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Saliba I, Dagher T, Valentin E, Cannell S, Moussellard HP, Anract P, Feruglio S, Vialle R, Bauer T, Hardy A. The Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) is a valid and reliable measure to assess psychological readiness before returning to sport following peroneal tendon pathology surgery. Knee Surg Sports Traumatol Arthrosc 2024; 32:542-549. [PMID: 38372173 DOI: 10.1002/ksa.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE The objective of this study was to validate a scale that could help surgeons evaluate patients' psychological readiness to return to sport (RTS) after peroneal tendon pathology surgery. METHODS The Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) scale, which had previously been validated in ankle ligament reconstruction patients, was adapted to evaluate the psychological preparedness for RTS in athletic patients who underwent peroneal tendinopathy surgery. The Foot and Ankle Outcome Score (FAOS) and Foot Ankle Ability Measurement (FAAM) scores were employed as patient-related outcome measurement (PROM) instruments. RESULTS This study included 57 patients. There was a strong correlation between ALR-RSI and both FAOS and FAAM (r = -0.68 and 0.74, respectively). ALR-RSI was considerably higher in patients who returned to sports than in those who did not. The mean score was 72.9 ± 19.0 in patients who returned to the same preinjury level, 48.5 ± 24.0 in those who returned to a lower level and 53.6 ± 31.1 in patients who changed their athletic activity (p < 0.0001). Furthermore, ALR-RSI showed at least a similar discrimination ability when compared to FAOS and FAAM. The test-retest intraclass correlation coefficient was 0.95. The Cronbach's α statistic used to measure the internal consistency was high (0.95). A Youden index of 0.65 was observed for a cut-off score of 68 points. CONCLUSION ALR-RSI is a valid instrument for assessing psychological readiness to RTS in an athletic population following peroneal tendon surgery. When compared to the most commonly used PROMs, it was strongly correlated and demonstrated at least similar discrimination capacity. This could assist surgeons in identifying athletes who will have poor postoperative results and advising them on their capability to RTS. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ibrahim Saliba
- Department of Orthopedic Surgery, Cochin Hospital, Paris, France
| | - Tanios Dagher
- Department of Orthopedic Surgery, Cochin Hospital, Paris, France
| | - Eugenie Valentin
- Department of Orthopedic surgery, Clinique Du Sport, Paris, France
| | - Stuart Cannell
- Department of Orthopedics, Robert Debré Hospital, Paris, France
| | | | - Philippe Anract
- Department of Orthopedic Surgery, Cochin Hospital, Paris, France
| | - Sylvain Feruglio
- Laboratoire d'informatique de Sorbonne Université (LIP6), Sorbonne Université, Paris, France
| | - Raphael Vialle
- Department of Orthopedics, Armand Trousseau Hospital, Paris, France
| | - Thomas Bauer
- Department of Orthopedics, Ambroise Paré Hospital, Paris, France
| | - Alexandre Hardy
- Department of Orthopedic surgery, Clinique Du Sport, Paris, France
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Lootsma J, Wuite S, Hoekstra H, Matricali GA. Surgical treatment options for chronic instability of the peroneal tendons: a systematic review and proportional meta-analysis. Arch Orthop Trauma Surg 2023; 143:1903-1913. [PMID: 35260916 DOI: 10.1007/s00402-022-04395-4] [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: 11/30/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Several surgical techniques for chronic instability of the peroneal tendons have been reported. Yet, the most optimal technique has not been clarified. This study aims to perform a systematic review and meta-analysis of all existing evidence and compare all published surgical techniques in both the athletic as the nonathletic population. MATERIALS AND METHODS A systematic review and a proportional meta-analysis, with a random-effects model, were carried out according to the PRISMA guidelines, using the keywords "chronic luxation" OR "instability" AND "peroneal tendon" AND "treatment" OR "treatment protocol". Four surgical techniques were compared in patients with chronic peroneal instability, comprising superior peroneal retinaculum (SPR) repair or replacement, groove deepening procedures (primarily with additional SPR operations), rerouting procedures, and bony procedures (respectively group S, G, R and B). Outcomes of interest include the pre- and postoperative American orthopedic foot and ankle society hindfoot score, return to sports, postoperative redislocation and complications. Pooled estimates of the last two outcomes were obtained. RESULTS For the systematic review, 31 studies were eligible. Of these, 25 papers met the criteria for inclusion in the meta-analysis. All techniques demonstrated a clinical improvement postoperatively. Group B, however, demonstrated overall more unsatisfactory results, and higher complication rates were observed for both group R and group B. The latter was established by the proportional meta-analysis as well [95% confidence interval group S: (0.01-0.10); group G: (0.02-0.10); group R: (0.13-0.57); group B: (0.24-0.40)]. Concerning surgical efficacy (= no postoperative redislocation), no significant difference was statistically observed. Finally, considerable differences in study quality were identified. CONCLUSION Surgical treatment results in excellent clinical and functional outcomes in patients with chronic peroneal instability. More inferior results were demonstrated for rerouting and bony procedures. However, no high-quality studies are available and future randomized controlled trials are necessary to advocate for the most advantageous approach.
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Affiliation(s)
- Joline Lootsma
- Faculty of Medicine, KU Leuven-University of Leuven, Leuven, Belgium.
- Center for Orthopedics, Trauma and Reconstructive Surgery, Rhein-Maas Klinikum, Würselen, Germany.
- , Boulevard du Midi 118, 1000, Brussels, Belgium.
| | - Sander Wuite
- Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Orthopaedic Research and Training, KU Leuven-University of Leuven, Leuven, Belgium
| | - Harm Hoekstra
- Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni A Matricali
- Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Orthopaedic Research and Training, KU Leuven-University of Leuven, Leuven, Belgium
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Hwang IM, Rayos del Sol S, Jenkins SM, Bryant SA, Gardner BB, McGahan P, Chen J. Open Peroneal Tendon Stabilization With Fibular Groove Deepening. Arthrosc Tech 2022; 11:e347-e352. [PMID: 35256974 PMCID: PMC8897588 DOI: 10.1016/j.eats.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/31/2021] [Indexed: 02/03/2023] Open
Abstract
Peroneal tendon subluxation often occurs because of sudden dorsiflexion of the ankle, leading to a traumatic rupture of the superior peroneal retinaculum. Currently, there are several surgical techniques to deepen the fibular groove, but there is no universally accepted gold standard. This technique article describes a fibular groove deepening with preservation of the fibrocartilage in conjunction with repair of the superior peroneal retinaculum. Addressing the main pathologies that may be leading to subluxation of the peroneal tendons, we offer an approach that avoids many of the common pitfalls from previously proposed techniques while preserving the natural fibrocartilage within the malleolar groove and repairing the retinaculum.
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Affiliation(s)
- Inga M. Hwang
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A.,Address correspondence to Inga Hwang, B.S., Advanced Orthopedics and Sports Medicine, San Francisco, CA, 94108, U.S.A.
| | | | - Sarah M. Jenkins
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Stewart A. Bryant
- Department of Orthopaedic Surgery, University of Hawaii Honolulu, Hawaii, U.S.A
| | - Brandon B. Gardner
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Patrick McGahan
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - James Chen
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
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Tendoscopic peroneal retinaculum repair for recurrent peroneal tendon dislocation enables earlier return to sports than the open procedure. Knee Surg Sports Traumatol Arthrosc 2020; 28:3318-3323. [PMID: 32030502 DOI: 10.1007/s00167-020-05877-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/22/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether tendoscopic peroneal retinaculum repair for patients with recurrent peroneal tendon dislocation (RPTD) is more useful than an open procedure. METHODS Twenty-five patients with RPTD were retrospectively reviewed. Twelve patients (13 ankles) with RPTD underwent the open procedure (Group A) between 2008 and 2014, and 13 patients (14 ankles) underwent the tendoscopic procedure (Group B) between 2014 and 2017. Evaluation parameters included clinical results [the Japanese Society for Surgery of the Foot (JSSF) ankle-hind foot scale], operation time, complications, return to sports, and recurrence. RESULTS Postoperative JSSF ankle/hindfoot scale scores were significantly better than the pre-surgical scores in both groups. The mean operation time was significantly longer in Group B than in Group A (75.7 ± 20.5 vs 38.4 ± 10.5 min). There was one recurrence in Group A, but none in Group B. Group A had no complications, and Group B had one wound infection. Group B, excluding the case of infection, could return to sports earlier than Group A, excluding the recurrent case (13.4 ± 1.5 vs 12.2 ± 0.6 weeks). CONCLUSIONS This tendoscopic procedure needs longer operation time and is more technically demanding, but it is a useful procedure, because it is less invasive and can accelerate return to sports. LEVEL OF EVIDENCE III.
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Deng E, Shi W, Jiao C, Xie X, Jiang D, Chen L, Hu Y, Guo Q. Reattachment of the superior peroneal retinaculum versus the bone block procedure for the treatment of recurrent peroneal tendon dislocation: two safe and effective techniques. Knee Surg Sports Traumatol Arthrosc 2019; 27:2877-2883. [PMID: 30903219 DOI: 10.1007/s00167-019-05479-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/06/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Clinical outcomes between reattachment of the superior peroneal retinaculum (SPR) and the bone block procedure were compared in this study to elucidate which procedure was safer and more effective. METHODS From 2012 to 2016, 25 patients with recurrent peroneal tendon dislocation underwent the bone block procedure (group A), and another 22 patients underwent reattachment of the SPR (group B). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Activity Score (AAS), time to return to sports activity, rate of return to sports level, range of motion (ROM) of the ankle, rate of recurrence, and overall patient satisfaction were collected to evaluate outcomes between the two groups. RESULTS In group A, 24 patients followed up at a mean period of 42.5 ± 16.7 months. The mean postoperative AOFAS score was 92.9 ± 3.9. The median time to return to sports activity was 6.0 months (IQR 4.3-6.0 months) with 19 patients (79.2%) returning to their previous sports level. Two patients experienced recurrent dislocation, and 22 patients (91.7%) were satisfied with the procedure. In group B, 20 patients followed up at a mean period of 35.8 ± 15.3 months. The mean postoperative AOFAS score was 95.0 ± 4.2. The median time to return to sports activity was 5.0 months (IQR 4.0-5.0 months) with 18 patients (90.0%) returning to their previous sports level. No recurrence was reported, and 18 patients (90.0%) were satisfied with the procedure. The time to return to sports activity in group B was significantly shorter than that in group A. There was no significant difference in complications or clinical outcomes between the two procedures. CONCLUSION Both procedures offered satisfactory results for recurrent peroneal tendon dislocation with low rates of recurrence and complications. However, the time to return to sports activity after the reattachment of the SPR was shorter than that after the bone block procedure. LEVEL OF EVIDENCE Retrospective Comparative Study, Level III.
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Affiliation(s)
- En Deng
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Weili Shi
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Chen Jiao
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xing Xie
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Dong Jiang
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Linxin Chen
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yuelin Hu
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Qinwei Guo
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Suh JW, Lee JW, Park JY, Choi WJ, Han SH. Posterior Fibular Groove Deepening Procedure With Low-Profile Screw Fixation of Fibrocartilaginous Flap for Chronic Peroneal Tendon Dislocation. J Foot Ankle Surg 2018; 57:478-483. [PMID: 29269024 DOI: 10.1053/j.jfas.2017.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Indexed: 02/03/2023]
Abstract
Chronic peroneal tendon dislocation is an uncommon disorder that frequently presents with concomitant pathology. Posterior fibular groove deepening and retinaculum repair have been increasing in popularity for treatment of peroneal tendon dislocations. The purpose of the present study was to introduce a posterior fibular groove deepening procedure using low-profile snap-off screws to securely and simply fix the fibrocartilaginous flap to facilitate faster rehabilitation and to assess the clinical outcomes of patients with chronic peroneal tendon dislocation and associated pathologic features. In the present retrospective case series, 34 ankles in 34 patients underwent the fibular groove deepening procedure using low-profile screws with superior peroneal retinaculum repair. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and patient subjective satisfaction rate. The time of return to recreational and sports activities was also assessed. Weightbearing ankle radiographs were evaluated to assess the stability of the flap by checking the screws. The mean follow-up period was 47.96 (range 12 to 142) months. The mean AOFAS scale score for all patients improved from 69.96 ± 13.14 to 87.72 ± 10.13 at the last follow-up examination (p < .001). Overall, 85.3% of patients subjectively rated their operative outcomes as excellent or good. The 18 (52.9%) patients with an isolated peroneal tendon dislocation had a faster return to recreational or sports activities than the 16 (47.1%) patients with concomitant pathologic features (2.95 ± 0.19 versus 4.14 ± 1.34 months; p = .002). No patient experienced residual dislocation, screw loosening, or irritation from the screws. The fibular groove deepening procedure using low-profile screws is be a simple procedure that offers rigid fixation. This leads to relatively fast rehabilitation and resumption of recreational or sports activities.
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Affiliation(s)
- Jae Wan Suh
- Assistant Professor, Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, Republic of Korea; Graduate Student, Department of Orthopaedic Surgery, Graduate School of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jin Woo Lee
- Professor, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Young Park
- Resident, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Choi
- Associate Professor, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Han
- Associate Professor, Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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7
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Yasui Y, Vig KS, Tonogai I, Hung CW, Murawski CD, Takao M, Kawano H, Kennedy JG. Incidence of reoperation and wound dehiscence in patients treated for peroneal tendon dislocations: comparison between osteotomy versus soft tissue procedures. Knee Surg Sports Traumatol Arthrosc 2018; 26:897-902. [PMID: 27904935 DOI: 10.1007/s00167-016-4383-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSES There is a lack of substantial clinical evidence endorsing the clinical outcomes of osteotomy for peroneal tendon dislocations. The aim of this study was to compare the post-operative reoperation rates following osteotomy techniques and soft tissues procedures using large database in order to investigate the efficacy of bony techniques. METHODS Patients who underwent osteotomy and soft tissue procedures for peroneal tendon dislocations were identified and subsequently analysed using the United Healthcare Orthopedic and the Medicare datasets (PearlDiver Patient Record Database, PearlDiver Technologies Inc., Fort Wayne, IN). The investigated period was from 2005 to 2012. The annual incidence, gender distribution, and incidences of reoperation and wound dehiscence following primary operative procedures were determined in these cohorts. RESULTS Of 6122 patients who received operative treatment for peroneal tendon dislocations, 1416 patients (23.1%) received the osteotomy technique, while 4706 (76.9%) were treated with the soft tissue techniques. The incidence of these operative procedures did not change significantly over the time periods of each database. In both databases, reoperation rates were 2.8% (40/1416) for osteotomy patients and 3.4% (158/4706) for soft tissue repair patients, with no statistical difference (2.8 vs. 3.4%. odds ratio 0.8, 95% confidence interval [CI] 0.6-1.2, [n.s.]) between them. Based on both databases, wound dehiscence occurred in 2.6% (37/1416) of the osteotomy patients and 2.3% (110/4706) of soft tissue repair patients with no statistical difference (2.6 vs. 2.3%, odds ratio 1.1, 95% CI 0.8-1.6, [n.s.]) between the groups. CONCLUSION The results of this study show that osteotomy techniques were frequently performed for patients with peroneal tendon dislocations. Nevertheless, osteotomy techniques for peroneal tendon dislocations are not associated with a lower risk of reoperation. In conclusion, soft tissue procedures offer a satisfactory method of treating peroneal tendon dislocations without any additional risk of reoperation when compared to osteotomy techniques that have potentially greater complication rates. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Youichi Yasui
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Khushdeep S Vig
- 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
| | - 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
| | - Chun Wai Hung
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,New York Medical College, Valhalla, NY, USA
| | - Christopher D Murawski
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - 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.
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Opdam KTM, van Dijk PAD, Stufkens SAS, van Dijk CN. The Peroneus Quartus Muscle in a Locking Phenomenon of the Ankle: A Case Report. J Foot Ankle Surg 2016; 56:108-111. [PMID: 27625201 DOI: 10.1053/j.jfas.2016.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Indexed: 02/03/2023]
Abstract
We present the case of a 64-year-old female who was referred to us with an unexplained clicking and locking phenomenon of the right ankle. The magnetic resonance imaging findings suggested a longitudinal tear of the peroneus brevis tendon. During tendoscopy, not only was a Raikin type B intrasheath tendon subluxation visible, but also a peroneus quartus muscle. The peroneus brevis tear was tubularized and the peroneus quartus muscle resected, which resolved the patient's complaints.
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Affiliation(s)
- Kim T M Opdam
- PhD Candidate, Department of Orthopaedic Surgery and Orthopaedic Research Center Amsterdam (ORCA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.
| | - Pim A D van Dijk
- PhD Candidate, Department of Orthopaedic Surgery and Orthopaedic Research Center Amsterdam (ORCA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands; Orthopedic Surgeon-Consultant Orthopaedic Surgeon, Flevoziekenhuis, Almere, The Netherlands; Postdoctoral Research Fellow, Department of Orthopaedic Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - C Niek van Dijk
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands; Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery and Orthopaedic Research Center Amsterdam (ORCA), Academic Medical Center, University of Amsterdam, The Netherlands
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9
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van Dijk PAD, Gianakos AL, Kerkhoffs GMMJ, Kennedy JG. Return to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:1155-64. [PMID: 26519186 PMCID: PMC4823328 DOI: 10.1007/s00167-015-3833-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/06/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study was to determine the outcome following different surgical treatment techniques in the treatment of peroneal tendon dislocation and to establish whether return to sports was achieved universally following the procedures. METHODS A systematic review and best-evidence synthesis was performed. PubMed and EMBASE were searched for eligible studies. The last search was done in March 2015. Quality assessment of pooled data was performed using a modified Macleod scale and a best-evidence synthesis was performed. In total, 14 studies were included. RESULTS Surgical treatment provides improvement in the post-operative AOFAS score (p < 0.0001) and high satisfaction rates. The redislocation rate is less than 1.5% at long-term follow-up. Patients treated with both groove deepening and SPR repair have higher rates of return to sports than patients treated with SPR repair alone (p = 0.022). CONCLUSIONS Surgical treatment of peroneal tendon dislocation provides good outcomes, high satisfaction and a quick return to sports. Rates in return to sports are significantly higher in patients treated with both groove deepening and SPR repair. To optimize treatment, the surgical management should involve increasing the superior peroneal tunnel volume by groove deepening and stabilizing the tendons by SPR repair. LEVEL OF EVIDENCE Level IV, systematic review of level IV studies.
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Affiliation(s)
- Pim A. D. van Dijk
- />Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Rm 507, New York, NY 10021 USA , />Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands , />Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Arianna L. Gianakos
- />Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Rm 507, New York, NY 10021 USA
| | - Gino M. M. J. Kerkhoffs
- />Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands , />Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - John G. Kennedy
- />Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Rm 507, New York, NY 10021 USA
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10
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Wedmore I, Young S, Franklin J. Emergency Department Evaluation and Management of Foot and Ankle Pain. Emerg Med Clin North Am 2015; 33:363-96. [DOI: 10.1016/j.emc.2014.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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11
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Yammine K. The accessory peroneal (fibular) muscles: peroneus quartus and peroneus digiti quinti. A systematic review and meta-analysis. Surg Radiol Anat 2015; 37:617-27. [PMID: 25638531 DOI: 10.1007/s00276-015-1438-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
Abstract
The denomination of "accessory peroneal muscle" (APM) refers usually to two muscles: the peroneus quartus (PQua) and the peroneus digit quinti (PQui) which were believed to be variants of a same muscle. Their morphology and prevalence show high variation in relevant literature mainly owing to the diverse terminology used to describe this muscle group. The aim of this meta-analysis is to generate more accurate description and frequency of those muscles. A total of 46 studies (3,928 legs/ankles) met the inclusion criteria. The aggregate results were: (a) a true APM prevalence of 16 % with 10.2 % for PQua vs. 34.3 % for PQui; (b) a crude prevalence of 16.6 % for PQua vs. 21.5 % for PQui; (c) a bilateral prevalence of 1.73 % for PQua vs. 12.5 % for PQui; (d) the PQua was significantly more prevalent in Indian populations compared to all other ancestries, and the PQui is significantly more prevalent in Europeans and Americans compared to Japanese and Korean populations; (e) though a tendency for higher frequency was found in males and on the right specimens, no significance was found for gender and side; for (f) the "surgical" occurrence of PQua in studies dealing with peroneal tendon surgery was 5.5 % where peroneal tendon pathology seems to be not associated with the presence of an APM; (g) the MRI prevalence of APM was 10.6 %; (h) APMs took origin from peroneus brevis in 60 %, from the distal fibula in 36 % and from other structures in 4 %; (i) APMs took insertion on retrotroclear eminence of the calcaneum in 53.4 %, on peroneal trochlea in 6.6 %, merged with a peroneal tendon in 9.3 %, and inserted on the extensor apparatus of the 5th toe in 18.4 %. Despite the acknowledged limitation owing to the varied terminology used to describe this accessory muscle group, the significant differences found between the aggregate frequency estimates of each muscle do not support the hypothesis that both muscles are variants of a same structure.
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Affiliation(s)
- Kaissar Yammine
- The Foot and Hand Clinic and the Center for Evidence-Based Anatomy, Sport and Orthopedic Research, Division of Evidence-based Anatomy, Emirates Hospital, Jumeirah Beach Road, P.O. Box 73663, Dubai, UAE,
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Mirmiran R, Squire C, Wassell D. Prevalence and Role of a Low-Lying Peroneus Brevis Muscle Belly in Patients With Peroneal Tendon Pathologic Features: A Potential Source of Tendon Subluxation. J Foot Ankle Surg 2015; 54:872-5. [PMID: 25998478 PMCID: PMC4553117 DOI: 10.1053/j.jfas.2015.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 02/03/2023]
Abstract
A peroneus brevis low-lying muscle belly (LLMB) is a rare anomaly. A few published studies have supported the presence of this anomaly as an etiology for a peroneal tendon tear. However, the association between a peroneus brevis LLMB and tendon subluxation has not been well explored. In the present retrospective study, the magnetic resonance imaging (MRI) and intraoperative findings of 50 consecutive patients undergoing primary peroneal tendon surgery during a 5-year period were assessed. The sensitivity and specificity of MRI compared with the intraoperative findings for identifying peroneal tendon disease were investigated. The presence of associated peroneal tendon pathologic features in patients with and without a peroneus brevis LLMB was also compared. The sensitivity of MRI was high for identifying peroneal tenosynovitis (81.58%) and tear (85.71%). Although the sensitivity of MRI for detecting a peroneus brevis LLMB (3.23%) and tendon subluxation (10.00%) was low, MRI had high specificity at 94.74% and 100%, respectively. Intraoperatively, a peroneus brevis LLMB was seen in 62.00% of the patients with chronic lateral ankle pain and was associated with 64.52% of the patients with tenosynovitis, 29.03% of those with tendon subluxation, and 80.65% of those with a peroneus brevis tendon tear. Although the presence of a peroneus brevis LLMB did not show any statistically significant association with peroneus brevis tendon subluxation, of the 10 patients with intraoperatively observed tendon subluxation, 9 had a concomitant peroneus brevis LLMB. More studies with larger patient populations are needed to better investigate the role of a peroneus brevis LLMB as a mass-occupying lesion resulting in peroneal tendon subluxation.
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Affiliation(s)
- Roya Mirmiran
- Chief of Podiatric Surgery, New Mexico VA Health Care System
| | - Chad Squire
- Former Resident, Podiatric Medicine & Surgery Residency at DVA-New Mexico/Kaiser Foundation
| | - Daniel Wassell
- Former Resident, Podiatric Medicine & Surgery Residency at DVA-New Mexico/Kaiser Foundation
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