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Goto K, Sanada T, Honda E, Sameshima S, Murakami T, Inagawa M, Ishida Y, Kuzuhara R, Iwaso H. Fibular morphology is not associated with incidence of peroneal tendon dislocation. Knee Surg Sports Traumatol Arthrosc 2024; 32:1607-1614. [PMID: 38509788 DOI: 10.1002/ksa.12160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The association of peroneal tendon dislocation with peroneal bone morphology and postoperative redislocation rates remains unknown. This study compared the fibula morphology in patients with peroneal tendon dislocation with that in a control population. METHODS The study enrolled 48 patients who underwent surgery for peroneal tendon dislocation at our institution during between 2018 and 2023. Thirty-five patients with preoperative magnetic resonance imaging of the ankle were defined as Group D and 35 with magnetic resonance imaging of the ankle for other reasons and with similar background data were selected as the control group (Group C). The posterior tilting angle of the fibula, posterolateral angle and posterolateral edge angle were evaluated at the plafond level. The posterior tilting angle, posterolateral angle and retromalleolar bone shape according to the Rosenberg classification (flat, convex, concave) were evaluated at the midpoint between the plafond and the tip. RESULTS At the plafond level, the posterior tilting, posterolateral and posterolateral edge angles were 57.7 ± 11.1°, 123.8 ± 12.3° and 90.8 ± 13.7°, respectively, in Group D and 64.1 ± 15.4°, 121.1 ± 12.3° and 88.7 ± 12.2°, respectively, in Group C, with no significant differences. No significant between-group differences existed in the posterior tilting and posterolateral angles at the midpoint level. Moreover, no significant differences existed in distribution of the bone geometry according to the Rosenberg classification. CONCLUSION There were no differences in morphology between patients with peroneal tendon dislocation and controls. This study provides useful information on the indications for primary surgery and whether bony approach is useful for peroneal tendon dislocation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kazumi Goto
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Takaki Sanada
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Eisaburo Honda
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Shin Sameshima
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Tomoki Murakami
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Miyu Inagawa
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Yutaro Ishida
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Ryota Kuzuhara
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Hiroshi Iwaso
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
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Yokoe T, Tajima T, Ouchi K, Yamaguchi N, Morita Y, Chosa E. Differences in Retromalleolar Fibular Groove Morphology According to Level of Axial Computed Tomography Scans. Orthop J Sports Med 2024; 12:23259671241237255. [PMID: 38532767 PMCID: PMC10964457 DOI: 10.1177/23259671241237255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 03/28/2024] Open
Abstract
Background Studies have evaluated types of retromalleolar groove using axial magnetic resonance imaging at the level of 10 mm above the tip of the lateral malleolus. However, no evidence is available to support that this level is appropriate for evaluating retromalleolar groove morphology. Purpose To assess the influence of the level of axial computed tomography (CT) scans on the assessment of retromalleolar groove morphology. Study Design Cross-sectional study; Level of evidence, 3. Methods The study population included 122 patients (mean age, 27.9 ± 11.8 years; 69 males, 53 female) who underwent CT scans to evaluate foot or ankle pathologies between 2020 and 2023. The shape of the retromalleolar groove (concave, flat, convex, or irregular) at 3 levels of axial CT scans (8, 10, and 12 mm above the tip of the lateral malleolus) was assessed independently by 2 orthopaedic surgeons. The length from the tip of the lateral malleolus to the proximal tip of the fossa of the lateral malleolus was also measured on coronal CT scans. Results The type of retromalleolar groove was significantly different according to the level of CT scans (8 vs 10 mm, P = .0001; 10 vs 12 mm, P = .0001; 8 vs 12 mm, P = .001). The type of retromalleolar groove was the same at all 3 levels in 31.1% of patients (38/122). The length from the tip of the lateral malleolus to the proximal tip of the fossa of the lateral malleolus was <10 mm in 17.2% of patients (21/122). Conclusion The shape of the retromalleolar fibular groove was affected by the level at which the CT scan was obtained. Approximately 70% of the patients showed different types of retromalleolar grooves among the 3 CT scan levels.
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Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Koki Ouchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
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Zhang P, Li S, Liu Y, Lin Z, Deng Y, Zhou P. Modified posterior fibular groove deepening procedure with repair of the superior peroneal retinaculum for peroneal tendon subluxation. INTERNATIONAL ORTHOPAEDICS 2023; 47:1259-1265. [PMID: 36881154 DOI: 10.1007/s00264-023-05750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE To evaluate the clinical results of modified peroneal sulcus deepening combined with superior peroneal retinaculum repair in peroneal tendon subluxation treatment. METHODS From 2016 to 2020, 18 patients with peroneal tendon subluxation were diagnosed and treated; all patients underwent modified peroneal sulcus deepening combined with superior peroneal retinaculum repair. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS-AH) score, and subjective patient satisfaction were evaluated before surgery and during follow-up. RESULTS The operative time was 66.44 ± 5.22 min. All patients' surgical incisions showed grade A healing, and there were no complications. All patients were followed up for 24-48 months; no patients were lost to follow-up. At the last follow-up, the VAS and AOFAS-AH scores were significantly improved compared with those pre-operatively (P < 0.05). There was no significant difference in the activity of the 18 patients between pre- and post-operatively, and all patients recovered their normal gait before injury. CONCLUSION Modified fibular groove deepening combined with superior peroneal retinaculum repair for treating peroneal tendon subluxation may be a simple operation with minimal trauma, rapid recovery, and good clinical efficacy.
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Affiliation(s)
- Peng Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - ShenSong Li
- Department of Sports Medicine, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, 730050, China
| | - Yang Liu
- Lintong Rehabilitation and Convalescent Center Joint Logistic Support Force of Chinese People's Liberation Army, Shaanxi, China
| | - ZiFan Lin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - YinShuan Deng
- Department of Trauma Orthopaedic, Gansu Province Central Hospital, Gansu, 730050, China.
| | - Peng Zhou
- Department of Sports Medicine, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, 730050, China.
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Vosoughi AR, Hashemipour B, Khademi S, Akbarzadeh A, Shayan Z. Clinical Outcomes Following Suturing of Sheath of Peroneal Tendons to the Calcaneal Plate as an Innovative Technique for Reduction of Peroneal Tendon Instability Accompanying Calcaneal Fracture. Foot Ankle Spec 2022:19386400221125373. [PMID: 36181273 DOI: 10.1177/19386400221125373] [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: 11/17/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the clinical and functional outcomes following suturing of sheath of peroneal tendons to the calcaneal plate as an innovative technique for reduction of peroneal tendon instability (PTI) accompanying calcaneal fracture surgically treated via extensile lateral approach (ELA). METHODS In a retrospective comparative study, among 245 operatively treated calcaneal fractures through ELA, we had 33 cases with PTI who underwent relocation of the peroneal tendons with ethibond suture in a figure-of-8 shape, passed through 2 parts of sheath of peroneal tendons and stitched to the calcaneal plate. Of the 33 cases, 12 were evaluated in the experimental group. Twelve surgically treated calcaneal fractures without PTI were matched as the control group. The outcome of the patients was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI) percentage, Visual Analog Scale (VAS) pain, changes in Tegner activity level, maximal peroneal muscles strength testing, modified Star Excursion Balance Test (mSEBT), and triple hop for distance (THD) test. For the last 3 tests, the difference between operated and normal feet was calculated for each patient and this difference was compared between the 2 groups. RESULTS There was no statistically significant difference between the 2 groups for AOFAS Ankle-Hindfoot Scale (P = .09), FFI percentage (P = .12), VAS pain (P = .73), changes in Tegner activity level (P = .87), maximal peroneal muscles strength testing (P = .45), mSEBT (P > .05), and THD (P = .87) tests. We had a case with point tenderness on retromalleolar groove and 4 cases with paresthesia in the territory of the sural nerve in the experimental group in contrary to one case of sural nerve paresthesia in the control group (P = .31). CONCLUSIONS Relocation of peroneal tendons in PTI accompanying calcaneal fractures by fixing sheath of peroneal tendons to the calcaneal plate could be an acceptable procedure with good outcomes but may have increased chance of sural nerve injury. LEVELS OF EVIDENCE Therapeutic, Level III: Retrospective.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Hashemipour
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Khademi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Akbarzadeh
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shayan
- Trauma Research Center, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Hwang IM, Rayos del Sol S, Jenkins SM, Bryant SA, Gardner BB, McGahan P, Chen J. Open Peroneal Tendon Stabilization With Fibular Groove Deepening. Arthrosc Tech 2022; 11:e347-e352. [PMID: 35256974 PMCID: PMC8897588 DOI: 10.1016/j.eats.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/31/2021] [Indexed: 02/03/2023] Open
Abstract
Peroneal tendon subluxation often occurs because of sudden dorsiflexion of the ankle, leading to a traumatic rupture of the superior peroneal retinaculum. Currently, there are several surgical techniques to deepen the fibular groove, but there is no universally accepted gold standard. This technique article describes a fibular groove deepening with preservation of the fibrocartilage in conjunction with repair of the superior peroneal retinaculum. Addressing the main pathologies that may be leading to subluxation of the peroneal tendons, we offer an approach that avoids many of the common pitfalls from previously proposed techniques while preserving the natural fibrocartilage within the malleolar groove and repairing the retinaculum.
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Affiliation(s)
- Inga M. Hwang
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A.,Address correspondence to Inga Hwang, B.S., Advanced Orthopedics and Sports Medicine, San Francisco, CA, 94108, U.S.A.
| | | | - Sarah M. Jenkins
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Stewart A. Bryant
- Department of Orthopaedic Surgery, University of Hawaii Honolulu, Hawaii, U.S.A
| | - Brandon B. Gardner
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Patrick McGahan
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - James Chen
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
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Peroneal Subluxation and Associated Tears. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Peroneal tendon disorders remain an often overlooked source of lateral hindfoot pain and tenderness. Medical professionals who specialize in foot and ankle care are still far more likely to diagnose a peroneal tendon disorder as an ankle injury. In fact, acute peroneal dislocations are misdiagnosed in up to 40% of cases. The major subsets of peroneal disorders include peroneal tendonitis and tenosynovitis, painful os peroneum syndrome, subluxation, and tearing of the peroneal tendons. Proper history and physical exam maneuvers must be performed to help identify the source of the injury and differentiate these categories. Detailed imaging through X-ray and magnetic resonance imaging must also be used to diagnose the etiology of the patient's condition in order to direct management. Currently, there is very limited knowledge on peroneal pathologies, and treatment protocol is highly variable and limited to expert opinion. Despite the individual preferences and nuances held by each surgeon when it comes to operating, the overarching principles that guide appropriate management of tendonitis, subluxation, and tendon tear should maintain a higher level of consistency. Therefore, the authors of this review aim to elucidate the most current methods to diagnose these disorders as well as evidence-based practices for optimal management.Levels of Evidence: Level V.
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Affiliation(s)
- Akhil Sharma
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
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Gökkuş K, Sahin MS, Sargin MB. The Ellis Jones Method of Treating Chronic Peroneal Subluxation: Revisited and Colorized After 87 Years. Foot Ankle Spec 2021; 14:68-73. [PMID: 32844668 DOI: 10.1177/1938640020951385] [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: 11/16/2022]
Abstract
Chronic cases of peroneal subluxation typically call for surgical treatment; however, research on current surgical procedures suggests nonuniformity. The purpose of this study is to remind surgeons of the efficacy of an older surgical method by using the case of a selected patient. In this study, the Ellis Jones procedure was performed on a patient who had been suffering from a chronic peroneal subluxation for 22 years, since, in this particular case, other approaches were deemed likely to be unsuccessful. The patient had hypertrophied, frayed, and swollen tendons, which were unsuitable to be rerouted, whereas the superior peroneal retinaculum was diminished and deepening procedures would not be able to establish sufficient volume for retaining the hypertrophied tendons. After the debridement and repair of the peroneal tendons, ¼ of the lateral Achilles tendon was split, passed through a hole in the fibula, and sutured onto itself, and the subluxation path of the peroneal tendons was closed with an effective tendon barrier. The patient returned to work after 8 weeks of the surgery and was followed up for 4 years postoperatively. On selected patients, the Ellis Jones surgical method might therefore still be applied.Levels of Evidence: Level V.
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Affiliation(s)
- Kemal Gökkuş
- Orthopaedics and Trauma Department, Baskent University School of Medicine Alanya Research and Practice Center, Orthopedics and Traumatology, Antalya, Turkey
| | - Mehmet Sukru Sahin
- Orthopaedics and Trauma Department, Baskent University School of Medicine Alanya Research and Practice Center, Orthopedics and Traumatology, Antalya, Turkey
| | - Mehmet Baris Sargin
- Orthopaedics and Trauma Department, Baskent University School of Medicine Alanya Research and Practice Center, Orthopedics and Traumatology, Antalya, Turkey
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Shazadeh Safavi K, Ratnasingam S, Janney CF. Chronic Peroneal Tendon Dislocation: A Case Report. Mil Med 2020; 185:e1882-e1886. [PMID: 32501507 DOI: 10.1093/milmed/usaa093] [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: 11/14/2022] Open
Abstract
We present a unique case of chronic peroneal tendon dislocation in a 47-year-old active duty military member with a 2-mo history of acute onset lateral ankle pain due to sports injury. Magnetic resonance imaging revealed superficial peroneal retinaculum (SPR) disruption, a flattened retrofibular groove, dislocation of the peroneus longus tendon, and a tear of the peroneus brevis tendon. The patient was managed operatively with fibular groove deepening, SPR reconstruction, peroneus brevis debridement, and peroneus longus tubulurization. No complications were observed during the intra- or perioperative periods. At their 3-mo follow-up, the patient reported near complete resolution of pain and the ability to ambulate without any brace or support. He returned to running and was able to deploy fit for full duty 4.5 mo from injury.
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Affiliation(s)
- Kiya Shazadeh Safavi
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Saruthija Ratnasingam
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Cory F Janney
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
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Deng E, Shi W, Jiao C, Xie X, Jiang D, Chen L, Hu Y, Guo Q. Reattachment of the superior peroneal retinaculum versus the bone block procedure for the treatment of recurrent peroneal tendon dislocation: two safe and effective techniques. Knee Surg Sports Traumatol Arthrosc 2019; 27:2877-2883. [PMID: 30903219 DOI: 10.1007/s00167-019-05479-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/06/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Clinical outcomes between reattachment of the superior peroneal retinaculum (SPR) and the bone block procedure were compared in this study to elucidate which procedure was safer and more effective. METHODS From 2012 to 2016, 25 patients with recurrent peroneal tendon dislocation underwent the bone block procedure (group A), and another 22 patients underwent reattachment of the SPR (group B). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Activity Score (AAS), time to return to sports activity, rate of return to sports level, range of motion (ROM) of the ankle, rate of recurrence, and overall patient satisfaction were collected to evaluate outcomes between the two groups. RESULTS In group A, 24 patients followed up at a mean period of 42.5 ± 16.7 months. The mean postoperative AOFAS score was 92.9 ± 3.9. The median time to return to sports activity was 6.0 months (IQR 4.3-6.0 months) with 19 patients (79.2%) returning to their previous sports level. Two patients experienced recurrent dislocation, and 22 patients (91.7%) were satisfied with the procedure. In group B, 20 patients followed up at a mean period of 35.8 ± 15.3 months. The mean postoperative AOFAS score was 95.0 ± 4.2. The median time to return to sports activity was 5.0 months (IQR 4.0-5.0 months) with 18 patients (90.0%) returning to their previous sports level. No recurrence was reported, and 18 patients (90.0%) were satisfied with the procedure. The time to return to sports activity in group B was significantly shorter than that in group A. There was no significant difference in complications or clinical outcomes between the two procedures. CONCLUSION Both procedures offered satisfactory results for recurrent peroneal tendon dislocation with low rates of recurrence and complications. However, the time to return to sports activity after the reattachment of the SPR was shorter than that after the bone block procedure. LEVEL OF EVIDENCE Retrospective Comparative Study, Level III.
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Affiliation(s)
- En Deng
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Weili Shi
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Chen Jiao
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xing Xie
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Dong Jiang
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Linxin Chen
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yuelin Hu
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Qinwei Guo
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Fibular groove morphology and measurements on MRI: correlation with fibularis tendon abnormalities. Surg Radiol Anat 2018; 41:75-85. [PMID: 30406355 DOI: 10.1007/s00276-018-2134-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/01/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Fibular (peroneal) groove morphology may influence fibularis tendon pathology, including tendinosis, tears, and luxation. The study goal was to evaluate the inter-reader agreement of morphologic characterization and measures of the fibular groove at two different levels on MRI and correlation with fibularis tendon pathology. MATERIALS AND METHODS 47 ankle MRIs in patients without lateral ankle pain were reviewed by two musculoskeletal radiologists. Fibular groove morphology and various measurements were assessed at both the level of the tibial plafond and 1 cm proximal to the tip of the lateral malleolus. Fibularis tendon pathology and other variants were also recorded. Intraclass correlation (ICC) and kappa statistic (κ) were applied to assess inter-observer agreement. Receiver operating characteristic (ROC) and area under the curve (AUC) analysis were performed to determine correlation between fibular groove morphometry and fibularis (peroneus) brevis tendon tears. RESULTS Between readers, there was fair-to-excellent agreement (ICC = 0.61-0.95) for performed fibular groove measurements and moderate-to-very good agreement for identification and description of fibular groove and fibularis tendon morphology and pathology and normal variants in this region (κ = 0.46-1), with the exception of fibular groove morphology at 1 cm proximal to the lateral malleolar tip (κ = 0.34). Individually, no measurement or description of pathology could discriminate between patients with or without fibularis brevis tendon tears except fibularis brevis tendinosis (AUC = 0.87 for reader 1). CONCLUSION There is overall moderate-to-excellent inter-reader agreement for various measurements and descriptors of fibular groove and fibularis tendon morphometry and pathology, including novel measurements introduced in this study.
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Suh JW, Lee JW, Park JY, Choi WJ, Han SH. Posterior Fibular Groove Deepening Procedure With Low-Profile Screw Fixation of Fibrocartilaginous Flap for Chronic Peroneal Tendon Dislocation. J Foot Ankle Surg 2018; 57:478-483. [PMID: 29269024 DOI: 10.1053/j.jfas.2017.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Indexed: 02/03/2023]
Abstract
Chronic peroneal tendon dislocation is an uncommon disorder that frequently presents with concomitant pathology. Posterior fibular groove deepening and retinaculum repair have been increasing in popularity for treatment of peroneal tendon dislocations. The purpose of the present study was to introduce a posterior fibular groove deepening procedure using low-profile snap-off screws to securely and simply fix the fibrocartilaginous flap to facilitate faster rehabilitation and to assess the clinical outcomes of patients with chronic peroneal tendon dislocation and associated pathologic features. In the present retrospective case series, 34 ankles in 34 patients underwent the fibular groove deepening procedure using low-profile screws with superior peroneal retinaculum repair. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and patient subjective satisfaction rate. The time of return to recreational and sports activities was also assessed. Weightbearing ankle radiographs were evaluated to assess the stability of the flap by checking the screws. The mean follow-up period was 47.96 (range 12 to 142) months. The mean AOFAS scale score for all patients improved from 69.96 ± 13.14 to 87.72 ± 10.13 at the last follow-up examination (p < .001). Overall, 85.3% of patients subjectively rated their operative outcomes as excellent or good. The 18 (52.9%) patients with an isolated peroneal tendon dislocation had a faster return to recreational or sports activities than the 16 (47.1%) patients with concomitant pathologic features (2.95 ± 0.19 versus 4.14 ± 1.34 months; p = .002). No patient experienced residual dislocation, screw loosening, or irritation from the screws. The fibular groove deepening procedure using low-profile screws is be a simple procedure that offers rigid fixation. This leads to relatively fast rehabilitation and resumption of recreational or sports activities.
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Affiliation(s)
- Jae Wan Suh
- Assistant Professor, Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, Republic of Korea; Graduate Student, Department of Orthopaedic Surgery, Graduate School of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jin Woo Lee
- Professor, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Young Park
- Resident, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Choi
- Associate Professor, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Han
- Associate Professor, Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Fischetti A, Zawaideh JP, Orlandi D, Belfiore S, SIlvestri E. Traumatic peroneal split lesion with retinaculum avulsion: Diagnosis and post-operative multymodality imaging. World J Radiol 2018; 10:46-51. [PMID: 29876022 PMCID: PMC5985235 DOI: 10.4329/wjr.v10.i5.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/23/2018] [Accepted: 05/23/2018] [Indexed: 02/06/2023] Open
Abstract
Tears of peroneus brevis tendon represent a cause of underdiagnosed lateral ankle pain and instability. The typical clinical presentation is retro-malleolar pain, in some cases associated with palpable swelling around the fibular malleolus, pain during activities and difficulty in walking. We present a case of peroneus brevis split lesion with superior peroneal retinaculum avulsion in a young athlete who referred to the emergency ward of our hospital for left ankle pain after an inversion injury. An early diagnosis allowed treating the injury and promptly resuming sport activity, after rehabilitation training. Surgical reconstruction key-points and post-surgical follow-up were also discussed. A late diagnosis would have caused a symptomatology worsening and an increased recovery time.
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Affiliation(s)
- Aldo Fischetti
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa 16100, Italy
| | - Jeries P Zawaideh
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa 16100, Italy
| | - Davide Orlandi
- Radiology Department, Ospedale Evangelico Internazionale, Genova 16122, Italy
| | - Stefano Belfiore
- Orthopedic and Trauma Department, Ospedale Evangelico Internazionale, Genova 16122, Italy
| | - Enzo SIlvestri
- Radiology Department, Ospedale Evangelico Internazionale, Genova 16122, Italy
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