptures of the peroneus longus tendon are uncommon, with a small number of case reports found in published studies. The presence of an os peroneum can predispose the peroneus longus tendon to rupture at the cuboid level with or without concomitant fracture, or fracture through a partite os peroneum. Whether the os peroneum can be represented by various stages of ossification is still a matter of debate. We present 2 cases of acute peroneus longus tendon rupture at the cuboid notch in the presence of an intact os peroneum in the ossified and nonossified form. We treated patients with excision of the os peroneum and tenodesis of the peroneus longus to the peroneus brevis tendon.
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Affiliation(s)
- Mark Maurer
- Crozer-Keystone Podiatric Surgical Residency, Springfield, PA, USA.
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Lateral plantar pain: diagnostic considerations. Emerg Radiol 2010; 17:291-8. [DOI: 10.1007/s10140-009-0855-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 11/23/2009] [Indexed: 12/28/2022]
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