Incidence of talar dome lesions with concomitant peroneal tendon pathologic features: a magnetic resonance imaging evaluation

Normal Distal Excursion of the Peroneus Brevis Myotendinous Junction

A low-lying peroneus brevis muscle belly has been described as a risk factor for the development of peroneal tendon pathology, but this finding has primarily been described based on cohorts with pre-existing clinical findings. Therefore, the objective of this investigation was to evaluate the frequency of apparently abnormal low-lying muscle bellies from a series of subjects without clinical or imaging findings of peroneal tendon pathology. One hundred consecutive MRIs were reviewed with measurement of the distance from the distal peroneal myotendinous junction to the tip of the fibula. This distance was observed to be 23.9 ± 8.8 mm (10.8-55.4 mm; 95% confidence interval 22.2-26.7 mm). If one assumed that a myotendinous junction within 2 cm of the distal tip of fibula represented an abnormal low-lying muscle, then we observed 37% of extremities without clinical or radiographic evidence of peroneal tendon pathology that would be considered anatomically "abnormal." When a low-lying muscle belly was defined as occurring within 2 cm of the distal tip of the fibula, then a probability analysis of our data distribution found a 32.6% probability for individuals to have an "abnormally" low-lying muscle belly. These results indicate that what has traditionally been defined intraoperatively as an abnormally low-lying peroneus brevis muscle belly might simply represent intraoperative confirmation bias of relatively normal structural anatomy.

Predictors of Osteochondral Lesions of the Talus in Patients Undergoing Broström-Gould Ankle Ligament Reconstruction

Chronic ankle instability is associated with intra-articular and extra-articular ankle pathologies, including osteochondral lesions of the talus. Patients with these lesions are at risk for treatment failure for their ankle instability. Identifying these patients is important and helps to guide operative versus nonoperative treatment. There is no literature examining which patient characteristics may be used to predict concomitant osteochondral lesions of the talus. A retrospective chart review was performed on patients (N = 192) who underwent a primary Broström-Gould lateral ankle ligament reconstruction for chronic ankle instability from 2010 to 2014. Preoperative findings, magnetic resonance imaging, and operative procedures were documented. Patients with and without a lesion were divided into 2 cohorts. Fifty-three (27.6%) patients had 1 lesion identified on preoperative magnetic resonance imaging. Forty (69.0%) of these lesions were medial, 18 (31.0%) were lateral, and 5 patients had both. Female sex was a negative predictor of a concomitant lesion (p = .013). Patients were less likely to have concomitant peroneal tendinopathy (30.2% vs 48.9%; p = .019) in the presence of a lesion. However, sports participation was a positive predictor of a concomitant lesion (p = .001). The remainder of the variables (age, body mass index, smoking, trauma, duration, contralateral instability, global laxity) did not show a significant difference. In patients who underwent lateral ankle ligament reconstruction, females were less likely to have a lesion than males. Patients with peroneal tendinopathy were less likely to have a lesion compared with patients without. Additionally, athletic participation was a positive predictor of a concomitant lesion.

MRI evaluation of ligaments and tendons of foot arch in talar dome osteochondral lesions

Background There are no publications in literature describing an association between disorders of the ligaments and tendons supporting the foot arch and osteochondral lesions of the talus (OCLT). We believe there may be a correlation between the damage of these structures. Purpose To investigate the pathologies of main ligaments and tendons that support the foot arch in sprained ankles, by reviewing magnetic resonance imaging (MRI) studies and comparing the results in two groups of patients, with and without OCLT. Material and Methods MR images from 316 patients examined in the orthopedic clinic for ankle sprain were evaluated for pathologic findings of the plantar fascia, short and long plantar ligaments, spring ligament, sinus tarsi, and ankle tendons supporting the foot arch. Findings were compared between two groups of patients: 158 patients with OCLT and 158 patients without OCLT. Results Plantar fascia, short plantar ligament, and spring ligament abnormalities were seen in 50 (31.6%), 28 (17.7%), and 60 (38%) patients with OCLT, and in nine (5.6%), three (1.9%), and 18 (11.4%) patients without OCLT, respectively ( P < 0.05). Sinus tarsi and tendon abnormalities were seen in 11 (6.7%) and nine (5.7%) patients with OCLT, and in eight (5%) and eight (5%) patients without OCLT, respectively ( P > 0.05). Two or more associated abnormalities were present in 50 (31.6%) patients with OCLT and in 11 (6.7%) without OCLT ( P < 0.05). Conclusion Plantar fascia, short plantar ligament, and spring ligament abnormalities were commonly seen in patients with OCLT on MRI, while sinus tarsi and tendon abnormalities were not. Concomitant pathologies have an increased incidence in patients with OCLT.

T2* Mapping of Peroneal Tendons Using Clinically Relevant Subregions in an Asymptomatic Population

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.

Is there a relationship between talar osteochondral lesions and foot angles?

PURPOSE

We aimed to evaluate the relationship between talar osteochondral defects (OCDs) and foot angles in this study.

MATERIALS AND METHODS

We performed a retrospective study that included 25 patients with talar OCD and 29 patients without OCD who underwent magnetic resonance imaging in our department between September 2013 and January 2015. We retrospectively measured the foot angles (Bohler's angle, lateral talocalcaneal angle and calcaneal inclination angle) on ankle radiographs in both groups.

RESULTS

Bohler's angle showed no significant differences between the patients (range 20.50°-48.10°, mean 33.40° ± 6.09°) and the control group (range18.80°-42.40°, mean 31.95° ± 4.21°) (p = 0.397). Calcaneal inclination angle showed no significant differences between the patients (range 3°-29.2°, mean 20.55° ± 6.73°) and the control group (range 10.20°-29.80° mean 20.47° ± 4.21°) (p = 0.956). However, talocalcaneal angle was significantly higher in the patients (range 27.80°-44.80°, median 39.50° ± 6.18°) compared with the control group (range 22.60°-40.50°, median 34.10° ± 4.26°) (p = 0.032).

CONCLUSION

There is an association between lateral talocalcaneal angle and non-traumatic talar OCD.

Magnetic Resonance Imaging Analysis of Peroneal Tendon Pathology Associated With Low-Lying Peroneus Brevis Muscle Belly: A Case-Control Study

BACKGROUND

Low-lying peroneus brevis tendon muscle belly has been speculated to be an associated factor with symptomatic peroneal tendon pathology. Multiple studies have analyzed normal and anomalous anatomy associated with peroneal tendon pathology; however, no study has confirmed the clinical association between peroneal tendon pathology and low-lying peroneus brevis muscle belly.

PURPOSE

To identify the correlation of low-lying peroneus brevis muscle belly with peroneal tendon pathology.

STUDY DESIGN

Case-control study; Level of evidence 3.

METHODS

The level of peroneus brevis muscle belly was compared between patients with symptomatic peroneal tendon pathology (experimental group) and asymptomatic individuals with otherwise normal lateral ankle using magnetic resonance images.

RESULTS

Of the 32 consecutive patients with symptomatic peroneal tendon pathology, 28 (87.5%) demonstrated peroneus brevis muscle distal to the fibular groove while 53.8% of control patients demonstrated such findings (P = .022). The most common diagnosis associated with peroneal tendon pathology was ankle instability and osteochondral defect of the talus or tibial plafond. Peroneal tendon pathology in isolation was less common.

CONCLUSION

Peroneal tendon pathology is often associated with lateral ankle instability and osteochondral defects of the ankle joint. Low-lying peroneus brevis muscle belly may be a common anatomic variant, but in the setting of instability it can become a source of pain and pathology secondary to overcrowding.

LEVELS OF EVIDENCE

Diagnostic, level III: Case-control study.

Predictors of peroneal pathology in Broström-Gould ankle ligament reconstruction for lateral ankle instability

BACKGROUND

Chronic ankle instability has a well-known association with intra- and extraarticular ankle pathologies, including peroneal tendonitis and subluxation. Patients with peroneal pathology are at risk for failure of conservative treatment for their ankle instability, thus identifying these patients is important and helps to guide management. There has been no literature looking at, in patients with chronic ankle instability, which associated ankle pathologies and patient characteristics are predictive of peroneal pathology.

METHODS

A retrospective chart review was performed on all patients (N = 136) who underwent a Broström-Gould ankle ligament reconstruction at a single institution from 2010 to 2014. Preoperative clinical examinations and MRIs as well as operative procedures were documented. Patients with and without peroneal pathology were divided into 2 cohorts, and their preoperative characteristics underwent a univariate analysis with P < .05 defined as showing a significant difference.

RESULTS

Of patients undergoing lateral ankle ligament reconstruction, 53.3% required operative intervention for symptomatic peroneal tendon pathology. Female gender was the only significant predictor of peroneal pathology (P = .008). The presence of an osteochondral lesion of the talus (OLT) was a significant negative predictor of peroneal pathology (P < .001). The remainder of the variables (age, BMI, duration of symptoms, tobacco, traumatic etiology, worker's compensation, global hyperlaxity, contralateral ankle instability, sport participation, ankle tilt, and deltoid tear) did not show a significant difference between cohorts.

CONCLUSION

In patients who underwent Broström-Gould ankle ligament reconstruction for chronic lateral ankle instability, female gender was significantly associated with concomitant peroneal tendon pathology. Conversely, preoperative MRI findings of an OLT showed a significant negative association with peroneal pathology. All of the other variables did not show a positive or negative association.

Examining the relation of osteochondral lesions of the talus to ligamentous and lateral ankle tendinous pathologic features: a comprehensive MRI review in an asymptomatic lateral ankle population

Given the frequency and burden of ankle sprains, the pathologic features identified on magnetic resonance imaging (MRI) scans are widely known in the symptomatic population. Ankle MRI pathologic features in the asymptomatic population, however, are poorly understood. Such examinations are rarely undertaken unless an ankle has been injured or is painful. We report the systematic MRI findings from the reports of 108 consecutive asymptomatic lateral ankles (104 patients). Our purpose was to (1) report the prevalence of osteochondral lesions of the talus (OLTs) and pathologic features of the medial and lateral ligaments, peroneal tendons, and superior peroneal retinaculum (SPR); (2) correlate the presence of OLTs with the pathologic features of the medial and lateral ligaments, peroneal tendons, and SPR; and (3) correlate ligamentous discontinuity with the peroneal pathologic features, OLTs, and SPR pathologic features. A total of 16 OLTs (14.81%) were present (13 medial and 3 lateral). Of the 16 patients with OLTs, 8 (50.00%) had concomitant peroneal pathologic findings. Healthy medial and lateral ligaments were noted in 41 patients (37.96%), and ligamentous discontinuity was grade I in 25 (23.15%), II in 32 (29.63%), III in 5 (4.63%), and grade IV in 5 patients (4.63%). A weak positive correlation was found between attenuation or tears of the superficial deltoid and medial OLTs (phi coefficient = 0.23, p = .0191) and a moderate positive correlation between tears of the posterior talofibular ligament and lateral OLTs (phi coefficient = 0.30, p = .0017). Additionally, a moderate positive correlation between ligamentous discontinuity and tendinopathy of the peroneus brevis was noted [Spearman's coefficient(106) = 0.29, p = .0024]. These findings add to the evidence of concomitant pathologic features in the asymptomatic population. To definitively assess causation and evaluate the clinical evolution of radiologic findings, future, prospective, longitudinal cohort studies are necessary.