1
|
Azam MT, Butler JJ, Weiss MB, Ubillus HA, Kirschner N, Mercer NP, Kennedy JG. Surgical Management of Chronic Achilles Tendon Ruptures: A Systematic Review and Proposed Treatment Algorithm. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231200491. [PMID: 37810568 PMCID: PMC10557420 DOI: 10.1177/24730114231200491] [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: 10/10/2023] Open
Abstract
Background As no evidence-based treatment guidelines exist for chronic Achilles tendon rupture (CATR), a systematic review of the literature was performed to compare the different treatment options and recommend a literature-based algorithm. Methods In June 2022, MEDLINE, Embase, and Cochrane Library databases were systematically reviewed based on the PRISMA guidelines. The level of evidence (LOE) and quality of evidence were evaluated, and statistics on clinical outcomes and complications were calculated. Results Twenty-seven studies with 614 patients were included. Three studies were LOE III and 25 studies were LOE IV. The mean Achilles tendon rupture score improved from a preoperative weighted mean of 38.8 ± 12.4 to a postoperative score 90.6 ± 4.7. The overall complication rate was 11.4%. Single techniques were used in 23 studies and dual techniques were used in 5 studies. The FHL tendon transfer was the most frequently used technique. We devised an algorithmic approach based on time from injury to surgical intervention and the length of the gap between the tendon stumps: >3 months: FHL transfer; <3 months (a) gap <2 cm, end-to-end repair; (b) gap 2 to 5 cm, gastrocnemius transfer, (c) gap >5 cm, semitendinosus autograft. Conclusion Surgical management of CATR produced improvements in patient-reported outcome scores at midterm follow up, but a high complication rate (11.4%) was noted. Our proposed treatment algorithm may assist in shared decision making for this complex problem.
Collapse
Affiliation(s)
- Mohammad T. Azam
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - James J. Butler
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
- Royal College Surgeons in Ireland, Dublin, Ireland
| | - Matthew. B. Weiss
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Hugo A. Ubillus
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Noah Kirschner
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - John G. Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| |
Collapse
|
2
|
Local Tendon Transfers for Chronic Ruptures of the Achilles Tendon: A Systematic Review. J Clin Med 2023; 12:jcm12020707. [PMID: 36675635 PMCID: PMC9866603 DOI: 10.3390/jcm12020707] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction: A rupture of the Achilles tendon with a delay in diagnosis or treatment for more than 6 weeks is considered a chronic tear. Local tendon transfer procedures can be used in chronic Achilles tendon ruptures. This study evaluated the outcome, return to sport, and complications of local tendon transfer in patients with chronic Achilles tendon rupture. Material and methods: The present study was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in November 2022. Results: Data were retrieved from 23 articles (463 patients, mean age 50.9 ± 13.5 years). The mean duration of the follow-up was 58.3 ± 76.8 months. The VAS improved by 1.8/10 (p = 0.4), the AOFAS by 33.4/100 (p < 0.0001), and the ATRS by 32.5/100 (p = 0.0001) points. Patients were able to return to sport after a mean of 19.6 ± 16.4 weeks. A total of 79% of patients were able to return to their previous activities. The rate of complications was 13.3%. Conclusions: The use of local tendon transfer for chronic Achilles tendon ruptures using the FHL or PB tendon resulted in good clinical outcomes and a reliable return to daily activities and sports. The rate of complications reflects the chronicity of the condition and the technical complexity of the procedure. Level of evidence: IV.
Collapse
|
3
|
Muacevic A, Adler JR, Saito M, Kubota M. Lateralizing Calcaneal Osteotomy and First Metatarsal Dorsiflexion Osteotomy for Cavovarus Foot and Peroneal Sheath Release with Peroneus Brevis Repair for Peroneal Tendinopathy in Chronic Ankle Instability and Sprain. Cureus 2022; 14:e32235. [PMID: 36620823 PMCID: PMC9812816 DOI: 10.7759/cureus.32235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
A 47-year-old male presented with an eight-year history of pain in the posterior inferior part of the lateral malleolus, ankle instability, and repeated right-sided ankle sprains. He had pes cavus and hind-foot varus in his right foot, which is an unknown congenital entity or acquired with tenderness in the inferior peroneal retinaculum. There is no deformity in his left foot. The pain was elicited by the movement of the subtalar joint. Imaging revealed a high medial longitudinal arch, an enlarged peroneal tubercle, thinning of the peroneus brevis tendon, and hypertrophy of the peroneus longus tendon. We diagnosed peroneal tendinopathy with cavovarus foot in a chronic ankle sprain. The supination generated by pes cavus was thought to be aggravating the peroneal tendinopathy and causing the ankle sprains. Incision of the peroneal tendon sheath, repair of the peroneus brevis tendon, lateralizing calcaneal osteotomy, and first metatarsal dorsiflexion osteotomy were performed. At the one-year follow-up, Meary's angle was corrected to 0°, the calcaneal pitch was corrected to 20°, and the hindfoot varus was improved. He was pain-free and reported no further instability when walking. His Japanese Society of Surgery of the Foot ankle-hindfoot scale score improved from 59 preoperatively to a maximum of 100 and the Self-Administered Foot Evaluation Questionnaire gave an almost perfect score for non-sports-related items and a score of 83.3 for sports-related items. We believe that the addition of treatment of the pes cavus, which was the center of the pathology, as well as treatment of the peroneal tendon, resulted in a good outcome.
Collapse
|
4
|
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]
|
5
|
Soft Tissue Reconstruction and Osteotomies for Pes Planovalgus Correction. Clin Podiatr Med Surg 2022; 39:207-231. [PMID: 35365324 DOI: 10.1016/j.cpm.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The correction of the flexible pes planovalgus foot and ankle is a complicated and somewhat controversial topic. After conservative methods fail, there is a wide range of possible soft tissue and bony procedures. The appropriate work up and understanding of the pathomechanics are vital to the correct choice of procedures to correct these deformities. Once the work up and procedure selection are done, the operation must also be technically performed well and with efficiency, as most often the condition is corrected with a variety of procedures. This article discusses some of the most common procedures necessary to fully correct the pes planovalgus foot and discusses the authors' technique and pearls.
Collapse
|
6
|
Mercer NP, Gianakos AL, Mercurio AM, Kennedy JG. Clinical Outcomes of Peroneal Tendon Tears: A Systematic Review. J Foot Ankle Surg 2021; 60:1008-1013. [PMID: 33785239 DOI: 10.1053/j.jfas.2021.03.003] [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: 01/25/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to provide an overview of the available evidence on peroneal tendon tears and the outcomes after surgical intervention. A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Criteria for inclusion were clinical studies reporting outcomes after treatment for peroneal tendon tear within the last 10 years. Nine studies evaluating 336 patients (146 males/190 females) and 336 ankles were included in this review. The mean age of included patients was 46.3 years (range, 46-56.9 years). The weighted mean follow-up was 23.82 months (range 9.2-78 months. Five surgical interventions were reported: primary repair with tenodesis, primary repair without tenodesis, FDL tendon transfer, FHL tendon transfer, and allograft reconstruction. Four studies recorded the AOFAS score, with a weighted mean preoperative score of 69.58 and a weighted mean postoperative score of 88.82. Six studies measured the VAS score showing an improvement from a mean weighted preoperative score of 4.68 to a mean weighted postoperative score of 1.2. FAAM score was measured in 3 studies, which showed an improvement from 41.1 preoperatively to 84.4 postoperatively. The average overall complication rate was 38.7% (130/336) with the most commonly reported minor complication being ankle pain, which made up 46.2% of all minor complications (56/121). Primary repair without tenodesis was associated with a higher complication rate compared to any other surgical intervention (p=.001176). The current systematic review showed that overall clinical outcomes were positive in lieu of the different modalities of surgical intervention for peroneal tendon tears.
Collapse
Affiliation(s)
| | - Arianna L Gianakos
- Department of Orthopedic Surgery, Robert Wood Johnson Barnabas Health, Jersey City Medical Center, Jersey City, NJ
| | - Angela M Mercurio
- Department of Orthopedic Surgery, Robert Wood Johnson Barnabas Health, Jersey City Medical Center, Jersey City, NJ
| | - John G Kennedy
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY.
| |
Collapse
|
7
|
The Role of Peroneal Tendinopathy and the Cavovarus Foot and Ankle. Clin Podiatr Med Surg 2021; 38:445-460. [PMID: 34053654 DOI: 10.1016/j.cpm.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Peroneal tendon pathology is often an overlooked and underdiagnosed condition. It is often confused with chronic ankle instability. It is important when surgically managed to assess the condition of the tendons, muscle viability and strength, and associated cavovarus deformity. Complex reconstruction may be needed, including 2-stage procedures with a silicone rod and tendon transfer.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Taniguchi A, Alejandro SF, Kane JM, Daoud Y, Tanaka Y, Ford SE, Brodsky JW. Association of Cavovarus Foot Alignment With Peroneal Tendon Tears. Foot Ankle Int 2021; 42:750-756. [PMID: 33847151 DOI: 10.1177/1071100721990348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although it is a widely accepted clinical principle that cavovarus deformity predisposes to peroneal tendon problems, there are limited data to support that assumption. This study tested the hypothesis that cavovarus is associated with peroneal tendon tears and evaluated which radiographic measures correlated with that association. METHODS A retrospective comparison of radiographic measures of cavovarus in 234 consecutive patients operatively treated for chronically symptomatic peroneal tendon tears was compared to a matched control group. Measures included calcaneal pitch, anteroposterior (AP) talometatarsal and talocalcaneal angles, and talonavicular coverage angle. A novel coordinate system analyzed midfoot and hindfoot components of cavovarus. Analysis of variance was used to compare cohorts, and a Tukey-Kramer test used to analyze 3 subgroups of brevis and longus tears, and concomitant tears. RESULTS The distribution of tears was 73% peroneus brevis, 8% longus, and 19% both tendons. Compared with controls, the study group, and subgroups, had multiple measures of increased cavovarus, including greater calcaneal pitch (P = .0001), decreased AP talo-first metatarsal angle (P = .0001), and increased talonavicular coverage angle (P = .0001). Elevated medial longitudinal arch, and rotational changes in the radiographic profiles of the hindfoot were found with the coordinate system described by Yokokura. CONCLUSION This study found a statistically significant association of increased cavovarus deformity with peroneal tendon tears, compared to controls. It documented the relative incidence of tears of peroneus brevis, peroneus longus, and concomitant tears in a large surgical series. It demonstrated which simple radiographic angles and complex coordinate measurements of cavovarus deformity were significantly associated with peroneal tendon tears. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.
Collapse
Affiliation(s)
- Akira Taniguchi
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | | | - Justin M Kane
- Orthopedic Associates of Dallas, Baylor University Medical Center, Dallas, TX, USA
| | - Yahya Daoud
- Orthopedic Associates of Dallas, Baylor University Medical Center, Dallas, TX, USA
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Samuel E Ford
- Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - James W Brodsky
- Orthopedic Associates of Dallas, Baylor University Medical Center, Dallas, TX, USA
| |
Collapse
|
10
|
Zou Y, Li X, Wang L, Tan C, Zhu Y. Endoscopically Assisted, Minimally Invasive Reconstruction for Chronic Achilles Tendon Rupture With a Double-Bundle Flexor Hallucis Longus. Orthop J Sports Med 2021; 9:2325967120979990. [PMID: 33748303 PMCID: PMC7940742 DOI: 10.1177/2325967120979990] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background: High morbidity has been reported regarding Achilles tendon (AT) injuries, and the upward trend has accelerated since the mid-1990s. A chronic Achilles tendon rupture usually results from a neglected or misdiagnosed acute rupture, and about one-fifth of acute AT ruptures are missed and lead to chronic AT rupture. Although many techniques have been described, there is no gold standard in the treatment of chronic AT ruptures. Hypothesis: Endoscopically assisted, minimally invasive reconstruction for chronic AT rupture using a double-bundle flexor hallucis longus (FHL) tendon would result in improvement of the overall function, with a low rate of wound complications. Study Design: Case series; Level of evidence, 4. Methods: Between May 2015 and November 2016, a total of 19 consecutive patients were enrolled and treated using endoscopically assisted, minimally invasive reconstruction for chronic AT rupture using a double-bundle FHL. The operative assessment comprised the Achilles Tendon Total Rupture Score, the American Orthopaedic Foot & Ankle Society score, the Victorian Institute of Sports Assessment–Achilles score, and a postoperative questionnaire. All postoperative complications were recorded. Results: The mean follow-up time for all patients was 31 months (range, 20-42 months). According to the postoperative questionnaire, the result of surgery was excellent in 8 (42%) of 19 patients, good in 10 (53%), and fair in 1 (5%). All clinical outcome scores (mean ± SD) improved significantly after surgery: Achilles Tendon Total Rupture Score, 23.3 ± 10.3 vs 98.3 ± 9.2 (postoperatively vs preoperatively); American Orthopaedic Foot & Ankle Society, 52.1 ± 12.4 vs 97.5 ± 18.9; and Victorian Institute of Sports Assessment–Achilles, 23.4 ± 11.2 vs 95.7 ± 17.1 (P < .05). No complications with regard to wound healing or infection were noted. Twelve relatively young patients returned to preinjury activity levels, such as playing basketball or badminton, and the older patients were able to meet their daily needs, such as walking up stairs and jogging. Conclusion: Chronic AT ruptures were successfully treated via minimally invasive reconstruction using a double-bundle FHL, which provided excellent functional improvement. It is best suited for patients with complex requirements who are at high risk for wound complications.
Collapse
Affiliation(s)
- Yunxuan Zou
- Department of Foot and Ankle Surgery, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, People's Republic of China
| | - Xue Li
- Department of Foot and Ankle Surgery, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, People's Republic of China
| | - Lei Wang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Caixia Tan
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, People's Republic of China
| | - Yongzhan Zhu
- Department of Foot and Ankle Surgery, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, People's Republic of China
| |
Collapse
|
11
|
Nelson SC. Revision Surgery for Peroneal Tendon Tears. Clin Podiatr Med Surg 2020; 37:569-576. [PMID: 32471619 DOI: 10.1016/j.cpm.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Peroneal tendon tears that require revision are rare and often present a unique challenge for foot and ankle surgeons. Biomechanical issues that may be present or missed initially need to be addressed and evaluated thoroughly for an optimized outcome. Tendon degeneration is usually present, and planning for tendon transfer or tendon graft is necessary to improve mechanical strength. The use of MRI can aid in preoperative planning and identification of concomitant disorders that may be present. The postoperative rehabilitation is often longer and patient education is imperative to manage expectations of outcomes.
Collapse
Affiliation(s)
- Scott C Nelson
- Department of Orthopedics, Catholic Health Initiatives (CHI Health), 16909 Lakeside Hills Court Suite 208, Omaha, NE 68130, USA.
| |
Collapse
|
12
|
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.
Collapse
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.
| |
Collapse
|
13
|
Hayden SR. Pop in the Foot Causing POPS: The Painful Os Peroneum Syndrome. J Emerg Med 2019; 56:337-339. [PMID: 30594352 DOI: 10.1016/j.jemermed.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 11/15/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Stephen R Hayden
- Department of Emergency Medicine, UC San Diego Health Systems, San Diego, California
| |
Collapse
|
14
|
Wagner E, Wagner P, Ortiz C, Radkievich R, Palma F, Guzmán-Venegas R. Biomechanical Cadaveric Evaluation of Partial Acute Peroneal Tendon Tears. Foot Ankle Int 2018. [PMID: 29519147 DOI: 10.1177/1071100718760256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND No clear guideline or solid evidence exists for peroneal tendon tears to determine when to repair, resect, or perform a tenodesis on the damaged tendon. The objective of this study was to analyze the mechanical behavior of cadaveric peroneal tendons artificially damaged and tested in a cyclic and failure mode. The hypothesis was that no failure would be observed in the cyclic phase. METHODS Eight cadaveric long leg specimens were tested on a specially designed frame. A longitudinal full thickness tendon defect was created, 3 cm in length, behind the tip of the fibula, compromising 66% of the visible width of the peroneal tendons. Cyclic testing was initially performed between 50 and 200 N, followed by a load-to-failure test. Tendon elongation and load to rupture were measured. RESULTS No tendon failed or lengthened during cyclic testing. The mean load to failure for peroneus brevis was 416 N (95% confidence interval, 351-481 N) and for the peroneus longus was 723 N (95% confidence interval, 578-868 N). All failures were at the level of the defect created. CONCLUSION In a cadaveric model of peroneal tendon tears, 33% of remaining peroneal tendon could resist high tensile forces, above the physiologic threshold. CLINICAL RELEVANCE Some peroneal tendon tears can be treated conservatively without risking spontaneous ruptures. When surgically treating a symptomatic peroneal tendon tear, increased efforts may be undertaken to repair tears previously considered irreparable.
Collapse
Affiliation(s)
- Emilio Wagner
- 1 Orthopedic Department, Clinica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Pablo Wagner
- 1 Orthopedic Department, Clinica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Cristian Ortiz
- 1 Orthopedic Department, Clinica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Ruben Radkievich
- 1 Orthopedic Department, Clinica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Felipe Palma
- 2 Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Chile
| | - Rodrigo Guzmán-Venegas
- 2 Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Chile
| |
Collapse
|
15
|
Abstract
A high clinical suspicion and greater understanding of the anatomy and pathophysiology of lateral ankle injuries have enabled early diagnosis and treatment-improving outcomes of acute peroneal tendon tears. Multiple conditions can be the cause of lateral ankle pain attributed to the peroneal tendons: tenosynovitis, tendinosis, subluxation and dislocation, stenosing tenosynovitis, abnormality related to the os peroneum, as well as tears of the peroneal tendons. It is imperative for the clinician to maintain a high suspicion for peroneal tendon abnormality when evaluating patients with lateral ankle pain.
Collapse
Affiliation(s)
- James W Brodsky
- Foot and Ankle Surgery Division, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA; Texas A&M University Health Science Center, 3302 Gaston Avenue, Dallas, TX 75246, USA; Department of Orthopaedic Surgery, UT Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Jacob R Zide
- Foot and Ankle Surgery Division, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA; Texas A&M University Health Science Center, 3302 Gaston Avenue, Dallas, TX 75246, USA
| | - Justin M Kane
- Foot and Ankle Surgery Division, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA; Texas A&M University Health Science Center, 3302 Gaston Avenue, Dallas, TX 75246, USA.
| |
Collapse
|
16
|
Hagen M, Lemke M, Lahner M. Deficits in subtalar pronation and supination proprioception in subjects with chronic ankle instability. Hum Mov Sci 2017; 57:324-331. [PMID: 28941635 DOI: 10.1016/j.humov.2017.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 09/14/2017] [Accepted: 09/16/2017] [Indexed: 12/19/2022]
Abstract
Deficits in joint position sense (JPS) and force sense (FS) are two functional insufficiencies contributing to chronic ankle instability (CAI). To date, JPS and FS have been only investigated in the sagittal and transverse movement planes but not in the functional movement plane of the pronators and supinators defined by the axis of the subtalar joint (STJ). The purpose of this study was to investigate subtalar JPS as well as pronator and supinator FS in supinated and pronated joint angle in subjects with CAI. Using a force transducer and a goniometer integrated in an apparatus with a movement axis corresponding to Inman's STJ axis, JPS and FS were examined in 20 sport students with CAI and 20 age- and sex-matched controls. Compared to uninjured subjects, CAI leads to reduced pronator (p<0.01) and supinator FS (p<0.01) as well as JPS (p<0.05). A significant main effect for 'angle' was found for JPS (P<0.0001). JPS is affected by a significant 'group'×'angle' interaction (p<0.05) indicating reduced JPS in the 24° supinated angle however not in the 8° pronated angle. The angle-specific JPS deficits indicate that the anatomical STJ axis has to be considered when assessing pronation and supination proprioception in subjects with CAI.
Collapse
Affiliation(s)
- Marco Hagen
- University of Duisburg-Essen, Institute of Sport and Movement Sciences, Biomechanics Laboratory, Gladbecker Str. 182, 45141 Essen, Germany.
| | - Martin Lemke
- University of Duisburg-Essen, Institute of Sport and Movement Sciences, Biomechanics Laboratory, Gladbecker Str. 182, 45141 Essen, Germany.
| | - Matthias Lahner
- Ruhr-University Bochum, Department of Orthopaedic Surgery, St. Josef-Hospital, Gudrunstr. 56, 44791 Bochum, Germany; Leben in Bewegung, Department of Orthopaedic, Bahnhofsallee 7, Bahnhofsallee 20, 40721 Hilden, Germany.
| |
Collapse
|
17
|
|
18
|
|
19
|
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
|
20
|
Stone TJ, Rosenberg ZS, Velez ZR, Ciavarra G, Prost R, Bencardino JT. Subluxation of the peroneus long tendon in the cuboid tunnel: is it normal or pathologic? An ultrasound and magnetic resonance imaging study. Skeletal Radiol 2016; 45:357-65. [PMID: 26659451 DOI: 10.1007/s00256-015-2293-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 11/04/2015] [Accepted: 11/08/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the position of the peroneus longus (PL) tendon relative to the cuboid tuberosity and cuboid tunnel during ankle dorsiflexion and plantarflexion using ultrasound and MRI. MATERIALS AND METHODS The study population included two groups: 20 feet of 10 asymptomatic volunteers who underwent prospective dynamic ultrasound and 55 ankles found through retrospective review of routine ankle MRI examinations. The location of the PL tendon at the cuboid tuberosity and cuboid tunnel was designated as completely within the tunnel, indeterminate, or subluxed with respect to ankle dorsiflexion and plantarflexion. RESULTS On dynamic ultrasound, the PL tendon was perched plantar to the cuboid tuberosity in dorsiflexion, and glided to enter the cuboid tunnel distal to the tuberosity in plantarflexion in all 20 feet. On the MRI evaluation, there was a statistically significant difference (p = 0.0006) in the location of the PL tendon between the ankles scanned in dorsiflexion and plantarflexion. CONCLUSION Based on our findings on ultrasound and MRI, the PL tendon can glide in and out of the cuboid tunnel along the cuboid tuberosity depending on ankle position. Thus, "subluxation" of the tendon as it curves to enter the cuboid tunnel, which to the best of our knowledge has not yet been described, should be recognized as a normal, position-dependent phenomenon and not be reported as pathology.
Collapse
Affiliation(s)
| | - Zehava S Rosenberg
- New York Langone Medical Center / Hospital for Joint Diseases, New York, NY, USA
| | | | - Gina Ciavarra
- New York Langone Medical Center / Hospital for Joint Diseases, New York, NY, USA
| | | | - Jenny T Bencardino
- New York Langone Medical Center / Hospital for Joint Diseases, New York, NY, USA
| |
Collapse
|
21
|
Abstract
Insertion of the peroneus brevis tendon normally occurs at the lateral aspect of the fifth metatarsal base. However, there is new evidence that congenital variant insertion of the tendon on the calcaneal peroneal tubercle occurs in a small segment of the population. We report a case of 24-year old male presenting with non-traumatic ankle pain who underwent ankle magnetic resonance imaging. Imaging demonstrated insertion of the peroneus brevis tendon on the calcaneal peroneal tubercle with absence of the tendon distal to the calcaneus. Furthermore, in reviewing 200 consecutive ankle magnetic resonance examinations, the authors discovered one additional case of this variant. We discuss the magnetic resonance imaging characteristics of this anatomic variant, the implications for clinical management, and review the literature on peroneal anatomic variations.
Collapse
Affiliation(s)
- Nathan D Cecava
- Department of Radiology, Mike O'Callaghan Federal Medical Center, Nellis AFB, NV, USA
| | - Scot E Campbell
- Department of Radiology, Landstuhl Regional Medical Center, Landstuhl, Germany
| |
Collapse
|
22
|
Raikin SM, Schick FA, Karanjia HN. Use of a Hunter Rod for Staged Reconstruction of Peroneal Tendons. J Foot Ankle Surg 2015; 55:198-200. [PMID: 26282362 DOI: 10.1053/j.jfas.2015.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Indexed: 02/03/2023]
Abstract
Peroneal tendon pathology is a commonly reported cause of lateral ankle pain. The causes include cavovarus foot type, overuse, chronic tendinosis, peroneal subluxation or dislocation, acute traumatic split tears, and traumatic rupture. The purpose of the present report is to describe an alternative approach for surgical reconstruction of the peroneal tendons in patients when repair might no longer be effective. The use of a Hunter rod was originally described by Hunter in 1971 for 2-stage reconstruction of tendons in the hand. We present a 2-stage surgical technique with the use of a Hunter rod as a temporary implant to stimulate generation of a healthy peroneal tendon sheath to host a flexor hallucis longus tendon transfer. This has proved to be a successful treatment option for patients with severe peroneal tendon damage and scarring along the peroneal tendon sheath. We offer a sample case to illustrate a patient with such indications.
Collapse
Affiliation(s)
- Steven M Raikin
- Director, Foot and Ankle Service, Professor, Department of Orthopedic Surgery, and Director, Foot and Ankle Fellowship Program, Rothman Institute, Jefferson Medical College, Thomas Jefferson Hospital, Philadelphia, PA.
| | - Faith A Schick
- Foot and Ankle Specialist, Rothman Institute, Philadelphia, PA
| | - Homyar N Karanjia
- Director, Podiatric Medicine and Surgery, Rothman Institute, Philadelphia, PA
| |
Collapse
|
23
|
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
|
24
|
Abstract
Peroneal tendoscopy is indicated for peroneal tenosynovitis, subluxation or dislocation, snapping, partial tears requiring debridement, and postoperative adhesions and scarring. Peroneal tendoscopy was also found to be valuable as a diagnostic tool in some instances. It is generally reported to have good to excellent outcomes in most patients with a relatively low occurrence of complications.
Collapse
Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong 999077, China.
| | - Lung Fung Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong 999077, China
| |
Collapse
|
25
|
Singh A, Nag K, Roy SP, Gupta RC, Gulati V, Agrawal N. Repair of Achilles tendon ruptures with peroneus brevis tendon augmentation. J Orthop Surg (Hong Kong) 2014; 22:52-5. [PMID: 24781614 DOI: 10.1177/230949901402200114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To report 22 patients who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation. METHODS Records of 6 women and 19 men aged 21 to 42 (mean, 28) years who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation were reviewed. All the wounds were transverse/oblique, minimally contaminated, and could be closed primarily. Patients were evaluated at months 3, 9, and 12, using the Foot and Ankle Outcome Score (FAOS) questionnaire. RESULTS Of the 22 patients, 3 developed superficial skin complications that healed gradually, and 2 developed a superficial discharging sinus and underwent minor debridement. No patient had a re-rupture of the Achilles tendon. At the one-year follow-up, all patients achieved good functional outcome in terms of the FAOS. CONCLUSION Repair of Achilles tendon ruptures with peroneus brevis tendon augmentation achieved good functional outcome.
Collapse
Affiliation(s)
- Amarjeet Singh
- Department Of Orthopaedics, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | | | | | | |
Collapse
|
26
|
Arbab D, Tingart M, Frank D, Abbara-Czardybon M, Waizy H, Wingenfeld C. Treatment of isolated peroneus longus tears and a review of the literature. Foot Ankle Spec 2014; 7:113-8. [PMID: 24381076 DOI: 10.1177/1938640013514273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Isolated peroneus longus tendon tears are rare and represent a frequently overlooked source of lateral ankle pain and dysfunction. Only few cases of isolated peroneus longus tendon tears have been reported and a common treatment algorithm does not exist. The purpose of this study was to give an overview of the literature and to present our experience of 6 consecutive cases that have been treated successfully by operation and immobilizing cast. METHODS A comprehensive chart review was performed to compile each patient's age, sex, onset of symptoms, time between first symptoms and diagnosis, surgical findings, surgical treatment, length of follow-up, and outcome. The average patient age was 48 years (range 20-63 years). RESULTS Acute tears occurred in 4 cases, and 2 patients reported about a chronic onset of symptoms. The cause for acute tears was an acute inversion ankle sprain in all cases. Diagnosis was made after an average of 11 months (range 0.75-24 months). There were 2 complete tears, and other 4 were incomplete. An os peroneum was present in 2 cases. In 5 of 6 cases, the results after surgical treatment were excellent or good after a mean follow-up of 28.6 months (range 12-78 months). CONCLUSION This study indicates that lateral ankle pain may be due to isolated acute or chronic peroneus longus tendon tears. Thorough clinical and radiological diagnosis is necessary to detect this uncommon injury in time. Patients with acute onset of symptoms and short time between symptoms and diagnosis tend to fare better than the chronic tears and delayed diagnosis. Surgical intervention yields successful and predictable results.
Collapse
Affiliation(s)
- Dariusch Arbab
- Department of Orthopaedic Surgery, University of Aachen Medical Center, Germany (DA, MT)
| | | | | | | | | | | |
Collapse
|
27
|
Lee SJ, Jacobson JA, Kim SM, Fessell D, Jiang Y, Dong Q, Morag Y, Choo HJ, Lee SM. Ultrasound and MRI of the peroneal tendons and associated pathology. Skeletal Radiol 2013; 42:1191-200. [PMID: 23685674 DOI: 10.1007/s00256-013-1631-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 04/08/2013] [Accepted: 04/17/2013] [Indexed: 02/02/2023]
Abstract
Lateral ankle pain is common with overuse and sports-related injuries and may cause considerable morbidity. The differential diagnosis of lateral ankle pain is extensive. Disorders of the peroneal tendons should be an important consideration during interpretation of a routine ankle magnetic resonance imaging (MRI) or ultrasound (US). This article presents a review of the common causes of peroneal tendon pathology with particular reference to anatomy, US, and MRI features. The importance of dynamic evaluation with ultrasound is also emphasized.
Collapse
Affiliation(s)
- Sun Joo Lee
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Mook WR, Parekh SG, Nunley JA. Allograft reconstruction of peroneal tendons: operative technique and clinical outcomes. Foot Ankle Int 2013; 34:1212-20. [PMID: 23613331 DOI: 10.1177/1071100713487527] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Irreparable peroneal tendon tears are uncommon and require complex surgical decision making. Intercalary segment allograft reconstruction has been previously described as a treatment option; however, there are no reports of the outcomes of this technique in the literature. We describe our technique and present our results using this method. METHODS A retrospective chart review was conducted to identify all patients who underwent intercalary allograft reconstruction of the peroneal tendons. Mechanism of injury, concomitant operative procedures, pertinent radiographic findings, pre- and postoperative physical examination, intercalary graft length, medical history, visual analog scale (VAS) score for pain, Short Form-12 (SF-12) physical health survey, Lower Extremity Functional Score (LEFS), and complications were reviewed. RESULTS Fourteen patients with peroneal tendon ruptures requiring reconstruction were identified. Mean follow-up was 17 months (range, 7-47 months; median, 12 months). The average length of the intercalary segment reconstructed was 10.8 ± 3.8 cm (range, 6-20 cm). The average postoperative VAS score decreased to 1.0 ± 1.4 (P = .0005). No patient had a higher postoperative pain score than preoperative pain score. Average postoperative eversion strength as categorized by the Medical Research Council grading scale improved to 4.8 ± 0.5 (P = .001). The average SF-12 score improved to 48.8 ± 7.8 (P = .02). The average LEFS improved to 86.4. ± 14.9 (P = .00001). Four patients experienced sensory numbness in the sural nerve distribution, and 2 of these were transient. There were no postoperative wound healing complications, infections, tendon reruptures, or reoperations. No allograft associated complications were encountered. All patients returned to their preinjury activity levels. CONCLUSION Allograft reconstruction of the peroneal tendons can improve strength, decrease pain, and yield satisfactory patient-reported outcomes. It can be performed without incurring the deleterious effects associated with tendon transfer procedures. We believe that allograft reconstruction is a safe and useful alternative in the treatment of irreparable peroneal tendon ruptures. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- William R Mook
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | | |
Collapse
|
29
|
Chan JY, Elliott AJ, Ellis SJ. Reconstruction of achilles rerupture with peroneus longus tendon transfer. Foot Ankle Int 2013; 34:898-903. [PMID: 23696187 DOI: 10.1177/1071100712473273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jeremy Y Chan
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | | | | |
Collapse
|
30
|
El Rassi G, Kouvalchouk JF, Mcfarland E. Isolated dislocation of the peroneus longus tendon over the calcaneal tubercle in an ice skater: a case report. J Bone Joint Surg Am 2012; 94:e43. [PMID: 22488627 DOI: 10.2106/jbjs.j.01786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- George El Rassi
- Saint George Hospital, PO Box 166378 Ashrafieh Beirut 1100 2807, Lebanon.
| | | | | |
Collapse
|
31
|
The Accuracy of Ultrasound-Guided and Palpation-Guided Peroneal Tendon Sheath Injections. Am J Phys Med Rehabil 2011; 90:564-71. [DOI: 10.1097/phm.0b013e31821f6e63] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
32
|
Lateral ankle triad: the triple injury of ankle synovitis, lateral ankle instability, and peroneal tendon tear. Clin Podiatr Med Surg 2011; 28:105-15. [PMID: 21276521 DOI: 10.1016/j.cpm.2010.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many articles have been published that discuss various lateral ankle injuries and specific lateral ankle pathology. The purpose of this article is to explore and present a specific combination of findings that the author's multiphysician practice has noticed on a frequently recurring basis. The triple injury of ankle synovitis, ankle instability, and peroneal tendon tear can be termed the Lateral Ankle Triad. While it is common to find each of these specific injuries individually, they are often found in combination.
Collapse
|
33
|
Maffulli N, Spiezia F, Longo UG, Denaro V. Less-invasive reconstruction of chronic achilles tendon ruptures using a peroneus brevis tendon transfer. Am J Sports Med 2010; 38:2304-12. [PMID: 20802093 DOI: 10.1177/0363546510376619] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A less-invasive technique to reconstruct chronic Achilles tendon rupture with transfer of the tendon of peroneus brevis is suitable in patients with a tendon gap less than 6 cm. PURPOSE To report the results of a longitudinal study on reconstruction of chronic Achilles tendon rupture using a less-invasive peroneus brevis repair through 2 paramidline incisions. STUDY DESIGN Case series; Level of evidence, 4. METHODS Thirty-two patients underwent surgery for chronic Achilles tendon rupture with a tendon gap during surgery less than 6 cm, occurring between 60 days and 9 months preoperatively. All participants were prospectively followed for 5 to 8 years; final review was performed at 48.4 ± 13.5 months from the operation. Clinical and functional assessment (anthropometric measurements, isometric strength, postoperative Achilles tendon total rupture score) was performed. RESULTS All patients were able to walk on tiptoes, and no patient used a heel lift or walked with a visible limp. No patient developed a clinically evident deep vein thrombosis or sustained a rerupture. Five patients were managed nonoperatively after a superficial infection of one of the surgical wounds. At final review, the maximum calf circumference remained significantly decreased in the operated leg (39.2 ± 6.2 cm [side with rupture] vs 40.9 ± 7.0 cm [uninjured side]; P = .04). The operated limb was significantly less strong than the nonoperated one (231.2 ± 132.4 N vs 275.3 ± 150.2 N; P = .033). The Achilles tendon total rupture score at final follow-up was 92.5 ± 14.2. CONCLUSION The management of chronic Achilles tendon tears by a less-invasive peroneus brevis repair is technically demanding but safe. It allows good recovery, even in patients with a chronic rupture of 9 months' duration. These patients should be warned that they are at risk for postoperative complications and that their ankle plantar flexion strength is likely to be reduced.
Collapse
Affiliation(s)
- Nicola Maffulli
- Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England.
| | | | | | | |
Collapse
|
34
|
Petersen B, Fitzgerald J, Schreibman K. Musculotendinous Magnetic Resonance Imaging of the Ankle. Semin Roentgenol 2010; 45:250-76. [PMID: 20727454 DOI: 10.1053/j.ro.2009.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
35
|
Lateral plantar pain: diagnostic considerations. Emerg Radiol 2010; 17:291-8. [DOI: 10.1007/s10140-009-0855-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 11/23/2009] [Indexed: 12/28/2022]
|
36
|
Bare A, Ferkel RD. Peroneal tendon tears: associated arthroscopic findings and results after repair. Arthroscopy 2009; 25:1288-97. [PMID: 19896052 DOI: 10.1016/j.arthro.2009.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 03/16/2009] [Accepted: 05/23/2009] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to identify the intra-articular pathology associated with peroneal tendon tears and report the outcomes after tendon repair or tenodesis with arthroscopic treatment. METHODS Thirty patients were evaluated who underwent ankle arthroscopy followed by peroneal tendon repair. Intra-articular pathology was treated arthroscopically before peroneal tendon surgery was performed. All patients were available for a minimum 2-year follow-up. Preoperative and postoperative American Orthopaedic Foot & Ankle Society and Karlsson scores were analyzed for all patients. RESULTS A total of 60 intra-articular lesions were treated arthroscopically in 30 ankles. We diagnosed 13 lesions preoperatively (22%), and 47 lesions (78%) were discovered during arthroscopy. Of the patients, 5 (17%) had associated anterolateral instability requiring an open reconstruction. Soft-tissue impingement was seen in 6 patients (20%), anterior osteophytes in 4 (13%), loose bodies in 4 (13%), osteochondral lesions in 4 (13%), extensive scar tissue in 24 (80%), extensive synovitis in 7 (23%), chondral injuries in 2 (7%), and a torn posterior transverse tibiofibular ligament in 2 (5%). Postoperative American Orthopaedic Foot & Ankle Society and Karlsson scores were significantly improved compared with preoperative scores. Patients with chronic complaints before surgery had better outcome scores than patients with an isolated, acute twisting injury. It is unclear whether the incidental pathology discovered at the time of arthroscopic examination influenced outcome measures. CONCLUSIONS All patients with peroneal tendon tears had associated intra-articular pathology, with the majority of patients having more than 1 intra-articular lesion. For patients meeting surgical criteria, correction of the tendon tears and arthroscopic treatment of the intra-articular lesions produced statistically significantly improved results and patient satisfaction, paralleling historical controls. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Aaron Bare
- OAD Orthopaedics, Warrenville, Illinois, USA
| | | |
Collapse
|
37
|
Anatomic Reconstruction of Neglected Achilles Tendon Rupture With Autogenous Peroneal Longus Tendon by EndoButton Fixation. ACTA ACUST UNITED AC 2009; 67:1109-12. [DOI: 10.1097/ta.0b013e3181a73f02] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
38
|
|
39
|
Abstract
Peroneal tendon injuries in the athlete are recognized with increasing frequency as a pathologic entity. Once considered uncommon, they have been attributed to many cases of persistent lateral ankle symptoms after a "typical" ankle sprain. Acute tears of the peroneus brevis, and less commonly the peroneus longus, have been implicated in sport activities and are often coexistent with peroneal instability. Subluxation typically occurs when the foot is in a dorsiflexed position and the peroneal muscles strongly contract, causing an eversion force simultaneously. Peroneal instability, as well as tearing, has been linked to ballet dancing, skiing, soccer, tennis, American football, running, basketball, and ice skating. This article discusses the mechanism of injury, methods of patient evaluation and management, complications, and outcomes.
Collapse
Affiliation(s)
- Rebecca A Cerrato
- The Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD 21202, USA.
| | | |
Collapse
|
40
|
Heckman DS, Gluck GS, Parekh SG. Tendon disorders of the foot and ankle, part 1: peroneal tendon disorders. Am J Sports Med 2009; 37:614-25. [PMID: 19251687 DOI: 10.1177/0363546508331206] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pathologic abnormality of the peroneal tendons is an uncommon but underappreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from lateral ankle ligament injuries. When left untreated, peroneal tendon disorders can lead to persistent lateral ankle pain and substantial functional problems. Unfortunately, the treatment recommendations for these disorders are primarily based on case series and expert opinion. The goals of this review are to develop a current understanding of the anatomy and diagnostic evaluation of the peroneal tendons, and to present current treatment options and the authors' preferred surgical techniques for operative management of peroneal tendon lesions.
Collapse
Affiliation(s)
- Daniel S Heckman
- Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | | |
Collapse
|
41
|
Affiliation(s)
- Franz Kopp
- San Diego Orthopaedic Associates, 4060 4th Avenue, 7th Floor, San Diego, CA 92103-2181, USA.
| |
Collapse
|
42
|
Heckman DS, Reddy S, Pedowitz D, Wapner KL, Parekh SG. Operative treatment for peroneal tendon disorders. J Bone Joint Surg Am 2008; 90:404-18. [PMID: 18245603 DOI: 10.2106/jbjs.g.00965] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Peroneal tendon disorders are rare, are frequently missed, and can be a source of lateral ankle pain. Magnetic resonance imaging is the standard method of radiographic evaluation of peroneal tendon disorders; however, diagnosis and treatment are based primarily on the history and physical examination. Peroneal tenosynovitis typically responds to conservative therapy, and operative treatment is reserved for refractory cases. Operative treatment is frequently required for peroneal tendon subluxation and consists of anatomic repair or reconstruction of the superior peroneal retinaculum with or without deepening of the retromalleolar groove. Operative treatment of peroneal tendon tears is based on the amount of remaining viable tendon. Primary repair and tubularization is indicated for tears involving <50% of the tendon, and tenodesis is indicated for tears involving >50% of the tendon.
Collapse
Affiliation(s)
- Daniel S Heckman
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, 3135 Bioinformatics Building, CB #7055, Chapel Hill, NC 27599-7055, USA
| | | | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND Our aim was to investigate the morphometric features of malleolar groove of the lateral malleolus in humans. METHODS This study was performed on the malleolar grooves of 93 (80 dry and 13 cadaveric) fibulae. We measured the length of the fibula; length, width, and depth of the malleolar groove; the angle between malleolar groove and the fibular axis. Furthermore, we measured the distances between the distal tip of the fibula and the lateral and medial tubercles of lateral malleolus, and the width of posterior surface of the lateral malleolus. RESULTS We found the shape of malleolar groove regularly concave in 63 out of 93 (68%) fibulae. The features of the triangular area at the posterior aspect of the lateral malleolus, where the peroneal tendons pass over, may serve as a bed for the peroneal tendons. There was a significant correlation between the depth of the malleolar groove and the distances between the distal tip of the fibula and the medial and lateral tubercles, as well (p<0.05). CONCLUSION A strong correlation existed between either the shape of the groove or the values of the reference points. CLINICAL RELEVANCE The shape of the groove may be important in reinforcing the superior peroneal retinaculum (SPR) and other structures restraining the tendons.
Collapse
Affiliation(s)
- Davut Ozbag
- Faculty of Medicine, Kahramanmaras Sutcu Imam University, Department of Anatomy, Yorukselim mh. Hastane cd. No: 32., Kahramanmaras 46050, Turkey.
| | | | | | | |
Collapse
|
44
|
Abstract
Acute peroneal tendon tears lay at one end of a spectrum of peroneal tendon pathology. Because a tear represents a mechanical abnormality, surgical treatment is frequently required. Anatomical variants need to be considered as potential causes of lateral ankle pain. Most acute peroneus brevis tears are longitudinal, occur adjacent to the tip of the fibula, and require surgical treatment. Acute peroneus longus tears more commonly occur at the level of the cuboid tunnel and may initially be managed nonoperatively, but, if associated with stenosing tendonitis, may require debridement and tenodesis. Rarely, complete ruptures of both peronei occur and, if there is a significant defect, reconstructive procedures are required.
Collapse
Affiliation(s)
- H K Slater
- North Sydney Orthopaedic and Sports Medicine Centre, 286 Pacific Highway, Crows Nest, NSW 2065, Sydney, Australia.
| |
Collapse
|
45
|
Abstract
The focus of this article is the diagnosis and treatment of peroneal tendon tears. The article first describes mechanisms of injuries resulting in peroneal brevis and longus tears. Associated pathologies, such as ankle instability, hindfoot varus, hypertrophied peroneal tubercle, are discussed. Following sections on diagnosis and conservative treatment, the article describes operative treatment for isolated peroneus brevis tear, isolated peroneus longus tear, and tears of both the peroneus longus and brevis. The authors also discuss hamstring allograft reconstruction, the silicone rod technique, flexor digitorum longus transfer to the peroneus brevis, and treatment of associated pathology.
Collapse
Affiliation(s)
- Natalie Squires
- InMotion Clinic, 1615 Delaware Street, Longview, WA 98632, USA
| | | | | |
Collapse
|
46
|
Abstract
Overuse syndromes due to lifestyle problems or sporting activities commonly lead to foot abnormalities. The tendons of the long flexor and extensor muscles are specifically prone to degeneration. The various disorders may be classified by a grading system that includes peritendinous inflammation, degenerative tendon disease, and ruptures. Bone marrow edema is another typical manifestation of overuse. It may be differentiated from inflammatory or traumatic forms of edema by its anatomic distribution. Systematic pattern recognition is based on the concept of musculotendinous and osseous kinetic chains.
Collapse
Affiliation(s)
- F Kainberger
- Klinik für Radiodiagnostik, AKH, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090 Wien.
| | | | | | | |
Collapse
|
47
|
Blitz NM, Nemes KK. Bilateral peroneus longus tendon rupture through a bipartite os peroneum. J Foot Ankle Surg 2007; 46:270-7. [PMID: 17586440 DOI: 10.1053/j.jfas.2007.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Indexed: 02/03/2023]
Abstract
Peroneus longus rupture with associated involvement of the os peroneum is an uncommon injury, and a small number of cases have been reported. Several mechanisms of injury have been suggested, but the most accepted theory is due to an inversion force placed on a cavovarus foot type. The sesamoid often becomes the focal point of the mechanical stresses and may fracture. Although the purpose of the sesamoid is to protect the tendon from rupture, the os peroneum may actually encourage fatigue (tear/rupture) under certain circumstances. Because this injury occurs at the cuboid notch, primary repair is complicated because of the inability to access the tendon as it courses deep within the midfoot. We present a bilateral case of peroneus longus rupture with involvement of the os peroneum in a patient with a cavovarus foot type. The injuries were sustained from an identical mechanism and occurred almost 1 year apart. In both situations, a peroneus longus to peroneus brevis tendon transfer was performed above the ankle joint in conjunction with partial excision of the fractured os peroneum. To the authors' knowledge, this is the only reported case of peroneus longus rupture associated with fracture of the os peroneum to occur bilaterally.
Collapse
Affiliation(s)
- Neal M Blitz
- Department of Orthopedics and Foot & Ankle Surgery, Kaiser Permanente Medical Center, 3925 Old Redwood Hwy, Santa Rosa, CA 95403, USA.
| | | |
Collapse
|
48
|
|
49
|
Kijowski R, De Smet A, Mukharjee R. Magnetic resonance imaging findings in patients with peroneal tendinopathy and peroneal tenosynovitis. Skeletal Radiol 2007; 36:105-14. [PMID: 17136379 DOI: 10.1007/s00256-006-0172-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 05/23/2006] [Accepted: 06/01/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the magnetic resonance (MR) imaging findings of a group of patients with clinically diagnosed peroneal tendonopathy and peroneal tenosynovitis with the MR imaging findings of a control group of patients with no clinical evidence of peroneal tendon disorder. SUBJECTS AND METHODS The MR examinations of 24 patients with symptomatic peroneal tendinopathy or peroneal tenosynovitis and 70 patients with no clinical evidence of peroneal tendon disorder were retrospectively reviewed to determine the presence or absence of four MR imaging findings: 1) predominantly or uniform intermediate signal intensity within the peroneal tendons on one or more axial proton density-weighted images, 2) predominantly or uniform intermediate signal intensity within the peroneal tendons on three consecutive axial proton density-weighted images, 3) intermediate T2 signal intensity within the peroneal tendons, and 4) circumferential fluid within the common peroneal tendon sheath greater than 3 mm in maximal width. The sensitivity and specificity of these MR imaging findings for determining the presence or absence or symptomatic peroneal tendinopathy or peroneal tenosynovitis were calculated. RESULTS The sensitivity of MR imaging findings 1, 2, 3, and 4 for determining the presence of peroneal tendinopathy or peroneal tenosynovitis were 92%, 92%, 50%, and 17% respectively. The specificity of MR imaging findings 1, 2, 3, and 4 for determining the absence of peroneal tendinopathy or peroneal tenosynovitis were 57%, 79%, 93%, and 100% respectively. CONCLUSION The presence of predominantly or uniform intermediate signal intensity within the peroneal tendons on three consecutive axial proton density-weighted images is a highly sensitive and moderately specific indicator of symptomatic peroneal tendinopathy. The presence of intermediate T2 signal within the peroneal tendons, and the presence of circumferential fluid within the peroneal tendon sheath greater than 3 mm in maximal width, are highly specific indicators of peroneal tendinopathy and peroneal tenosynovitis respectively.
Collapse
Affiliation(s)
- Richard Kijowski
- Department of Radiology, University of Wisconsin Hospital, Clinical Science Center- E3/311, 600 Highland Avenue, Madison, WI 53792-3252, USA.
| | | | | |
Collapse
|
50
|
Abstract
BACKGROUND Operative treatment has become the standard for peroneal tendon tears when nonoperative management fails. Successful return to sports has been reported in previous studies. We evaluated 30 patients who had operative treatment of peroneal tears. METHODS Patients who were evaluated by a questionnaire and by review of medical records, MRI, radiographs, and operative reports. RESULTS Nine of the 10 patients who were working outside the home were able to return to employment at the same level. A substantial number had residual symptoms, including scar tenderness (58%) and lateral ankle swelling (54%). Only 46% were able to successfully return to sports. CONCLUSIONS Although operative treatment was very effective in allowing patients to return to work, only half of our patients were able to return to sports at an average followup of 31 months.
Collapse
Affiliation(s)
- Maxwell W Steel
- Orthopaedic Surgery, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | | |
Collapse
|