1
|
Castilho RS, Magalhães JMB, Veríssimo BPM, Perisano C, Greco T, Zambelli R. Minimally Invasive Peroneal Tenodesis Assisted by Peroneal Tendoscopy: Technique and Preliminary Results. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:104. [PMID: 38256365 PMCID: PMC10819866 DOI: 10.3390/medicina60010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/19/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Introduction: Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability. Clicking, swelling, pain, and tenderness in the peroneal tendons track are frequent symptoms, but they can be confused with other causes of lateral ankle pain. The management of peroneal disorders can be conservative or surgical. When the conservative treatment fails, surgery is indicated, and open or tendoscopic synovectomy, tubularization, tenodesis or tendon transfers can be performed. The authors present a surgical technique of tendoscopy associated to minimally invasive tenodesis for the treatment of peroneal tendon tears, as well as the preliminary results of patients submitted to this procedure. Methods: Four patients with chronic lateral ankle pain who were diagnosed with peroneal brevis pathology were treated between 2020 and 2022 with tendoscopic-assisted minimally invasive synovectomy and tenodesis. Using a 2.7 mm 30° arthroscope and a 3.0 mm shaver blade, the entire length of the peroneus brevis tendon and most parts of the peroneus longus tendon can be assessed within Sammarco's zones 1 and 2. After the inspection and synovectomy, a minimally invasive tenodesis is performed. Results: All patients were evaluated at least six months after surgery. All of them reported improvement in daily activities and in the Foot Function Index (FFI) questionnaire (pre-surgery mean FFI = 23.86%; post-surgery mean FFI = 6.15%), with no soft tissue complications or sural nerve complaints. Conclusion: The tendoscopy of the peroneal tendons allows the surgeon to assess their integrity, confirm the extent of the lesion, perform synovectomy, prepare the tendon for tenodesis, and perform it in a safe and minimally invasive way, reducing the risks inherent to the open procedure.
Collapse
Affiliation(s)
- Rodrigo Simões Castilho
- Department of Orthopaedics and Traumatology, Mater Dei Hospital, Belo Horizonte 30170-041, Brazil
| | | | | | - Carlo Perisano
- Orthopaedics and Traumatology, Dipartimento di Scienze Dell'invecchiamento, Ortopediche e Reumatologiche Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Tommaso Greco
- Orthopaedics and Traumatology, Dipartimento di Scienze Dell'invecchiamento, Ortopediche e Reumatologiche Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Roberto Zambelli
- Department of Orthopaedics and Traumatology, Mater Dei Hospital, Belo Horizonte 30170-041, Brazil
- Surgical Department of Faculty of Medical Sciences of Minas Gerais, Belo Horizonte 30170-041, Brazil
| |
Collapse
|
2
|
Mota Gomes T, Guerra-Pinto F, Soares S, Andrade R, Pereira B, Espregueira-Mendes J, Oliva XM. The vascularization of the peroneal tendons: An anatomic study. Foot Ankle Surg 2021; 27:450-456. [PMID: 32600968 DOI: 10.1016/j.fas.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/22/2020] [Accepted: 06/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arterial vascularization is intimately related to the peroneal tendon ruptures. Our purpose is to describe the vascular anatomy of peroneal tendons and assess differences in the vascularization patterns between peroneus brevis tendon (PBT) and peroneus longus tendon (PLT). METHODS Anatomical study of 22 cadaveric lower extremities. We exposed tendons' vascularization by injecting latex. To systematize the vascular description, we considered four anatomical regions in the PBT and six in the PLT. RESULTS Vascularization was supplied by the peroneal, anterior tibial and lateral plantar arteries and from the deep plantar arch through the vincula connecting the tendons. No avascular areas were found in the PLT. 22.7% of specimens had avascular areas in the PBT. Two visual vascularization patterns were found (arcuate and weblike). Increasing age and a web-like vascularization were associated with a lower number of blood vessels at the tendons' post malleolus area. CONCLUSION Peroneal tendons are well vascularized throughout their course, running through a common vincula, with vascularization provided by various arteries. Avascular areas were observed in the PBT, but none at the PLT.
Collapse
Affiliation(s)
- Tiago Mota Gomes
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Francisco Guerra-Pinto
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital de Cascais Dr. Jose de Almeida, Alcabideche, Portugal.
| | - Sérgio Soares
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hôpital du Valais, Sion, Switzerland.
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Faculty of Sports, University of Porto, Porto, Portugal.
| | - Bruno Pereira
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Orthopedic Surgery, Hospital de Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; Clinica do Dragão, Espregueira-Mendes Sports Center, FIFA Medical Centre of Excellence, Minho University, Porto, Portugal; University of Porto Research Center, Porto, Portugal.
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; School of Medicine, Minho University, Braga, Portugal; 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal.
| | - Xavier Martin Oliva
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Orthopedics, Clinica Del Remei, Barcelona, Spain.
| |
Collapse
|
3
|
Bojanić I, Knežević I, Dimnjaković D. Importance of Space-Occupying Anatomical Variations in Peroneal Tendoscopy. Foot Ankle Int 2021; 42:448-457. [PMID: 33198525 DOI: 10.1177/1071100720966325] [Citation(s) in RCA: 2] [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 We hypothesized that peroneal tendons disorders are more commonly associated with anatomical variations, which could overcrowd the retrofibular groove. METHODS This single-center retrospective case study covered 84 consecutive cases that had undergone peroneal tendoscopy. Peroneal tendoscopy was performed on 82 patients, predominantly female (3:1) with a median age of 46 years. The preoperative evaluation and all the procedures were performed by a single surgeon using a standardized technique. RESULTS Two patients required revision surgery 8 and 52 months after the index procedure due to persistent posterolateral ankle pain. Peroneal tendoscopy was performed as a solitary procedure in 45.1% (37/82) of cases, while the remaining cases involved peroneal tendoscopy as a supplementary procedure. Low-lying peroneus brevis muscle belly (LLMB) was the most common finding in this series in 53.7% (44/82) of cases. In 41.5% (34/82) of cases, longitudinal tears of the peroneus brevis tendon were noted. Some patients presented with more than 1 concomitant peroneal tendon pathology. The LLMB was observed in 23.5% (8/34) of cases with a longitudinal tear of the peroneus brevis tendon. CONCLUSION Peroneal tendon anatomical variations, especially LLMB, were associated with the presence of peroneus brevis tendon ruptures and intrasheath peroneal tendon subluxations as well as posttraumatic posterolateral ankle pain. Due to high rates of undiagnosed and misdiagnosed cases of LLMB preoperatively, we believe special care should be taken to recognize it during tendoscopy. Peroneal tendoscopy is a high-efficiency, low-complication method to treat some peroneal tendon conditions. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Ivan Bojanić
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.,Department of Orthopedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Igor Knežević
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Damjan Dimnjaković
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|
4
|
Abstract
Peroneal tendinosis and subluxation are lifestyle-limiting conditions that can worsen if not properly diagnosed and treated. Adequate knowledge of ankle anatomy and detailed history and comprehensive physical examination is essential for diagnosis. Peroneal tendinopathy is likely to result from overuse, whereas subluxation often precipitates from forceful contraction of peroneals during sudden dorsiflexion while landing or abruptly stopping. In athletes, conservative measures remain first-line treatment of tendinopathy, but surgery is often immediately indicated in cases of recurrent symptomatic subluxation or dislocation. Surgical technique varies on the type, mechanism, and severity of injury, but most procedures have a high success rate.
Collapse
Affiliation(s)
- Julian G Lugo-Pico
- Orthopaedic Surgery, University of Miami, Jackson Memorial Hospital, 1611 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Joshua T Kaiser
- University of Miami Miller School of Medicine, 1600 Northwest 10th Avenue, Miami, FL 33136, USA
| | - Rafael A Sanchez
- Orthopaedic Surgery, University of Miami, Jackson Memorial Hospital, 1611 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Amiethab A Aiyer
- Foot & Ankle Service, Department of Orthopaedics, University of Miami Miller School of Medicine, 1611 Northwest 12th Avenue, Miami, FL 33136, USA.
| |
Collapse
|
5
|
Stornebrink T, Stufkens SAS, Appelt D, Wijdicks CA, Kerkhoffs GMMJ. 2-Mm Diameter Operative Tendoscopy of the Tibialis Posterior, Peroneal, and Achilles Tendons: A Cadaveric Study. Foot Ankle Int 2020; 41:473-478. [PMID: 31868013 PMCID: PMC7160745 DOI: 10.1177/1071100719895504] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Technical innovation now offers the possibility of 2-mm-diameter operative tendoscopy with disposable arthroscopes and tablet-like control units. The promises of new technology should be critically scrutinized. Therefore, this study assessed whether 2-mm-diameter operative tendoscopy of the tibialis posterior, peroneal, and Achilles tendons was safe and effective in a cadaveric model. METHODS A 2-mm-diameter arthroscopic system was used to perform a tendoscopic procedure in 10 nonpaired, fresh-frozen, human ankles. Standard tendoscopic portals were utilized. Visual examination and operative reach with tailored tendoscopic instruments within the tendon sheaths were recorded and documented. Adhesiolysis and vincula resections were performed. After dissection, distances between portal tracts and neurovascular structures were measured and the tendons were inspected for signs of iatrogenic damage. RESULTS The entire tendon sheath and tendon of the tibialis posterior, peroneus brevis, and Achilles tendons were visualized and reached with tailored operative instruments. The proximal part of the peroneus longus tendon was visible and reachable from proximally up to the cuboid bone distally. Adhesiolysis and vincula resections were successfully performed in all specimens. The mean distances between portal tracts and local neurovascular structures ranged between 9.4 and 19.2 mm and there were no cases of contact. None of the tendons showed signs of iatrogenic damage. CONCLUSION Two-millimeter-diameter operative tendoscopy provided safe and effective visualization and operative reach of the tibialis posterior, peroneal, and Achilles tendons. CLINICAL RELEVANCE Compared with current practice, 2-mm-diameter operative tendoscopy has the potential to make tendoscopy around the ankle less invasive and more accessible. Diagnostic, interventional, and second-look procedures might be performed at substantially reduced risk, time, and costs.
Collapse
Affiliation(s)
- Tobias Stornebrink
- Department of Orthopedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands,Academic Center for Evidence Based
Sports Medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center,
Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A. S. Stufkens
- Department of Orthopedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands,Academic Center for Evidence Based
Sports Medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center,
Amsterdam UMC, Amsterdam, The Netherlands
| | - Daniel Appelt
- Department of Orthopedic Research,
Arthrex GmbH, Munich, Bayern, Germany
| | - Coen A. Wijdicks
- Department of Orthopedic Research,
Arthrex GmbH, Munich, Bayern, Germany
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands,Academic Center for Evidence Based
Sports Medicine (ACES), Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center,
Amsterdam UMC, Amsterdam, The Netherlands,Gino M. M. J. Kerkhoffs, MD, PhD, Department
of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC,
University of Amsterdam, Meibergdreef 9, Room K1-207, Amsterdam, 1105 AZ, The
Netherlands.
| |
Collapse
|
6
|
Carreira DS, Garden SR, Ueland T. Operative Approaches to Ankle and Hindfoot Arthroscopy. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419894968. [PMID: 35097358 PMCID: PMC8564949 DOI: 10.1177/2473011419894968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The role of arthroscopy in the management of ankle and hindfoot pathology management has increased greatly in recent years with the potential for lower complication rates, faster recovery, improved access, and improved outcomes when compared to open techniques. Procedural variations exist as techniques aim to optimize lesion access, decrease operative time, and improve patient safety. Our goal is to summarize the described approaches and patient positionings common in minimally invasive arthroscopic surgery for anterior, lateral, and posterior ankle pathologies. A survey of pathology organized by arthroscopic approach and a review of recent advances in concomitant lesion management may be useful when planning arthroscopic foot and ankle surgery. LEVEL OF EVIDENCE Level V, expert opinion.
Collapse
|
7
|
The distance from the peroneal tendons sheath to the sural nerve at the posterior tip of the fibula decreases from proximal to distal. Knee Surg Sports Traumatol Arthrosc 2019; 27:2852-2857. [PMID: 30888450 DOI: 10.1007/s00167-019-05438-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/22/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study is to compare the distance from the peroneal tendons sheath to the sural nerve in different points proximally and distally to the tip of the fibula. METHODS Ten fresh-frozen lower extremities were dissected to expose the nerves and tendons. Having the posterior tip of the fibula as a reference, the distance between the tendons sheath and the sural nerve was measured in each point with a tachometer with three independent different observers. Two measures were taken distally at 1.5 and 2 cm from fibula tip and 3 measures were performed proximally at 2, 3, and 5 cm from fibula tip. Data were described using means, standard deviations, medians, and minimum and maximum values. RESULTS The average distance between distance between the fibula tip and sural nerve is 16.6 ± 4.4 mm. The average distance between peroneal tendons sheath and the sural nerve at 5 cm, 3 cm, and 2 cm from the proximal fibular tip was 29.6 ± 3.2 mm, 24.2 ± 3.6 mm, and 19.7 ± 2.7 mm, respectively. The average distance between the peroneal tendons sheath and the sural nerve at 2 cm and 1.5 cm distal to fibular tip was 9.1 ± 3.5 mm and 7.8 ± 3.3 mm, respectively. CONCLUSION The distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal. As the distance between the peroneal tendons sheath and the sural nerve decreases from proximal to distal, performing the tendoscopy portal more distally would increase the risk of nerve iatrogenic injury.
Collapse
|
8
|
The distance from the peroneal tendons sheath to the sural nerve at the posterior tip of the fibula decreases from proximal to distal. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2019. [PMID: 30888450 DOI: 10.1007/s00167-019-05438-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
PURPOSE The aim of this study is to compare the distance from the peroneal tendons sheath to the sural nerve in different points proximally and distally to the tip of the fibula. METHODS Ten fresh-frozen lower extremities were dissected to expose the nerves and tendons. Having the posterior tip of the fibula as a reference, the distance between the tendons sheath and the sural nerve was measured in each point with a tachometer with three independent different observers. Two measures were taken distally at 1.5 and 2 cm from fibula tip and 3 measures were performed proximally at 2, 3, and 5 cm from fibula tip. Data were described using means, standard deviations, medians, and minimum and maximum values. RESULTS The average distance between distance between the fibula tip and sural nerve is 16.6 ± 4.4 mm. The average distance between peroneal tendons sheath and the sural nerve at 5 cm, 3 cm, and 2 cm from the proximal fibular tip was 29.6 ± 3.2 mm, 24.2 ± 3.6 mm, and 19.7 ± 2.7 mm, respectively. The average distance between the peroneal tendons sheath and the sural nerve at 2 cm and 1.5 cm distal to fibular tip was 9.1 ± 3.5 mm and 7.8 ± 3.3 mm, respectively. CONCLUSION The distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal. As the distance between the peroneal tendons sheath and the sural nerve decreases from proximal to distal, performing the tendoscopy portal more distally would increase the risk of nerve iatrogenic injury.
Collapse
|
9
|
Urguden M, Gulten IA, Civan O, Bilbasar H, Kaptan C, Cavit A. Results of Peroneal Tendoscopy With a Technical Modification. Foot Ankle Int 2019; 40:356-363. [PMID: 30466307 DOI: 10.1177/1071100718809350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: The aim of this study was to evaluate the role of tendoscopy in the diagnosis and treatment of peroneal tendon (PT) pathologies, and to evaluate the results of our technical modification. METHODS: Twenty ankles of 18 patients with retrofibular pain, operated on between 2006 and 2012, were included in this study. Peroneal tendoscopy was performed diagnostically for the patients who were diagnosed as having "peroneal tendinopathy" with physical examination, x-ray, or magnetic resonance imaging (MRI). After being diagnosed by peroneal tendoscopy, patients were definitively treated with either tendoscopy or open surgery. RESULTS: Thirteen of 20 ankles had accompanying ankle pathology with PT pathology, and the other 7 ankles had no concomitant pathology. We detected peroneal tenosynovitis (PTS) in 13 patients, PT tear in 7 patients, and vincula thickening in 1 patient. The American Orthopaedic Foot & Ankle Society (AOFAS) score was 76 preoperatively, and after 2 years' follow-up the AOFAS score was 96. CONCLUSION: Tendoscopy is a useful method for the diagnosis and treatment of PT pathologies. The patients with clinical suspicion of PT pathology were treated or diagnosed by peroneal tendoscopy with our technical modification. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Collapse
Affiliation(s)
- Mustafa Urguden
- 1 School of Medicine, Department of Orthopaedics and Traumatology, Akdeniz University, Antalya, Turkey
| | - Ismail Ayder Gulten
- 2 Clinic of Orthopaedics and Traumatology, Tokat State Hospital, Tokat, Turkey
| | - Osman Civan
- 3 Clinic of Orthopaedics and Traumatology, Yüksekova State Hospital, Hakkari, Turkey
| | - Hakan Bilbasar
- 4 Clinic of Orthopaedics and Traumatology, Private Akdeniz Hospital, Antalya, Turkey
| | - Cagri Kaptan
- 5 Clinic of Orthopaedics and Traumatology, Kepez State Hospital, Antalya, Turkey
| | - Ali Cavit
- 6 School of Medicine, Department of Hand Surgery, Uludag University, Bursa, Turkey
| |
Collapse
|
10
|
Abstract
BACKGROUND Despite multiple studies outlining peroneal tendoscopy, no study exists to evaluate how effective tendoscopy is at visualizing the peroneal tendons without missing a lesion. We sought to measure the length of the peroneal tendons that could be visualized using tendoscopy. METHODS Ten fresh cadaveric specimens were evaluated using standard peroneal tendoscopy techniques. Peroneus longus and brevis tendons were pierced percutaneously with Kirschner wires at the edge of what could be seen through the camera. The tendon sheaths were then dissected and the distances from anatomic landmarks were directly measured. During zone 3 peroneus longus tendoscopy, a more distal portal site was created for the final 5 specimens. RESULTS The peroneus brevis could be visualized through the entirety of zone 1 and up to an average of 19.5 mm (95% confidence interval, 16.5-22.5) from its insertion onto the base of the fifth metatarsal in zone 2. Peroneus longus could be visualized through the entirety of zones 1 and 2 and up to an average of 9.7 mm from its insertion onto the base of the first metatarsal in zone 3. This distance was decreased significantly with a more distal portal. The muscle belly of peroneus brevis terminated an average of 1.8 mm (-3.7 to 7.3) above the tip of the lateral malleolus. CONCLUSIONS Despite limitations, these results suggest that the vast majority of the length of the peroneal tendons can be seen during routine peroneal tendoscopy. A more distal skin portal site may improve visualization of zone 3 of peroneus longus. CLINICAL RELEVANCE This study confirms the ability of peroneal tendoscopy to see the entire tendon length with appropriate portal placement.
Collapse
Affiliation(s)
| | - John T Campbell
- 2 Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - Clifford L Jeng
- 2 Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - R Frank Henn
- 3 Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rebecca A Cerrato
- 2 Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| |
Collapse
|
11
|
Pereira H, Vuurberg G, Stone J, Lui TH. Ankle tendoscopy: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2017-000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
12
|
Abstract
Tendoscopy is an apparently safe and reliable procedure to manage some foot and ankle disorders.The most common foot and ankle tendoscopies are: Achilles; peroneal; and posterior tibial tendon.Tendoscopy may be used as an adjacent procedure to other techniques.Caution is recommended to avoid neurovascular injuries.Predominantly level IV and V studies are found in the literature, with no level I studies still available.There are many promising and evolving endoscopic techniques for tendinopathies around the foot and ankle, but studies of higher levels of evidence are needed to strongly recommend these procedures. Cite this article: EFORT Open Rev 2016;1:440-447. DOI: 10.1302/2058-5241.160028.
Collapse
|
13
|
Yasui Y, Tonogai I, Rosenbaum AJ, Moore DM, Takao M, Kawano H, Kennedy JG. Use of the arthroereisis screw with tendoscopic delivered platelet-rich plasma for early stage adult acquired flatfoot deformity. INTERNATIONAL ORTHOPAEDICS 2016; 41:315-321. [PMID: 27885384 DOI: 10.1007/s00264-016-3349-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Early stage adult acquired flatfoot deformity (AAFD) is traditionally treated with osteotomy and tendon transfer. Despite a high success rate, the long recovery time and associated morbidity are not sufficient. This study aims to evaluate the functional and radiological outcomes following the use of the arthroereisis screw with tendoscopic delivered PRP for early stage AAFD. METHODS Patients with stage IIa AAFD who underwent the use of the arthroereisis screw with tendoscopic delivered PRP with a minimum follow-up time of 24 months were retrospectively evaluated. Clinical outcomes for pain were evaluated with the Foot and Ankle Outcomes Score (FAOS) and Visual Analog Score (VAS). Radiographic deformity correction was assessed using weight-bearing imaging. RESULTS Thirteen patients (13 feet) with mean follow-up of 29.5 months were included. The mean age was 37.3 years (range, 28-65 years). FAOS-reported symptoms, pain, daily activities, sports activities, and quality of life significantly improved from 52.1, 42.6, 57.6, 35.7, and 15.4 pre-operatively to 78.5, 68.2, 83.3, 65.0, and 49.6 post-operatively, respectively (p < 0.05). Statistically significant radiographic improvements (lateral talus first metatarsal angle, calcaneal pitch, and cuneiform to ground distance) were also observed between the pre- and post-operative images. CONCLUSIONS This study elucidates the successful implementation of a less invasive approach to stage IIa AAFD. Through the use of a subtalar arthroereisis screw, PTT tendoscopy, and PRP injection, clinical and radiographic outcomes were improved.
Collapse
Affiliation(s)
- Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan.,Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
| | - Ichiro Tonogai
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,Department of Orthopedic Surgery, Tokushima University, Tokushima, Japan
| | - Andrew J Rosenbaum
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
| | - David M Moore
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Masato Takao
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - John G Kennedy
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
| |
Collapse
|
14
|
Kennedy JG, van Dijk PAD, Murawski CD, Duke G, Newman H, DiGiovanni CW, Yasui Y. Functional outcomes after peroneal tendoscopy in the treatment of peroneal tendon disorders. Knee Surg Sports Traumatol Arthrosc 2016; 24:1148-54. [PMID: 26846655 DOI: 10.1007/s00167-016-4012-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/19/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE The primary purpose of this study was to evaluate clinical outcomes following peroneal tendoscopy for the treatment of peroneal pathology. Correlation between pre-operative magnetic resonance imaging (MRI) and peroneal tendoscopic diagnostic findings was also assessed. METHODS Twenty-three patients with a mean age of 34 ± 8.8 years undergoing peroneal tendoscopy were pre- and post-operatively assessed with the foot and ankle outcome score (FAOS) and the Short Form-12 (SF-12) outcome questionnaires. Follow-up was over 24 months in all patients. The sensitivity and specificity of MRI were calculated in comparison with peroneal tendoscopy, including the positive predictive value (PPV). RESULTS Both the FAOS and the SF-12 improved significantly (p < 0.05) at a mean follow-up of 33 ± 7.3 months significantly. MRI showed an overall sensitivity of 0.90 (95% confidence interval (CI) = 0.82-0.95) and specificity of 0.72 (95% CI 0.62-0.80). The PPV for MRI diagnosis of peroneal tendon pathology was 0.76 (95% CI 0.68-0.83). CONCLUSIONS The current study found good clinical outcomes in patients with peroneal tendon disorders, treated with peroneal tendoscopy. Although a relatively small number of patients were included, the study suggests good correlation between tendoscopic findings and pre-operative MRI findings of peroneal tendon pathology, supporting the use of MRI as a useful diagnostic modality for suspected peroneal tendon disorders. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
| | - Pim A D van Dijk
- Hospital for Special Surgery, New York, NY, USA.,Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | | | - Gavin Duke
- East River Medical Imaging, New York, NY, USA
| | | | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Youichi Yasui
- Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
15
|
Pesquer L, Guillo S, Poussange N, Pele E, Meyer P, Dallaudière B. Dynamic ultrasound of peroneal tendon instability. Br J Radiol 2016; 89:20150958. [PMID: 26943704 DOI: 10.1259/bjr.20150958] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ankle snapping may be caused by peroneal tendon instability. Anterior instability occurs after traumatic superior peroneal retinaculum injury, whereas peroneal tendon intrasheath subluxation is atraumatic. Whereas subluxation is mainly dynamic, ultrasound allows for the diagnosis and classification of peroneal instability because it allows for real-time exploration. The purpose of this review is to describe the anatomic and physiologic bases for peroneal instability and to heighten the role of dynamic ultrasound in the diagnosis of snapping.
Collapse
Affiliation(s)
- Lionel Pesquer
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| | - Stéphane Guillo
- 2 Foot and Ankle Department, Orthopaedic Surgery Center, Clinique du Sport de Bordeaux, Mérignac, France
| | - Nicolas Poussange
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| | - Eric Pele
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| | - Philippe Meyer
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| | - Benjamin Dallaudière
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Bojanić I, Dimnjaković D, Bohaček I, Smoljanović T. Peroneal tendoscopy--more than just a solitary procedure: case-series. Croat Med J 2015; 56:57-62. [PMID: 25727043 PMCID: PMC4364349 DOI: 10.3325/cmj.2015.56.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study presents a series of 13 patients who underwent peroneal tendoscopy as a solitary or accessory procedure at our department in 2013. Patients were clinically diagnosed with peroneal tendons disorders and underwent an additional radiological assessment. Peroneal tendoscopy was carried out in a standard manner before any other arthroscopic or open procedure. Postoperative management depended on the type of pathology. We found 3 peroneus brevis tendon partial tears, 4 cases of a low-lying peroneus brevis muscle belly, 5 cases of tenosynovitis, and 1 case of an intrasheath peroneal tendon subluxation. In 5 patients peroneal tendoscopy was performed as a solitary procedure and in 8 patients as an accessory procedure – together with anterior or posterior ankle arthroscopy, combined posterior and anterior ankle arthroscopy, or open surgery. Both as a solitary and accessory procedure, peroneal tendoscopy was safe and successful, ie, all patients were without any symptoms at one-year follow-up. Our series of patients showed that peroneal tendoscopy can be used both as an independent procedure as well as a valuable accessory procedure.
Collapse
Affiliation(s)
- Ivan Bojanić
- Ivan Bojanic, Department of Orthopaedic Surgery, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Salata 7, 10000 Zagreb, Croatia,
| | | | | | | |
Collapse
|
18
|
Mattos e Dinato MC, de Faria Freitas M, Pereira Filho MV. Peroneal tenodesis with the use of tendoscopy: surgical technique and report of 1 case. Arthrosc Tech 2014; 3:e107-10. [PMID: 24749027 PMCID: PMC3986509 DOI: 10.1016/j.eats.2013.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/06/2013] [Indexed: 02/03/2023] Open
Abstract
Peroneus brevis tendon injury is the most common lesion of the peroneal tendons. The initial treatment is conservative, and surgical treatment is indicated if conservative treatment fails. It is often necessary to open the entire upper and lower retinaculum to obtain adequate visualization of the structures. We present a case in which the peroneus brevis tenodesis was used with the aid of tendoscopy. This technique should be used for patients with lesions affecting more than 50% of the tendon diameter. We found that, by making small incisions, the patient recovered well, quickly, with resolution of pain.
Collapse
Affiliation(s)
- Mauro Cesar Mattos e Dinato
- Instituto Vita, São Paulo,Universidade Estadual de Campinas, Campinas, Brazil,Address correspondence to Mauro Cesar Mattos e Dinato, M.D., Rua Mato Grosso, 306, 1a Andar, Higienópolis, São Paulo (SP), Brazil.
| | | | | |
Collapse
|
19
|
Abstract
Advances in foot and ankle arthroscopy have allowed surgeons to diagnose and treat a broadening array of disorders that were previously limited to open procedures. Arthroscopy of the posterior ankle, subtalar joint, and first metatarsophalangeal joint and tendoscopy can be used to address common foot and ankle ailments, with the potential benefits of decreased pain, fast recovery, and low complication rates. Posterior ankle and subtalar arthroscopy can be used to manage impingement, arthrofibrosis, synovitis, arthritis, fractures, and osteochondral defects. First metatarsophalangeal joint arthroscopy can address osteophytes, chronic synovitis, osteochondral defects, and degenerative joint disease. Tendoscopy is a minimally invasive alternative for evaluation and débridement of the Achilles, posterior tibial, flexor hallucis longus, and peroneal tendons.
Collapse
|
20
|
Bravo-Giménez B, García-Lamas L, Jiménez-Díaz V, Llanos-Alcázar L, Vilá-Rico J. Peroneal tendoscopy: Our experience. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013. [DOI: 10.1016/j.recote.2013.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
21
|
Bravo-Giménez B, García-Lamas L, Jiménez-Díaz V, Llanos-Alcázar L, Vilá-Rico J. Tendoscopia de los peroneos: nuestra experiencia. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 57:268-75. [DOI: 10.1016/j.recot.2013.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 02/19/2013] [Accepted: 02/19/2013] [Indexed: 12/01/2022] Open
|
22
|
Treatment of recurring peroneal tendon subluxation in athletes: endoscopic repair of the retinaculum. Foot Ankle Clin 2013; 18:293-300. [PMID: 23707178 DOI: 10.1016/j.fcl.2013.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Traumatic peroneal tendon subluxation is a rare lesion that occurs most frequently during sporting activities and generally after an ankle sprain. There is consensus regarding the need for surgical stabilization in symptomatic patients, but there is also a general agreement that acute subluxation or dislocations may require surgery in the athlete. Many surgical techniques have been described to treat this lesion. Overall, studies have reported excellent or good results in 90% of cases, although there have been reports of significant complications following open surgical procedures. Endoscopic anatomical retinacular repair offers an attractive alternative to open repair and may reduce complications and allow early return to sports.
Collapse
|
23
|
Abstract
This article discusses the role of ankle arthroscopy in the acute management of ankle trauma in athletes. The rate of intra-articular pathology associated with ankle trauma is high and arthroscopic treatment often has an important role to play. Its major role is in the assessment and treatment of joint surface damage, syndesmotic instability, and intra-articular fractures.
Collapse
Affiliation(s)
- Steve Hepple
- Department of Orthopaedics, Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
| | | |
Collapse
|
24
|
Vega J, Batista JP, Golanó P, Dalmau A, Viladot R. Tendoscopic groove deepening for chronic subluxation of the peroneal tendons. Foot Ankle Int 2013; 34:832-40. [PMID: 23513032 DOI: 10.1177/1071100713483098] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Recurrent subluxation of the peroneal tendons over the lateral malleolus is an uncommon disabling condition in young people involved in sports. Injury to the superior peroneal retinaculum, sometimes in association with a shallow fibular groove, can lead to this condition. There are several surgical treatments for recurrent peroneal tendon subluxation, but no tendoscopy technique has been reported to date. The aim of this study was to describe a tendoscopic groove-deepening technique and its results for treating patients with recurrent subluxation of the peroneal tendons. METHODS Seven patients (3 women and 4 men; mean age 26.4 [21-32] years) with chronic subluxation of the peroneal tendons were treated with a tendoscopic procedure. All patients experienced pain at the lateral retromalleolar area and recurrent subluxation of the peroneal tendons. The right ankle was affected in 4 patients. Mean follow-up was 15.4 (8-25) months. RESULTS On tendoscopic examination, all patients had a flat fibular groove, and the superior peroneal retinaculum was found to be detached in 4 cases. Three patients had a superficial injury of the peroneus brevis tendon which was debrided. Tendoscopic deepening of the peroneal groove without superior peroneal retinaculum repair was performed in all cases. None of the patients experienced recurrent subluxation during follow-up. The AOFAS score increased from 75 preoperatively to 93 at final follow-up. No complications were reported in any case. CONCLUSION Tendoscopic deepening of the fibular groove was a reproducible, minimally invasive technique that provided a favorable outcome for recurrent subluxation of the peroneal tendons in our limited number of patients. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Jordi Vega
- Etzelclinic, Foot and Ankle Surgery Unit, Pfäffikon, Schwyz, Switzerland.
| | | | | | | | | |
Collapse
|
25
|
Endoscopic treatment of intrasheath peroneal tendon subluxation. Case Rep Med 2012; 2013:274685. [PMID: 23424591 PMCID: PMC3569882 DOI: 10.1155/2013/274685] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 12/21/2012] [Indexed: 11/29/2022] Open
Abstract
Intrasheath subluxation of the peroneal tendons within the peroneal groove is an uncommon problem. Open exploration combined with a peroneal groove-deepening procedure and retinacular reefing is the recommended treatment. This extensive lateral approach needs incision of the intact superior peroneal retinaculum and repair afterwards. We treated three patients with a painful intrasheath subluxation using an endoscopic approach. During this tendoscopy both tendons were inspected. The distal muscle fibers of the peroneus brevis tendon were resected in two patients. A partial tear was debrided in the third patient. All patients had a good result. No wound-healing problems or other complications occurred. Early return to work and sports was possible. An endoscopic approach was successful in treatment of an intrasheath subluxation of the peroneal tendons.
Collapse
|
26
|
Marmotti A, Cravino M, Germano M, Del Din R, Rossi R, Tron A, Tellini A, Castoldi F. Peroneal tendoscopy. Curr Rev Musculoskelet Med 2012; 5:135-44. [PMID: 22527779 DOI: 10.1007/s12178-012-9123-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Peroneal tendoscopy is an innovative technique that allows visualization of the tendons from the myotendinous junction to the peroneal tubercle, together with adjacent anatomic structures such as the recently unveiled vincula. Through a minimally invasive approach, it is possible to diagnose and treat several disorders, such as common tenosynovitis, accessory muscles, hypertrophic bony prominences, and thickened vincula, that can cause pain and tendon catching. Surgical morbidity and postoperative pain are significantly reduced when compared with open procedures. In this paper, the main indications for peroneal tendoscopy are discussed, the available literature is reviewed, and the surgical technique is described. Advantages of this procedure and current limitations are also presented. Anatomic and histological studies were also performed in order to verify: 1) the feasibility of peroneal tendoscopy for evaluation of peroneal tendons, using cadaver specimens; 2) the presence of nervous tissue in cadaver peroneal vincula as well as in tendoscopic vincula biopsies from patients undergoing surgery for chronic lateral ankle pain.
Collapse
Affiliation(s)
- Antonio Marmotti
- Department of Orthopaedics and Traumatology, University of Turin, Turin, Italy,
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Peroneal tendon instability. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31823ea9a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
28
|
|
29
|
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]
|
30
|
Vega J, Golanó P, Dalmau A, Viladot R. Tendoscopic treatment of intrasheath subluxation of the peroneal tendons. Foot Ankle Int 2011; 32:1147-51. [PMID: 22381199 DOI: 10.3113/fai.2011.1147] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Intrasheath subluxation of the peroneal tendons does not have an injury of the proximal retinaculum. The aim of this study was to describe the tendoscopic technique and preliminary results. METHODS Six patients with intrasheath subluxation of the peroneal tendons were treated tendoscopically. All patients had preoperative pain and a clicking sensation at the lateral retromalleolar area. Mean followup was 18.3 (range, 14 to 24) months. These six patients included three males and three females, with a mean age of 23.5 (range, 18 to 33) years. The AOFAS and Visual Analog Score for pain were used to evaluate the patients. RESULTS During tendoscopy, two patients had a peroneus quartus tendon which was removed; three had a low-lying peroneus brevis muscle that was resected; and in two cases deepening of the peroneal groove was performed. At followup, all patients reported excellent results, without pain or clicking sensation. The mean AOFAS score increased from 79 to 99, and Visual Analog Score at followup was 0 in four patients and 1 in two patients. CONCLUSION Tendoscopic treatment of these pathologies led to improved function in a less aggressive manner than open surgery.
Collapse
Affiliation(s)
- Jordi Vega
- Hospital Asepeyo Sant Cugat, Orthopedic and Trauma Surgery, Barcelona, Spain.
| | | | | | | |
Collapse
|
31
|
Ogut T, Ayhan E, Irgit K, Sarikaya AI. Endoscopic treatment of posterior ankle pain. Knee Surg Sports Traumatol Arthrosc 2011; 19:1355-61. [PMID: 21311860 DOI: 10.1007/s00167-011-1428-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 01/27/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study is to describe the indications for two-portal hindfoot endoscopy in the treatment of posterior ankle compartment pathologies and to express the effectiveness of this technique by short- to mid-term outcomes on 59 consecutive patients. METHODS In our institute, between 2003 and 2009, patients operated by single surgeon with hindfoot endoscopy were enrolled. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and Maryland foot scores (MFS) were obtained preoperatively and postoperatively. In the final follow-up, besides the scores, patients were asked whether they were satisfied and whether they would elect this treatment again. RESULTS The indications for 59 patients were posterior ankle impingement syndrome (14), osteochondral lesion of talus (13), isolated flexor hallucis longus (FHL) tenosynovitis (11), synovial osteochondromatosis (2), pigmented villonodular synovitis (2), peroneal tenosynovitis (4), subtalar joint arthrosis (4), tibiotalar arthrosis (4), intraosseous talus cyst (4; 1 bilateral), and talus fracture (1). FHL tendon was affected in all cases, and tenolysis was performed for each patient. The mean preoperative AOFAS-hindfoot scores increased from 56.7 ± 14.5 to 85.9 ± 12.5 (P < 0.0001), and the mean preoperative MFS increased from 54.8 ± 17.5 to 84.9 ± 15.9 (P < 0.0001), postoperatively. Four patients with posttraumatic arthritis were dissatisfied. Two sural nerve-related complications were identified. DISCUSSION Hindfoot endoscopy was demonstrated to be a safe and effective procedure for the treatment of various hindfoot pathologies in this cohort, excluding patients with posttraumatic arthritis. Our results show that the prevalence of FHL tenosynovitis may be higher than previously reported and should always be considered in differential diagnosis of posteromedial ankle pain. LEVEL OF EVIDENCE Case series with no comparison group, Level IV.
Collapse
Affiliation(s)
- Tahir Ogut
- Cerrahpasa Medical Faculty, Orthopaedics and Traumatology Department, Istanbul University, Istanbul, Turkey
| | | | | | | |
Collapse
|
32
|
Abstract
In this article, the peroneus longus and brevis, posterior tibial, Achilles, and flexor hallucis longus tendon endoscopy are discussed individually. Tendoscopic indications and surgical technique are highlighted.
Collapse
Affiliation(s)
- Jeffrey C Christensen
- Department of Orthopedics, Division of Podiatric Surgery, Swedish Medical Center, Seattle, WA, USA.
| | | |
Collapse
|