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Conti MS, Kim J, Hoffman J, Jones CP, Ellis SJ, Deland JT, Steineman B. Peroneus Brevis to Longus Tendon Transfer in the Treatment of Flexible Progressive Collapsing Foot Deformity: A Cadaveric Study. Foot Ankle Int 2024; 45:656-663. [PMID: 38504500 DOI: 10.1177/10711007241238209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Although operative treatment of the flexible progressive collapsing foot deformity (PCFD) remains controversial, correction of residual forefoot varus and stabilization of the medial column are important components of reconstruction. A peroneus brevis (PB) to peroneus longus (PL) tendon transfer has been proposed to address these deformities. The aim of our study was to determine the effect of an isolated PB-to-PL transfer on medial column kinematics and plantar pressures in a simulated PCFD (sPCFD) cadaveric model. METHODS The stance phase of level walking was simulated in 10 midtibia cadaveric specimens using a validated 6-degree of freedom robot. Bone motions and plantar pressure were collected in 3 conditions: intact, sPCFD, and after PB-to-PL transfer. The PB-to-PL transfer was performed by transecting the PB and advancing the proximal stump 1 cm into the PL. Outcome measures included the change in joint rotation of the talonavicular, first naviculocuneiform, and first tarsometatarsal joints between conditions. Plantar pressure outcome measures included the maximum force, peak pressure under the first metatarsal, and the lateral-to-medial forefoot average pressure ratio. RESULTS Compared to the sPCFD condition, the PB-to-PL transfer resulted in significant increases in talonavicular plantarflexion and adduction of 68% and 72%, respectively, during simulated late stance phase. Talonavicular eversion also decreased in simulated late stance by 53%. Relative to the sPCFD condition, the PB-to-PL transfer also resulted in a 17% increase (P = .045) in maximum force and a 45-kPa increase (P = .038) in peak pressure under the first metatarsal, along with a medial shift in forefoot pressure. CONCLUSION The results from this cadaver-based simulation suggest that the addition of a PB-to-PL transfer as part of the surgical management of the flexible PCFD may aid in correction of deformity and increase the plantarflexion force under the first metatarsal. CLINICAL RELEVANCE This study provides biomechanical evidence to support the addition of a PB-to-PL tendon transfer in the surgical treatment of flexible PCFD.
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Affiliation(s)
- Matthew S Conti
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Jaeyoung Kim
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey Hoffman
- Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | | | - Scott J Ellis
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Brett Steineman
- Biomechanics, Hospital for Special Surgery, New York, NY, USA
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Urrutia T, Morales S, Mendez M, Filippi J, Vidal C, Palma J. Safety and exposure area in three different posteromedial surgical approaches for the treatment of ankle fractures. A cadaveric study. Foot Ankle Surg 2024:S1268-7731(24)00080-8. [PMID: 38714454 DOI: 10.1016/j.fas.2024.04.009] [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: 01/20/2024] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION This study aimed to compare the degree of posterior malleolar exposure, the tension of the flap containing the posteromedial neurovascular bundle (NVB), and the distance between the surgical incision and the NVB using three different posteromedial ankle approaches. METHODS Three approaches were compared: medial posteromedial (MePM) modified posteromedial (MoPM) and posteromedial (PM). We measured the minimal tension of the flap containing the NVB that allowed proper exposure. In the second stage, an axial cut was performed, and we measured the degree of posterior malleolar exposure and the distance between the incision and the NVB RESULTS: There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV,favoring the PM approach (71,00% ± 1.83 and 25.50 mm ± 4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ± 1.28) compared to the other two approaches CONCLUSION: The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choicefor large fractures of the posteromedial aspect of the PM.
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Affiliation(s)
- Tomas Urrutia
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | - Sergio Morales
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Magdalena Mendez
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jorge Filippi
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Catalina Vidal
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Joaquín Palma
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Davies JP, Smith WB. Management of Peroneal Tendon Complications. Foot Ankle Clin 2022; 27:401-413. [PMID: 35680296 DOI: 10.1016/j.fcl.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Trache T, Camenzind RS, Bachmann E, Viehöfer A, Jud L, Wirth S, Imhoff FB. A Biomechanical Analysis of Peroneus Brevis Split Lesions, Repair, and Partial Resection. Foot Ankle Int 2022; 43:710-716. [PMID: 35073766 DOI: 10.1177/10711007211069558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneus brevis tendon tears are associated with chronic ankle pain and instability following sprain injuries. The aim of this study is to elucidate the biomechanical changes induced by a peroneus brevis split and surgical treatment by tubularizing suture or partial resection. METHODS Nine human lower leg specimens were biomechanically tested. Preexisting tendon pathology was ruled out by magnetic resonance imaging and histology. Specimens were subjected to sequential testing of 4 conditions of the peroneus brevis tendon: (1) native, (2) longitudinal lesion, (3) tubularizing suture, and (4) 50% resection. The outcome parameters were the tendon stiffness (N/mm) and the length variation of the split portion at 5 N load. RESULTS The median specimen age at death was 55.8 years (range 50-64 years). The longitudinal tendon split led to an elongation by 1.21 ± 1.15 mm, which was significantly reduced by tubularizing suture to 0.24 ± 0.97 mm (P = .021). Furthermore, 50% resection of the tendon elongated it by a mean 2.45 ± 1.9 mm (P = .01) and significantly reduced its stiffness compared to the intact condition (4.7 ± 1.17 N/mm, P = .024) and sutured condition (4.76 ± 1.04 N/mm, P = .011). CONCLUSION Longitudinal split and 50% resection of the peroneus brevis tendon led to elongation and loss of tendon stiffness. These properties were improved by tubularizing suture. The significance of these changes in the clinical setting needs further investigation. CLINICAL RELEVANCE Tubularizing suture of a peroneus brevis split can restore biomechanical properties to almost native condition, potentially aiding ankle stability in symptomatic cases. A split lesion and partial resection of the tendon showed reduced stiffness and increased elongation.
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Affiliation(s)
- Tudor Trache
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Roland S Camenzind
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Elias Bachmann
- Institute for Biomechanics, Balgrist Campus, University of Zurich, Zurich, Switzerland
| | - Arnd Viehöfer
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Lukas Jud
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Stephan Wirth
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Florian B Imhoff
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
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Chrea B, Eble SK, Day J, Hansen OB, Ellis SJ, O'Malley MJ, Drakos MC. Clinical and Patient-Reported Outcomes Following Peroneus Brevis Reconstruction With Hamstring Tendon Autograft. Foot Ankle Int 2021; 42:1391-1398. [PMID: 34109840 DOI: 10.1177/10711007211015186] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneal tendon injuries are a common cause of lateral ankle pain and instability. While the use of hamstring autograft has been proposed as a viable surgical option for peroneus brevis reconstruction, reported outcomes with this technique are limited in the literature. We present patient-reported and clinical outcomes for patients who underwent peroneus brevis reconstruction with hamstring autograft. METHODS Thirty-one patients were retrospectively identified who underwent a procedure including peroneus brevis reconstruction with hamstring autograft for peroneal tendinopathy between February 2016 and May 2019. All patients who had a peroneus brevis reconstruction were included, and all concomitant procedures were noted. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were prospectively collected preoperatively and at a minimum of 1 year postoperatively (mean, 24.3; range, 12-52.7) months. Retrospective chart review was performed to evaluate the incidence of postoperative complications and reoperations. RESULTS When evaluating pre- and postoperative patient-reported outcome surveys (n = 26; 84%), on average, patients reported improvement in every PROMIS domain evaluated, with significant improvement in Physical Function (+5.99; P = .006), Pain Interference (-8.11; P < .001), Pain Intensity (-9.02; P < .001), and Global Physical Health (+7.29; P = .001). Three patients reported persistent pain at a minimum of 1 year postoperatively, of whom 2 required reoperation. No patient reported persistent pain or discomfort at the harvest site of the hamstring autograft. CONCLUSION Patients undergoing peroneus brevis reconstruction with hamstring autograft experienced clinically significant improvement in patient-reported and clinical outcomes. Few postoperative complications were observed, and patients reported improvements across all patient-reported outcome domains, with significant improvements for pain and function domains. Reconstruction with hamstring autograft represents a viable surgical option in the setting of peroneal tendinitis or tears. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Bopha Chrea
- Hospital for Special Surgery, New York, NY, USA
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Papadakis SA, Pallis D, Ampadiotaki MM, Tsivelekas K, Trygonis N, Artsitas D, Triantafyllou E, Badekas T. Peroneus brevis tendon injuries: Report of two cases and review of literature. Trauma Case Rep 2021; 35:100524. [PMID: 34504934 PMCID: PMC8414180 DOI: 10.1016/j.tcr.2021.100524] [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] [Accepted: 08/20/2021] [Indexed: 12/04/2022] Open
Abstract
The incidence of peroneal tendon disorders in the population is unknown and they are usually overlooked. We report two cases of peroneus brevis injuries and a comprehensive literature review was performed. The first case was a 53-year-old man presented with persistent pain on the lateral aspect on the left ankle during the last four years and difficulty to bear weight during the last year. MRI showed longitudinal tear of peroneus brevis tendon and the patient underwent surgical treatment. The second case was a 46-year-old woman with persistent pain on the lateral aspect of the ankle with a history of a road traffic accident two years ago. Although MRI showed a peroneus brevis tendon tear, this was a false positive finding. Surgical treatment revealed no tear and symphysiolysis managed to relieve patient's symptoms. Even though MRI is the most effective diagnostic tool in depicting peroneal tendon injuries, there are false positive findings. In cases when symptoms persist, surgical exploration is indicated.
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Affiliation(s)
| | - Dimitrios Pallis
- B' Department of Orthopaedics, KAT General Hospital of Attica, Greece
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Willegger M, Hirtler L, Schwarz GM, Windhager RH, Chiari C. [Peroneal tendon pathologies : From the diagnosis to treatment]. DER ORTHOPADE 2021; 50:589-604. [PMID: 34160639 PMCID: PMC8241798 DOI: 10.1007/s00132-021-04116-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 02/03/2023]
Abstract
Peronealsehnenpathologien sind selten, jedoch häufig unterdiagnostiziert. Eine Assoziation mit einer chronisch lateralen Sprunggelenkinstabilität sowie mit einer varischen Rückfußachse kann bestehen. Pathologien der Sehnen lassen sich in 3 Kategorien einteilen: Tendinitis und Tenosynovitis, Sehnenrisse und Rupturen sowie Sehnensubluxation und Sehnenluxation. Die Magnetresonanztomographie ist die Standardmethode zur radiologischen Beurteilung. Die Diagnose und Behandlung basieren jedoch in erster Linie auf Anamnese und klinischer Untersuchung. Eine primär konservative Therapie kann versucht werden, ausgenommen bei Peronealsehnenluxationen des professionellen Sportlers. Die chirurgische Therapie sollte gezielt auf die zugrunde liegende Pathologie abgestimmt werden und kann dementsprechend divers von der tendoskopischen Synovektomie bis zur anatomischen Reparatur des superioren peronealen Retinakulums mit Vertiefung der retromalleolären Rinne ausfallen. Die postoperativen Ergebnisse zeigen eine hohe Patientenzufriedenheit und niedrige Reluxationsraten.
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Affiliation(s)
- Madeleine Willegger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Lena Hirtler
- Zentrum für Anatomie und Zellbiologie, Abteilung für Anatomie, Medizinische Universität Wien, Wien, Österreich
| | - Gilbert M Schwarz
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Zentrum für Anatomie und Zellbiologie, Abteilung für Anatomie, Medizinische Universität Wien, Wien, Österreich
| | - Rein Hard Windhager
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Abousayed MM, Coleman MM, Abbasi P, Bean BA, Thompson JM, Guyton GP. Load to Failure and Stiffness of Interference Screw vs Pulvertaft Weave for Distal Fixation in Peroneal Allograft Reconstruction. Foot Ankle Int 2021; 42:83-88. [PMID: 32969276 DOI: 10.1177/1071100720952092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Allograft reconstruction of the peroneal tendons is an option for treatment of major tears of 1 or both peroneal tendons. No consensus on a superior distal fixation method has been reported. The purpose of the study was to compare load to failure and stiffness of a Pulvertaft weave (PTW) through a residual tendon stump to direct-to-bone interference screw (IS) fixation. METHODS Fifteen pairs of long leg cadaver specimens were used. All grafts were secured proximally to the peroneus brevis myotendinous junction via a PTW technique. Distally, the tendons were either sutured to the peroneus brevis stump via PTW or secured to the base of the fifth metatarsal via IS. Stiffness (slope of force/displacement) was measured for the intact tendon and after reconstruction, and finally each specimen was loaded to failure. RESULTS Mean load to failure was significantly higher in the PTW group compared with the IS group (373.6 ± 265.5 N vs 150.1 ± 93.1 N; P = .01). The PTW and IS groups had significantly lower stiffness compared with the intact specimens (P < .001). There was no statistical significance in stiffness between the 2 techniques (P = .96). CONCLUSION The PTW technique yielded higher load to failure in comparison to IS. There was no difference in overall construct stiffness between both techniques. Both constructs demonstrated 19% decrease in stiffness compared to the intact state. CLINICAL RELEVANCE The PTW and IS constructs were biomechanically similar, and these results suggest that both should be moderately overtensioned to compensate for an inherent decreased initial stiffness.
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Affiliation(s)
- Mostafa M Abousayed
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Michelle M Coleman
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Pooyan Abbasi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Bryan A Bean
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - John M Thompson
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Gregory P Guyton
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Danna NR, Brodsky JW. Diagnosis and Operative Treatment of Peroneal Tendon Tears. FOOT & ANKLE ORTHOPAEDICS 2020. [PMID: 35097372 DOI: 10.1177/2473011420910407.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Peroneal tendon tears are a common but under-recognized source of ankle pain and dysfunction. Recognition of the characteristic symptoms, physical findings, and imaging results of peroneal tendon tears is essential for accurate diagnosis and appropriate treatment. Acute, limited tears of a single peroneal tendon may be debrided and repaired. However, by the time operative treatment is undertaken, many tears of a single tendon are sufficiently advanced that the surgeon may need to consider excision of the nonviable segment and tenodesis of the damged tendon to the to the adjacent peroneal tendon. Irreparable tearing of both peroneal tendons may be treated with flexor tendon transfer and/or allograft reconstruction. This review article focuses on diagnosis and operative treatment of peroneal tendon tears, including the treatment algorithms, operative technique, and published outcomes.
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Danna NR, Brodsky JW. Diagnosis and Operative Treatment of Peroneal Tendon Tears. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420910407. [PMID: 35097372 PMCID: PMC8697126 DOI: 10.1177/2473011420910407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peroneal tendon tears are a common but under-recognized source of ankle pain and dysfunction. Recognition of the characteristic symptoms, physical findings, and imaging results of peroneal tendon tears is essential for accurate diagnosis and appropriate treatment. Acute, limited tears of a single peroneal tendon may be debrided and repaired. However, by the time operative treatment is undertaken, many tears of a single tendon are sufficiently advanced that the surgeon may need to consider excision of the nonviable segment and tenodesis of the damged tendon to the to the adjacent peroneal tendon. Irreparable tearing of both peroneal tendons may be treated with flexor tendon transfer and/or allograft reconstruction. This review article focuses on diagnosis and operative treatment of peroneal tendon tears, including the treatment algorithms, operative technique, and published outcomes.
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Bahad SR, Kane JM. Peroneal Tendon Pathology: Treatment and Reconstruction of Peroneal Tears and Instability. Orthop Clin North Am 2020; 51:121-130. [PMID: 31739875 DOI: 10.1016/j.ocl.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Peroneal tendon pathology is becoming an increasingly recognized source of lateral-sided ankle pain. High clinical suspicion, along with judicious physical examination coupled with confirmatory advanced imaging modalities, are necessary to make an accurate diagnosis and aid in guiding treatment. Peroneal pathology encompasses several distinct conditions. Peroneal tendon tears and injuries to the peroneal retinaculum must be identified to guide treatment. Patients with peroneal pathology report high levels of satisfaction after surgical management with most returning to their preinjury level of function. An early and accurate diagnosis, along with treatment tailored to the individual, is necessary to obtain optimal outcomes.
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Affiliation(s)
- Sophia R Bahad
- The Orthopedic Institute of North Texas, PA, Baylor Frisco - Professional Building #1, 5575 Warren Parkway, #115, Frisco, TX 75034, USA
| | - Justin M Kane
- Foot and Ankle Surgery Division; The Orthopedic Institute of North Texas, PA, Baylor Frisco - Professional Building #1, 5575 Warren Parkway, #115, Frisco, TX 75034, USA; Orthopaedics, Texas A&M University HSC, College of Medicine.
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Cavaliere RG, Mercado DM. Surgical Considerations: Repair of Long Segment Defect Posterior Tibial Tendon Using Fresh Frozen Tibial Tendon Allograft. J Foot Ankle Surg 2019; 58:995-1001. [PMID: 31153705 DOI: 10.1053/j.jfas.2018.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Indexed: 02/03/2023]
Abstract
Tibialis posterior (TP) tendon ruptures are common after ankle injuries, degenerative processes, or biomechanical instability. The TP tendon decelerates the subtalar joint pronation and internal rotation of the leg during the contact phase. It also plantarflexes and inverts the foot on the leg during the static phase of gait. When this function is lost, the medial longitudinal arch collapses, increasing the length of time of rearfoot pronation, eventually rupturing the TP tendon. Conservative treatment includes immobilization, strapping, antiinflammatories, custom-fabricated orthotics, and physical therapy. If the TP tendon rupture is severe, conservative treatment will provide little relief and surgery is indicated. This case study presents 53-year-old female who presented with left TP tendon rupture with a defect of 6 cm after sustaining an ankle injury that was surgically repaired using a TP tendon fresh frozen allograft and flexor digitorum longus tenodesis. After a 16-month follow-up, the patient was healed without complications and returned to preinjury activity. We believe that surgically repairing a TP tendon rupture with a TP tendon allograft and flexor digitorum longus tenodesis can be 1 of the treatment options for patients with extensive disruption of the TP tendon.
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Affiliation(s)
- Raymond G Cavaliere
- Department of Podiatric Surgery and Medicine at Mount Sinai Beth Israel Medical Center, New York, NY.
| | - Danielle M Mercado
- Department of Podiatric Surgery and Medicine at Mount Sinai Beth Israel Medical Center, New York, NY
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Abstract
Chronic disorders of the peroneal tendons are a common cause of posterolateral ankle pain, including tendinopathy, tendon instability, and chronic tendon tears. They are often preceded by ligamentous instability or predisposing anatomic abnormalities such as a shallow fibular groove or a cavovarus foot deformity. Given the substantial disability associated with chronic peroneal tendon disorders, it is important for orthopaedic surgeons to optimize the diagnostic and treatment strategies of these entities based on contemporary studies. This article reviews both classic and recent scientific evidence regarding the diagnosis and treatment of patients with chronic peroneal tendon disorders.
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14
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Reconstruction of the Peroneus Brevis Tendon Tears with Semitendinosus Tendon Autograft. Case Rep Orthop 2019; 2019:5014687. [PMID: 31285931 PMCID: PMC6594286 DOI: 10.1155/2019/5014687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/28/2019] [Indexed: 11/25/2022] Open
Abstract
Peroneal tendon disorders are common causes of lateral and retromalleolar ankle pain. For irreparable tears of the tendon, a salvage procedure is indicated with segmental resection followed by reconstruction with tenodesis, tendon transfer, or bridging the defect using allograft or autograft. Although there is insufficient evidence to guide which of these treatment options provides the best outcomes, reconstruction with tendon allograft has provided satisfactory clinical results and is effective for pain relief and restoration of tendon function. However, there are concerns about the use of tendon allografts which include its cost and availability, disease transmission, delayed incorporation, and stretching of the graft. The aim of this study is to present the surgical technique for the reconstruction of the peroneus brevis tendon tears using semitendinosus tendon autograft as an alternative to the allograft and report the short-term results of three cases.
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Sakurai R, Fukushi JI, Mizu-uchi H, Hanada M, Momii K, Nakashima Y. Anatomic Reconstruction of Lateral Ankle Ligaments and Both Peroneus Tendons After Open Fracture Dislocation of the Ankle: A Case Report. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011418794677. [PMID: 35097310 PMCID: PMC8500390 DOI: 10.1177/2473011418794677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Extensive soft tissue defects of the ankle are an uncommon but challenging problem that require a combination of reconstructive options. We report the case of a complex injury involving the skin, lateral ankle ligaments, and peroneal tendons that were anatomically reconstructed. A 15-year-old girl was injured in an automobile accident resulting in extensive soft tissue defects and marked instability of her right ankle. The lower two-thirds of the anterior talofibular ligament (ATFL) had segmental defects, and calcaneofibular ligament (CFL) was completely torn, and both peroneal longus and brevis tendons were severely damaged. Initial debridement was performed on the day on injury. Two weeks after injury, the ATFL and CFL were reconstructed using a semitendinosus autograft and suture tape augmentation. Both peroneal tendons were reconstructed using a gracilis autograft. The skin defect (10 × 10 cm) was covered with an anterolateral thigh flap. After removing a short leg cast at 3 weeks postoperatively, the patient started range of motion exercises without using any brace. Weightbearing was allowed at 4 weeks. At the 24-month follow-up examination, she had returned to her preoperative level of work and sports activities.
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Affiliation(s)
- Ryuta Sakurai
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Jun-ichi Fukushi
- Department of Artificial Joints and Biomaterials, Kyushu University, Fukuoka, Japan
| | - Hideki Mizu-uchi
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Masuo Hanada
- Department of Plastic Surgery, Kyushu University, Fukuoka, Japan
| | - Kenta Momii
- Department of Emergency Center, Kyushu University, Fukuoka, Japan
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Abstract
INTRODUCTION The purpose of this study was to determine whether tears of the peroneus brevis (PB) tendon correlate with increased fatty infiltration of the PB muscle on MRI compared with musculature without clinical evidence of peroneal pathology. METHODS Ankle MRI scans of patients with PB tendon tearing (tear group) were compared with those of patients without clinical evidence of peroneal pathology (control group). Two reviewers graded the PB muscle belly according to the Goutallier classification. RESULTS Thirty patients were included in each group. The mean Goutallier scores for the tear and control groups were 0.52 (±0.72) and 0.05 (±0.15), respectively (P = 0.0019). The level of interobserver agreement between reviewers was moderate (intraclass correlation coefficient = 0.75; 95% confidence interval, 0.57 to 0.85). DISCUSSION Patients with PB tendon tear demonstrate markedly higher grades of fatty degeneration compared with patients without peroneal pathology. The Goutallier classification may become a valuable instrument for assessing the severity of a PB tear. LEVEL OF EVIDENCE Level III-diagnostic study.
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Abstract
Achilles tendon ruptures, if neglected or identified late, lead to impairments in function and gait. Surgical reconstruction is typically required to restore the resting length and tension to the gastrocnemius-soleus complex. A variety of reconstructive options have been described, depending on several factors, including chronicity, residual gap size, remaining tissue quality and vascularity, location of tendon rupture or deficiency, and patient-specific factors. Despite the many surgical options described from local soft-tissue rearrangements and tendon transfers, to the use of allograft tissue and synthetic material augmentation, there is understandably a paucity of evidence-based guidelines available to direct surgeons in the optimal procedure for each patient-specific situation. Reconstructive options for the patient with a chronic Achilles rupture are detailed and reviewed here, to serve as a framework for the treating surgeon in these complex cases.
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The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2018. [PMID: 29767272 DOI: 10.1007/s00167-018-4971-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
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Hamstring Autograft Reconstruction of the Peroneus Brevis. TECHNIQUES IN FOOT AND ANKLE SURGERY 2018. [DOI: 10.1097/btf.0000000000000158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surg Sports Traumatol Arthrosc 2018; 26:3096-3107. [PMID: 29767272 PMCID: PMC6154028 DOI: 10.1007/s00167-018-4971-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
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Abstract
Chronic rupture of the peroneal tendons can be a functionally limiting condition with a multitude of causes. Conservative and operative interventions are heterogenous and tailored to the functional demands of the patient. Surgical plans are based on muscle viability, patient preference, and surgeon expertise. Clinical outcomes evidence remains limited in this domain, and further well-designed studies are warranted to guide treatment.
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Affiliation(s)
- Kamran S Hamid
- Rush University Medical Center, 1611 West Harrison Street, Chicago, Illinois 60612, USA.
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