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Bokwa-Dąbrowska K, Mocanu D, Alexiev A, Helander KN, Szaro P. Peroneus brevis split rupture is underreported on magnetic resonance imaging of the ankle in patients with chronic lateral ankle pain. Eur J Radiol Open 2024; 13:100591. [PMID: 39131949 PMCID: PMC11314861 DOI: 10.1016/j.ejro.2024.100591] [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] [Received: 06/06/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Peroneus brevis split rupture poses a diagnostic challenge, often requiring magnetic resonance imaging (MRI), yet splits are missed in initial radiological reports. However, the frequency of reported peroneus brevis split rupture in clinical MRI examinations is unknown. Aim This study aimed to investigate underreporting frequency of peroneus brevis split rupture in patients with lateral ankle pain. Methods We re-evaluated 143 consecutive MRI examinations of the ankle joint, conducted in 2021 in our region, for patients experiencing ankle pain persisting for more than 8 months. Two musculoskeletal radiologists, with 12 and 8 years of experience respectively, assessed the presence of peroneus brevis split rupture. Patients with recent ankle trauma, fractures, postoperative changes, or MRI artifacts were excluded. The radiologists evaluated each MRI for incomplete or complete peroneus brevis split rupture. The consensus between the raters was used as the reference standard. Additionally, raters reviewed the original clinical radiological reports to determine if the presence of peroneus brevis split rupture was noted. Agreement between raters' assessments, consensus, and initial reports was evaluated using Gwet's AC1 coefficients. Results Initial radiological reports indicated 23 cases (52.3 %) of peroneus brevis split rupture, meaning 21 cases (47.7 %) were underreported. The Gwet's AC1 coefficients showed that the agreement between raters and initial reports was 0.401 (standard error 0.070), 95 % CI (0.261, 0.541), p<.001, while the agreement between raters in the study was 0.716 (standard error 0.082), 95 % CI (0.551, 0.881), p<.001. Conclusion Peroneus brevis split rupture is underreported on MRI scans of patients with lateral ankle pain.
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Affiliation(s)
- Katarzyna Bokwa-Dąbrowska
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Mocanu
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alex Alexiev
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Nilsson Helander
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Melville DM, Taljanovic MS, Gimber LH, Miller M, Ahmad A, Sepich D, Latt LD. Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation. J Clin Med 2024; 13:740. [PMID: 38337434 PMCID: PMC10856550 DOI: 10.3390/jcm13030740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Suspected peroneal tendinopathy, tears, and subluxation are often confirmed preoperatively using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). No study has directly compared the accuracy of these tests for the diagnosis of peroneal tendon pathology. The purpose of this study is to directly compare MRI and US to intraoperative findings in patients who underwent surgery for suspected peroneal pathology to determine the imaging diagnostic accuracy. Operative records and diagnostic images for 21 consecutive patients who had both MRI and US prior to surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. The results of this review are compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality. For the diagnosis of peroneal tendon tears, US was found to have a sensitivity of 88% and specificity of 100%, compared to 100% sensitivity and specificity for MRI. In the diagnosis of peroneal tendinopathy, both US and MRI had a sensitivity and specificity of 100%. In diagnosing peroneal subluxation, US was 100% sensitive compared to 66% for MRI, and both were 100% specific. In conclusion, US was found to be more effective in diagnosing peroneal subluxation and MRI was slightly more accurate in the diagnosis of peroneal tendon tears.
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Affiliation(s)
- David M. Melville
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85259, USA;
| | - Mihra S. Taljanovic
- Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA;
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Lana H. Gimber
- Kaiser Permanente Moanalua Medical Center, Honolulu, HI 96819, USA;
| | - Matthew Miller
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA;
| | - Aamir Ahmad
- Department of Orthopaedic Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA;
| | | | - L. Daniel Latt
- Kaiser Permanente Moanalua Medical Center, Honolulu, HI 96819, USA;
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Clair BL, Winder ML, Neubauer EF. Open Evaluation of the Peroneal Tendons Should Be Considered in Patients With Chronic Lateral Ankle Instability Undergoing Ankle Arthroscopy With Lateral Ankle Stabilization. J Foot Ankle Surg 2022; 61:1177-1181. [PMID: 34782250 DOI: 10.1053/j.jfas.2021.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/12/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
Peroneal tendon pathology is commonly associated with chronic lateral ankle instability. Foot and ankle surgeons often rely on preoperative magnetic resonance imaging (MRI) for identification of related pathology and surgical planning in these patients. The purpose of this study was to assess the ability of preoperative MRI to accurately detect peroneal tendon pathology in patients with chronic lateral ankle instability. Consecutive surgical cases involving arthroscopic evaluation and management of lateral ankle instability sequelae were evaluated retrospectively. Preoperative MRI were compared to intraoperative findings in order to determine the sensitivity, specificity, positive and negative predictive values. Eighty-two patients met inclusion criteria, 58 females and 24 males. The average age at the time of surgery was 46 years (range 13-75). Peroneal tendon pathology was identified intraoperatively in 76 (92.7%) patients and on MRI in 40 (48.8%) patients. The most commonly identified pathologies were tenosynovitis, tendinopathy and longitudinal split/tear, with the peroneus brevis tendon being most commonly involved. MRI was 38.7% specific, 50.0% sensitive, had a positive predictive value of 92.5%, and a negative predictive value of 7.1%. While MRI is a helpful study for evaluation of co-pathologies and surgical planning in patients with lateral ankle instability, procedural selection should not be solely based on MRI results, and the peroneal tendons should be evaluated intraoperatively in patients undergoing arthroscopic procedures for lateral ankle instability.
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4
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Choi YG, Park HJ, Kim JN, Kim MS, Park SJ, Hong SW, Kim YH. Association between joint effusions and concomitant structural injuries (tendinitis and structural injury) on MRI in ankle trauma without fracture. Acta Radiol 2022; 63:942-947. [PMID: 34053224 DOI: 10.1177/02841851211021038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The evaluation of correlations among joint effusion, ligament injuries, tenosynovitis and osteochondral lesion of talus (OLT) in the ankle joint is important for developing a treatment plan and predicting prognosis. PURPOSE To evaluate correlations among tibiotalar (anterior) and talocalcaneal (posterior) joint effusion, tenosynovitis of major flexor tendons, ligaments, and OLT in a group of patients with ankle trauma. MATERIAL AND METHODS This retrospective study included 101 patients with ankle trauma who underwent magnetic resonance imaging. Two radiologists assessed the presence and amount of effusion in the tibiotalar and talocalcaneal joints from grade 0 to 2, according to the amount of capsular distension. Concomitant structural injuries were assessed in the tibialis posterior (TP), flexor digitorum longus, flexor hallucis longus, and peroneus tendons, and the anterior talofibular ligament, calcaneofibular ligament, anteroinferior tibiofibular ligament, posteroinferior tibiofibular ligament, and OLT. RESULTS The proportion of anterior and posterior joint effusion according to grade was 67.3% for anterior joint effusion grade 0, 22.8% for grade 1, and 9.9% for grade 2; for posterior joint effusion, grade 0 was 74.2%, grade 1 was 22.8%, and grade 2 was 3.0%. We found statistically significant correlations between posterior joint effusion and tenosynovitis of TP (P < 0.05) and between posterior joint effusion and OLT (P < 0.05). CONCLUSION Posterior joint effusion is correlated with TP injury and OLT; however, tendon injuries have no correlation with other structural injuries of the ankle joint in a general population with ankle trauma.
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Affiliation(s)
- Yeon Gyu Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Jin Park
- Department of Orthopaedic surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Woo Hong
- Department of Orthopaedic surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Hwan Kim
- Department of Nuclear medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Sharpe J, Feltner M, Carroll P, Harrington T, Walker S, Bala V, Logan D. Comparison of Preoperative MRI With Intraoperative Findings for Peroneal Tendon Pathologies. J Foot Ankle Surg 2022; 61:680-685. [PMID: 35562304 DOI: 10.1053/j.jfas.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 02/03/2023]
Abstract
Magnetic resonance imaging (MRI) is commonly used to evaluate soft tissue pathology of the foot and ankle. Prior investigations have reported limitations of this modality, however, in evaluation of pathologies related to the peroneal tendons. This article investigates the correlation of pre-operative MRI studies with intraoperative findings. Five board-certified radiologists interpreted MRIs of 80 ankles that subsequently underwent surgical procedures performed by one board-certified foot and ankle surgeon, after which comparison was made between their findings. Statistically significant disagreement was found between radiologist and surgeon findings of a normal peroneus brevis (PB), PB and peroneus longus (PL) tendinosis, PB and PL hypertrophy, PB and PL partial linear tears, PB and PL flattening, PB longitudinal split tears, and the PB attritional spectrum (combined analysis of flattening, partial linear tearing, and longitudinal split tears). These results suggest that given the disconcordance between MRI and intraoperative findings, surgeons should remain cautious in their reliance upon this imaging modality when evaluating this anatomic region.
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Affiliation(s)
| | | | - Paul Carroll
- Orthopedic Associates of Lake County, Concord, OH
| | | | - Scott Walker
- Orthopedic Associates of Lake County, Concord, OH
| | - Vikram Bala
- Orthopedic Associates of Lake County, Concord, OH
| | - Daniel Logan
- Orthopedic Associates of Lake County, Concord, OH
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Miller CP, Smith SE, Goodman EM, Fisk E, Smith JT, Chiodo CP, Bluman EM. Peroneal Sheath Volumes Are Greater in Patients With Peroneal Pathology Compared With Controls. Foot Ankle Spec 2022; 15:258-265. [PMID: 32851867 DOI: 10.1177/1938640020950897] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Peroneal tendon pathology is common. Several factors have been implicated, including low-lying muscles and accessory tendons. Studies have reported on the presence and length measurements of these structures. This study evaluates volume measurements within the sheath using magnetic resonance images for patients with operatively treated peroneal tendon pathology and control patients without peroneal disease. METHODS Fifty-one patients with peroneal tendon pathology and 15 controls were included. The volumes of the peroneal sheath, peroneal tendons, peroneal muscle, and accessory peroneus tendons were measured. The distal extent of the peroneus brevis (PB) muscle was measured. Volume and length measurements were then compared. RESULTS The mean PB muscle length from the tip of the fibula was 5.55 ± 2.5 mm (peroneal group) and 11.79 ± 4.07 mm (control) (P = .017). The mean peroneal sheath volume was 7.06 versus 5.12 mL, respectively (P = .001). The major contributors to this increased volume was the tenosynovitis (3.58 vs 2.56 mL, respectively; P = .019), the peroneal tendons (2.17 vs 1.7 mL, P = .004), and the accessory peroneus tendon + PB muscle (1.31 vs 0.86 mL, P = .023). CONCLUSION The current study supports that the PB muscle belly is more distal in patients with peroneal tendon pathology. The study also demonstrates increased total volume within the peroneal sheath among the same patients. We propose that increased volume within the sheath, regardless of what structure is enlarged, is associated with peroneal tendon pathology. Further studies are needed to determine if debridement and decompression of the sheath will result in improved functional outcomes for these patients. LEVELS OF EVIDENCE Level III: Case control imaging study.
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Affiliation(s)
- Christopher P Miller
- Carl J. Shapiro Department of Orthopaedics, Division of Foot and Ankle Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric M Goodman
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erica Fisk
- Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeremy T Smith
- Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher P Chiodo
- Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric M Bluman
- Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Peronealsehnenverletzungen. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00519-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund
Verletzungen der Peronealsehnen gelten als häufig unterdiagnostizierte Ursache lateraler Rückfußschmerzen. Prädisponierende Ursachen sind u. a. eine chronische laterale Instabilität sowie ein Rückfußvarus, da dies zu einer Überbelastung der Peronealsehnen führt. Klinisch äußern sich Peronealsehnenverletzungen meist unspezifisch mit lateralen Rückfußschmerzen.
Material und Methoden
In der Untersuchung zeigen sich Schmerzen bei Aktivierung der Sehnen gegen Widerstand. Die Sonographie zur Diagnostik bietet die Möglichkeit einer dynamischen Untersuchung, in der Magnetresonanztomographie (MRT) können gleichzeitig weitere Strukturen beurteilt werden. Zu unterscheiden sind eine Tendinopathie der Sehnen, eine Instabilität mit Luxation oder Subluxation verbunden mit Pathologien des superioren Peronealsehnenretinakulums sowie Längssplit und komplette Sehnenruptur. Bei Tendinopathien und Längsrissen erfolgt die Therapie primär konservativ. Ein kompletter Riss und eine Läsion über 50 % sollten operativ versorgt und, falls möglich, direkt genäht werden. Alternativ sind eine Tenodese oder ein Sehnenersatz mit einem Graft zu evaluieren.
Ergebnisse
Bei Patienten mit einer Peronealsehneninstabilität führen die Naht oder Rekonstruktion des superioren Peronealsehnenretinakulums zu guten Resultaten. Eine frühe Therapie zeigt eine bessere Heilungschance und kann somit zu einem besseren Outcome führen.
Schlussfolgerung
Zusammenfassend kann gesagt werden, dass bei chronischen lateralen Rückfußschmerzen an eine Peronealsehnenverletzung gedacht und bei Verdacht auf eine Läsion eine MRT oder eine Sonographie zur Bestätigung respektive Ausschluss der Diagnose durchgeführt werden sollte.
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Chinitz N, Bohl DD, Reddy M, Tenenbaum S, Coleman S, Brodsky JW. Preoperative Gait Analysis of Peroneal Tendon Tears. Foot Ankle Int 2022; 43:233-243. [PMID: 34596438 DOI: 10.1177/10711007211036876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known regarding the impact of peroneal tendon tears on function. This study quantifies gait changes associated with operatively-confirmed peroneal tendon tears. METHODS Sixty-five patients with unilateral peroneal tendon tears were prospectively evaluated using preoperative 3D multisegment gait analysis of both limbs. Data were analyzed according to pattern/severity of tears, as confirmed surgically: peroneus brevis tears, reparable (PBR); peroneus brevis tears, irreparable (PBI); peroneus longus tears, irreparable (PLI); and concomitant irreparable tears of both tendons (PBI+PLI). The following parameters were analyzed: ankle sagittal motion, coronal motion, axial rotation, foot progression angle, sagittal power, sagittal moment. RESULTS Twelve patients (18.5%) had the PBR pattern, 37 (56.9%) PBI, 10 (15.4%) PLI, and 6 (9.2%) PBI+PLI. Compared with the contralateral, nonpathologic extremities, limbs with peroneal tears had diminished ankle sagittal motion (mean 23.14 vs 24.30 degrees, P = .012), ankle/hindfoot axial rotation (6.26 vs 7.23 degrees, P = .001), sagittal moment (1.16 vs 1.29 Nm/kg, P < .001), and sagittal power (1.24 vs 1.47 W/kg, P < .001). The most severe tear patterns had the greatest derangements in multiple parameters of gait (PBI+PLI > PBI or PLI > PBR). For example, all groups except PBR had loss of ankle sagittal moment and/or power in the affected limb, and the greatest losses in moment and power were in the PBI+PLI group (1.22 vs 0.91 Nm/kg, P = .003 for moment; 0.73 vs 1.31 W/kg, P < .001 for power). The PBI+PLI group had a >10-degree varus shift in coronal motion on the affected side (P = .002). CONCLUSION This is the first study to demonstrate diminished biomechanical function in patients with peroneal tendon tears. In vivo 3-dimensional gait analysis found significant changes in hindfoot motion, ankle motion, and ankle power. Impairments were related to the pattern and severity of the tears, and demonstrated a strong association of peroneal tendon tears with diminished ankle plantarflexion strength. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Noah Chinitz
- Baylor University Medical Center, Dallas, TX, USA
| | | | - Manoj Reddy
- Baylor University Medical Center, Dallas, TX, USA
| | - Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Burkhard MD, Wirth SH, Andronic O, Viehöfer AF, Imhoff FB, Fröhlich S. Clinical and Functional Outcomes of Peroneus Longus to Brevis Tendon Transfer. Foot Ankle Int 2021; 42:699-705. [PMID: 33451277 DOI: 10.1177/1071100720982592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneal tendon lesions can cause debilitating pain, but operative treatment remains controversial. Some studies recommend peroneal tenodesis or transfer if more than half of the tendon is affected. However, clinical outcomes and inversion/eversion motion after peroneal transfer have not been investigated yet. METHODS Patients who underwent distal peroneus longus to brevis transfer for major peroneus brevis tendon tears with a minimum follow-up of 2 years were included. Clinical outcome parameters included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the German Foot Function Index (FFI-D), and Karlsson-Peterson score. Functional outcome was tested with a standardized active range-of-motion (ROM) and isokinetic strength measurement protocol, including concentric and eccentric eversion and inversion tests. RESULTS Of total 23 eligible patients, 14 (61%) were available for follow-up. Clinical outcome scores were good with AOFAS 86 ± 16 points, FFI-D pain 26% and FFI-D disability 26%, and Karlsson-Peterson score 78 ± 23 points. There was no difference in strength in comparison to the contralateral foot (all P > .05). Isokinetic strength was 16.3 ± 4.9 Nm (108% of contralateral side) and 18.8 ± 4.5 Nm (101%) at concentric 30 deg/s and eccentric 30 deg/s eversion tests, as well as 15.7 ± 5.2 Nm (102%) and 18.7 ± 3.3 Nm (103%) at concentric 30 deg/s and eccentric 30 deg/s inversion tests, respectively. There was no difference in ROM compared to the contralateral side (eversion/inversion 14.5-0-18.7 vs 14.1-0-16.1 degrees). CONCLUSION Peroneus longus to brevis transfer is a viable option for treating severe peroneus brevis tendon tears and does not compromise measurable strength or ROM in inversion or eversion in comparison to the contralateral ankle joint. LEVEL OF EVIDENCE Level IV, prospective case series.
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Affiliation(s)
- Marco D Burkhard
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan H Wirth
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Octavian Andronic
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Arnd F Viehöfer
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian B Imhoff
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Fröhlich
- University Center for Prevention and Sports Medicine, Balgrist University Hospital, Zurich, Switzerland
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Bojanić I, Knežević I, Dimnjaković D. Importance of Space-Occupying Anatomical Variations in Peroneal Tendoscopy. Foot Ankle Int 2021; 42:448-457. [PMID: 33198525 DOI: 10.1177/1071100720966325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We hypothesized that peroneal tendons disorders are more commonly associated with anatomical variations, which could overcrowd the retrofibular groove. METHODS This single-center retrospective case study covered 84 consecutive cases that had undergone peroneal tendoscopy. Peroneal tendoscopy was performed on 82 patients, predominantly female (3:1) with a median age of 46 years. The preoperative evaluation and all the procedures were performed by a single surgeon using a standardized technique. RESULTS Two patients required revision surgery 8 and 52 months after the index procedure due to persistent posterolateral ankle pain. Peroneal tendoscopy was performed as a solitary procedure in 45.1% (37/82) of cases, while the remaining cases involved peroneal tendoscopy as a supplementary procedure. Low-lying peroneus brevis muscle belly (LLMB) was the most common finding in this series in 53.7% (44/82) of cases. In 41.5% (34/82) of cases, longitudinal tears of the peroneus brevis tendon were noted. Some patients presented with more than 1 concomitant peroneal tendon pathology. The LLMB was observed in 23.5% (8/34) of cases with a longitudinal tear of the peroneus brevis tendon. CONCLUSION Peroneal tendon anatomical variations, especially LLMB, were associated with the presence of peroneus brevis tendon ruptures and intrasheath peroneal tendon subluxations as well as posttraumatic posterolateral ankle pain. Due to high rates of undiagnosed and misdiagnosed cases of LLMB preoperatively, we believe special care should be taken to recognize it during tendoscopy. Peroneal tendoscopy is a high-efficiency, low-complication method to treat some peroneal tendon conditions. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Ivan Bojanić
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.,Department of Orthopedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Igor Knežević
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Damjan Dimnjaković
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
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Impact of the T2-weighted axial oblique MRI sequence in the assessment of peroneal tendons. Clin Radiol 2020; 75:642.e15-642.e23. [PMID: 32327227 DOI: 10.1016/j.crad.2020.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/28/2020] [Indexed: 11/21/2022]
Abstract
AIM To define the role of the T2-weighted axial oblique sequence for the magnetic resonance imaging (MRI) assessment of peroneal tendon pathologies. MATERIALS AND METHODS Two radiologists interpreted 180 ankle MRI examinations using standard sequences alone and then in combination with an axial oblique sequence. The readers indicated how likely a peroneal pathology was present using a five-level confidence scale. Diagnostic confidence, interobserver agreement, and clinical correlation were compared. Changes in diagnosis were recorded. RESULTS For both readers, the diagnostic confidence was significantly higher using the axial oblique sequence for tendinosis and inframalleolar tenosynovitis for both tendons and for peroneus brevis partial and longitudinal split tears (p<0.001). For reader 1, the diagnostic confidence was also higher using the axial oblique sequence for peroneus longus partial tears (p=0.007). Changes in diagnosis were seen for tendinosis and tenosynovitis of both tendons and for peroneus brevis partial and longitudinal split tears in 0.6-10.8% of cases. Inter-rater reliability was significantly higher with the axial oblique sequence for the diagnosis of tendinosis, inframalleolar tenosynovitis, and partial tear for both tendons, and for peroneus brevis longitudinal split tear. Amongst 105 examinations with clinical information, peroneal pathologies were most frequently diagnosed as present in cases with lateral symptoms (17% versus 14%) and absent in cases without lateral symptoms (92% versus 86%) on the axial oblique sequence. CONCLUSION The axial oblique sequence for the assessment of peroneal tendons allows for higher diagnostic confidence, inter-rater reliability, and clinical correlation and can lead to changes in diagnosis.
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Danna NR, Brodsky JW. Diagnosis and Operative Treatment of Peroneal Tendon Tears. FOOT & ANKLE ORTHOPAEDICS 2020. [PMID: 35097372 DOI: 10.1177/2473011420910407.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Peroneal tendon tears are a common but under-recognized source of ankle pain and dysfunction. Recognition of the characteristic symptoms, physical findings, and imaging results of peroneal tendon tears is essential for accurate diagnosis and appropriate treatment. Acute, limited tears of a single peroneal tendon may be debrided and repaired. However, by the time operative treatment is undertaken, many tears of a single tendon are sufficiently advanced that the surgeon may need to consider excision of the nonviable segment and tenodesis of the damged tendon to the to the adjacent peroneal tendon. Irreparable tearing of both peroneal tendons may be treated with flexor tendon transfer and/or allograft reconstruction. This review article focuses on diagnosis and operative treatment of peroneal tendon tears, including the treatment algorithms, operative technique, and published outcomes.
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Danna NR, Brodsky JW. Diagnosis and Operative Treatment of Peroneal Tendon Tears. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420910407. [PMID: 35097372 PMCID: PMC8697126 DOI: 10.1177/2473011420910407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peroneal tendon tears are a common but under-recognized source of ankle pain and dysfunction. Recognition of the characteristic symptoms, physical findings, and imaging results of peroneal tendon tears is essential for accurate diagnosis and appropriate treatment. Acute, limited tears of a single peroneal tendon may be debrided and repaired. However, by the time operative treatment is undertaken, many tears of a single tendon are sufficiently advanced that the surgeon may need to consider excision of the nonviable segment and tenodesis of the damged tendon to the to the adjacent peroneal tendon. Irreparable tearing of both peroneal tendons may be treated with flexor tendon transfer and/or allograft reconstruction. This review article focuses on diagnosis and operative treatment of peroneal tendon tears, including the treatment algorithms, operative technique, and published outcomes.
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Bahad SR, Kane JM. Peroneal Tendon Pathology: Treatment and Reconstruction of Peroneal Tears and Instability. Orthop Clin North Am 2020; 51:121-130. [PMID: 31739875 DOI: 10.1016/j.ocl.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Peroneal tendon pathology is becoming an increasingly recognized source of lateral-sided ankle pain. High clinical suspicion, along with judicious physical examination coupled with confirmatory advanced imaging modalities, are necessary to make an accurate diagnosis and aid in guiding treatment. Peroneal pathology encompasses several distinct conditions. Peroneal tendon tears and injuries to the peroneal retinaculum must be identified to guide treatment. Patients with peroneal pathology report high levels of satisfaction after surgical management with most returning to their preinjury level of function. An early and accurate diagnosis, along with treatment tailored to the individual, is necessary to obtain optimal outcomes.
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Affiliation(s)
- Sophia R Bahad
- The Orthopedic Institute of North Texas, PA, Baylor Frisco - Professional Building #1, 5575 Warren Parkway, #115, Frisco, TX 75034, USA
| | - Justin M Kane
- Foot and Ankle Surgery Division; The Orthopedic Institute of North Texas, PA, Baylor Frisco - Professional Building #1, 5575 Warren Parkway, #115, Frisco, TX 75034, USA; Orthopaedics, Texas A&M University HSC, College of Medicine.
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15
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Ersoz E, Tokgoz N, Kaptan AY, Ozturk AM, Ucar M. Anatomical variations related to pathological conditions of the peroneal tendon: evaluation of ankle MRI with a 3D SPACE sequence in symptomatic patients. Skeletal Radiol 2019; 48:1221-1231. [PMID: 30725160 DOI: 10.1007/s00256-019-3151-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/18/2018] [Accepted: 01/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate anatomical variations in the lateral ankle and their relationships with pathological conditions of the peroneal tendon on magnetic resonance imaging (MRI) in symptomatic patients. MATERIALS AND METHODS Sixty-nine ankles MRIs of 60 adult patients with symptomatic ankles were included. The presence and sizes of peroneal tubercle and retrotrochlear eminence (RTE), the prevalence of peroneus quartus (PQ), os peroneum, and boomerang-shaped peroneus brevis (PB) tendon, the shape of the retromalleolar fibular groove (RMFG), and the location of the PB muscle-tendon junction were evaluated. The relationships of these variations with peroneal tendinopathies were assessed. The correlations between pathological peroneal conditions on MRI and clinical findings were evaluated. RESULTS Peroneal tubercle (mean size, 3.2 mm) and RTE (mean size, 4.5 mm) were identified in 58 (84%) and 69 (100%) ankles respectively. PQ muscle, os peroneum, and boomerang-shaped PB tendon were found in 9 (13%), 7 (10%), and 24 (34.8%) ankles respectively. The RMFG was concave, flat, convex, and irregular in 14 (20.3%), 40 (58%), 13 (18.8%), and 2 (2.9%) ankles respectively. Sixteen (23.2%) patients had low-lying PB muscle belly. Only boomerang-shaped PB tendons showed a significant relationship with peroneal tendinopathies. MRI and clinical findings had a poor correlation in pathological peroneal conditions and both had low sensitivity in diagnosis. CONCLUSION Lateral ankle anatomical variations are common and cannot be attributed to pathological conditions of the peroneal tendon, except for boomerang-shaped PB tendons. Both clinical and MRI findings have low sensitivity in the diagnosis of peroneal tendinopathies, which are often incidental findings on MRI.
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Affiliation(s)
- Elif Ersoz
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Nil Tokgoz
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Y Kaptan
- Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Akif M Ozturk
- Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Ucar
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
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16
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Hudson PW, de Cesar Netto C, Araoye IB, Jones CW, Bergstresser SL, Shah A. Preoperative Assessment of the Peroneal Tendons in Lateral Ankle Instability: Examining Clinical Factors, Magnetic Resonance Imaging Sensitivity, and Their Relationship. J Foot Ankle Surg 2019; 58:208-212. [PMID: 30553746 DOI: 10.1053/j.jfas.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Indexed: 02/03/2023]
Abstract
The purpose of our study was to examine the preoperative clinical factors and magnetic resonance imaging (MRI) findings associated with peroneal pathology in chronic lateral ankle instability patients, as well as the clinical factors associated with peroneal lesions being detected on MRI. Peroneal pathology was determined from intraoperative findings. Patients with/without peroneal pathology were compared regarding their preoperative clinical findings. MRI reports were examined to determine the sensitivity of detecting peroneal pathologies. Clinical factors were compared between patients (N = 238) with undetected and detected peroneal lesions on MRI. Conservative treatment, preoperative physical therapy, and lack of a traumatic inciting event were associated with peroneal pathology. MRI had a sensitivity of 61.11% for detecting peroneal pathology. No clinical factors were significantly different between "detected" and "undetected" cases. Certain historical factors were associated with peroneal pathology in patients with chronic lateral ankle instability, and MRI had a high false-negative rate. Surgeons should exercise caution when ruling out peroneal pathology based on preoperative physical examination or MRI.
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Affiliation(s)
- Parke W Hudson
- Research Fellow, Foot and Ankle Surgery, Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL
| | - Cesar de Cesar Netto
- Clinical Fellow, Foot and Ankle Surgery, Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL
| | - Ibukunoluwa B Araoye
- Research Fellow, Foot and Ankle Surgery, Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL
| | - Caleb W Jones
- Medical Student, Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL
| | - Shelby L Bergstresser
- Medical Student, Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL
| | - Ashish Shah
- Assistant Professor, Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL.
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17
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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.
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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.
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18
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Wilson KJ, Surowiec RK, Johnson NS, Lockard CA, Clanton TO, Ho CP. T2* Mapping of Peroneal Tendons Using Clinically Relevant Subregions in an Asymptomatic Population. Foot Ankle Int 2017; 38:677-683. [PMID: 28552042 DOI: 10.1177/1071100717693208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneal tendon evaluation is particularly demanding using current magnetic resonance imaging (MRI) techniques because of their curving path around the lateral malleolus. Quantifiable, objective data on the health of the peroneal tendons could be useful for improving diagnosis of tendon pathology and tracking post-treatment responses. The purpose of this study was to establish a method and normative T2-star (T2*) values for the peroneal tendons in a screened asymptomatic cohort using clinically reproducible subregions, providing a baseline for comparison with peroneal tendon pathology. METHODS Unilateral ankle scans were acquired for 26 asymptomatic volunteers with a 3-Tesla MRI system using a T2* mapping sequence in the axial and sagittal planes. The peroneus brevis and peroneus longus tendons were manually segmented and subregions were isolated in the proximity of the lateral malleolus. Summary statistics for T2* values were calculated. RESULTS The peroneus brevis tendon exhibited a mean T2* value of 12 ms and the peroneus longus tendon was 11 ms. Subregions distal to the lateral malleolus had significantly higher T2* values ( P < .05) than the subregions proximal in both tendons, in both the axial and sagittal planes. CONCLUSION Peroneal tendon regions distal to the inferior tip of the lateral malleolus had significantly higher T2* values than those regions proximal, which could be related to anatomical differences along the tendon. CLINICAL RELEVANCE This study provides a quantitative method and normative baseline T2* mapping values for comparison with symptomatic clinically compromised peroneal tendon patients.
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Affiliation(s)
| | | | | | | | | | - Charles P Ho
- 1 Steadman Philippon Research Institute, Vail, CO, USA
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19
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20
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O'Neil JT, Pedowitz DI, Kerbel YE, Codding JL, Zoga AC, Raikin SM. Peroneal Tendon Abnormalities on Routine Magnetic Resonance Imaging of the Foot and Ankle. Foot Ankle Int 2016; 37:743-7. [PMID: 26941162 DOI: 10.1177/1071100716635645] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Abnormalities of the peroneal tendons can frequently be identified on routine MRI of the foot and ankle. Previous studies in the orthopedic literature have discussed the prevalence of abnormal MRI findings in asymptomatic patients, most notably with regards to the spine and shoulder. The purpose of this study was to determine the prevalence of abnormal findings of the peroneal tendons on MRI in asymptomatic individuals. METHODS We retrospectively reviewed all foot and ankle MRIs from 2 independent time periods that were either performed or reviewed at our institution. Studies were excluded if performed on patients with documented inversion injuries, ankle sprains, or lateral ankle trauma. A total of 294 (of 617) MRIs were eligible for inclusion in this study. A single attending musculoskeletal radiologist reviewed each MRI. Pathologies of the peroneal tendons included tendinosis, tenosynovitis, acute tears, chronic tears, and tendon splits. Additionally, the primary pathology encountered on each MRI was noted. The mean age of the MRIs included in this study was 46.8 years (range 9-82) with 155 females and 139 males. RESULTS The most commonly occurring primary pathology was Achilles tendinosis/tears (86), followed by posterior tibial tendon dysfunction (43). With regards to the peroneal tendons, 103 of the 294 (35%) MRIs demonstrated some pathology. CONCLUSION The results of this study demonstrated that a sizeable percentage of asymptomatic individuals could have peroneal tendon pathology on MRI of the foot and ankle. This study can have important clinical implications for when patients present with concerning MRI findings that do not correlate clinically. Physicians providing musculoskeletal care can counsel and reassure patients who present with peroneal pathology on MRI but an absence of clinical findings. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Joseph T O'Neil
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David I Pedowitz
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Bryn Mawr, PA, USA
| | - Yehuda E Kerbel
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jason L Codding
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Adam C Zoga
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven M Raikin
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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21
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Park HJ, Lee SY, Kim E, Kim MS, Chung EC, Choi SH, Yun JS. Peroneal tendon pathology evaluation using the oblique sagittal plane in ankle MR imaging. Acta Radiol 2016; 57:620-6. [PMID: 26253929 DOI: 10.1177/0284185115597264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 06/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because peroneal tendons course from the lateral side of the proximal fibula through the posterior side of the distal fibula, correct diagnosis of the tendon pathology on an orthogonal sagittal plane can be difficult. PURPOSE To evaluate the diagnostic usefulness of oblique sagittal imaging (peroneal view) for evaluation of peroneal tendon pathology. MATERIAL AND METHODS This retrospective study included 69 patients at our institution who underwent routine ankle magnetic resonance imaging (MRI) using the peroneal view. Twenty-three patients underwent arthroscopy. Anatomic identification of the peroneal tendons on orthogonal sagittal MRI sequences and peroneal views were evaluated. Two radiologists evaluated the peroneal tendons based on an entire length view, an entire width view, and margin sharpness using a 4-point scale. Diagnostic accuracy using orthogonal sagittal and peroneal views was evaluated by calculating sensitivity, specificity, and accuracy. Arthroscopic or clinical findings were used as the reference standard. RESULTS Total anatomical scores on the peroneal view were higher than those of the orthogonal sagittal views (P < 0.001). Both readers were able to identify anatomy of the tendon using the full length, full width and sharp margin, and determined that the peroneal view was better when compared with the orthogonal sagittal views (P < 0.001). Although the sensitivity and accuracy of the peroneal view in the diagnosis of peroneal tendon injury were slightly higher than orthogonal view, the values were not statistically significant. CONCLUSION Peroneal views provide better anatomic evaluation of the peroneal tendons itself, although cannot show significant superiority in the diagnostic performances.
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Affiliation(s)
- Hee Jin Park
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - So Yeon Lee
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Mi Sung Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Eun Chul Chung
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Seon Hyung Choi
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Ji Sup Yun
- Department of Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
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22
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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.
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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
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Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners. Knee Surg Sports Traumatol Arthrosc 2016; 24:1175-9. [PMID: 25786820 DOI: 10.1007/s00167-015-3562-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE A painful episode in the region of the peroneal tendons, within the retromalleolar groove, is a common precipitating event of an acute lateral ankle sprain. A forefoot striking pattern is suspected to cause peroneal tendinosis. The aim of this study is to analyse the role of peroneal tendinosis as a predisposing factor for ankle sprain trauma in runners. METHODS Fifty-eight runners who had experienced acute ankle sprain trauma, with pre-existing pain episodes for up to 4 weeks in the region of the peroneal tendons, were assessed clinically. Fractures were excluded by conventional radiography. An magnetic resonance imaging (MRI) scan had been performed within 14 days after the traumatic event and was subsequently evaluated by two experienced radiologists. RESULTS MRI revealed peroneal tendinosis in 55 patients (95% of the total study population). Peroneus brevis (PB) tendinosis was found in 48 patients (87% of all patients with peroneal tendinosis), and peroneus longus (PL) tendinosis was observed in 42 cases (76%). Thirty-five patients (64%) had combined PB and PL tendinosis. A lesion of the anterior talofibular ligament was found to be the most common ligament injury associated with peroneal tendinosis (29 cases; 53%), followed by a lesion of the calcaneofibular ligament (16 cases; 29%) and a lesion of the posterior tibiofibular ligament (13 cases; 24%). CONCLUSION The results of this study reflect the correlation between peroneal tendinosis and ankle sprain trauma. Injuries of one or more ligaments are associated with further complications. A period of rest or forbearance of sports as well as adequate treatment of the peroneal tendinosis is essential to prevent subsequent ankle injuries, especially in runners. Modification of the running technique would also be beneficial. LEVEL OF EVIDENCE IV.
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24
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Horn DB, Meyers S, Astor W. True Pathologic Abnormality versus Artifact Foot Position and Magic Angle Artifact in the Peroneal Tendons with 3T Imaging. J Am Podiatr Med Assoc 2015; 105:443-50. [PMID: 26429616 DOI: 10.7547/14-068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Magnetic resonance imaging is a commonly ordered examination by many foot and ankle surgeons for ankle pain and suspected peroneal tendon pathologic abnormalities. Magic angle artifact is one of the complexities associated with this imaging modality. Magic angle refers to the increased signal on magnetic resonance images associated with the highly organized collagen fibers in tendons and ligaments when they are orientated at a 55° angle to the main magnetic field. We present several examples from a clinical practice setting using 3T imaging illustrating a substantial reduction in magic angle artifact of the peroneal tendon in the prone plantarflexed position compared with the standard neutral (right angle) position.
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Affiliation(s)
- Deena B. Horn
- Department of Orthopaedic Surgery, Inova Fairfax Hospital, Orthopaedic/Podiatry Department, Falls Church, VA
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25
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Galli MM, Protzman NM, Mandelker EM, Malhotra AD, Schwartz E, Brigido SA. An examination of anatomic variants and incidental peroneal tendon pathologic features: a comprehensive MRI review of asymptomatic lateral ankles. J Foot Ankle Surg 2015; 54:164-72. [PMID: 25619812 DOI: 10.1053/j.jfas.2014.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Indexed: 02/03/2023]
Abstract
Intraoperatively, foot and ankle surgeons will encounter peroneal pathologic features in patients with asymptomatic lateral ankles. The purpose of the present study was to review the ankle magnetic resonance imaging (MRI) scans of patients without a history of ankle trauma or lateral ankle pain to determine which anatomic variants correlate with peroneal tendon pathologic features and noted pathophysiology. A total of 500 MRI scans were screened, 108 (41.90 ± 20.42) of which met the inclusion criteria. The peroneus brevis tendon was intact in 104 MRI scans (96.30%), and the peroneus longus tendon was intact in 108 (100.00%). The results of the present study have confirmed statistically significant correlations between the presence of an os perineum and tendinopathy of the peroneus longus [rs(106) = 0.27], undulating peroneal grooves and the severity of peroneal brevis tears [rs(106) = 0.32], a boomerang-shaped peroneus brevis tendon and increasing tendinopathy of the peroneal tendons [brevis (rs(106) = 0.37; longus rs(106) = 0.33], and low-lying muscle bellies and chronic injuries of the superior peroneal retinaculum (rϕ = 0.19). However, the present study did not find evidence to support the presumed correlations between peroneal tendon pathologic findings and hypertrophied peroneal tubercles, low-lying muscle bellies, or the peroneus quartus muscle. Adding to the published data, the present study found a statistically significant correlation between undulating peroneal grooves and an increasing prevalence of osteophytes within the peroneal groove [rs(106) = 0.32]. MRI findings of anatomic variants or peroneal pathologic features might be useful for injury prevention; however, we advise caution from using the findings alone to advocate surgical intervention. To definitively assess causation, prospective, long-term cohort studies are warranted.
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Affiliation(s)
- Melissa M Galli
- Fellowship Trained, Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA
| | | | | | - Amit D Malhotra
- Musculoskeletal Radiologist, Coordinated Health, Bethlehem, PA
| | - Edward Schwartz
- Attending Physician, Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA
| | - Stephen A Brigido
- Fellowship Director, Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA.
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26
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Galli MM, Protzman NM, Mandelker EM, Malhotra AD, Wobst GM, Schwartz E, Brigido SA. Examining the Relationship Between Pathologies of the Peroneal, Achilles, and Posterior Tibial Tendons: An MRI Review in an Asymptomatic Lateral Ankle Population. Foot Ankle Spec 2014; 7:277-285. [PMID: 25005701 DOI: 10.1177/1938640014537298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED The hindfoot and ankle are dynamic structures to which the interplay of tendinous pathologies is scarcely understood. Five hundred consecutive ankle magnetic resonance imaging examinations, obtained between December 27, 2011 and April 9, 2013, were reviewed. Patients without a history of hindfoot or ankle trauma or lateral ankle pain were included. The 108 MRIs that met the inclusion and exclusion criteria were then re-evaluated by 2 musculoskeletal radiologists. Of these, 55.56% demonstrated pathology of the Achilles tendon (AT), 44.44% demonstrated pathology of the posterior tibial tendon (PTT), 35.19% demonstrated pathology of the peroneus brevis (PB), and 37.96% demonstrated pathology of the peroneus longus (PL). In our asymptomatic patient population, 16 (14.81%) patients demonstrated concomitant pathology of the AT, PTT, and peroneal tendons. There were positive, moderate correlations between graded pathology of the AT and the PTT, rs(106) = 0.32, P = .001; the AT and PB, rs(106) = 0.38, P = 0.001; and the AT and PL, rs(106) = 0.46, P = .001. However, there were no statistically significant correlations between pathology of the PTT and PB, rs(106) = 0.17, P = .08, or the PTT and PL, rs(106) = 0.14, P = .15. These findings suggest an intimate relationship between the AT, PTT, and the peroneal tendons. These individual anatomic structures may have underappreciated functional relationships that could lead to future investigations. LEVEL OF CLINICAL EVIDENCE Level IV.
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Affiliation(s)
- Melissa M Galli
- Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, Pennsylvania (MMG, GMW)Foot and Ankle Department, Coordinated Health, Bethlehem, Pennsylvania (ES, SAB)Clinical Education and Research Department, Coordinated Health, Bethlehem, Pennsylvania (NMP)Imaging Department, Coordinated Health, Allentown, Pennsylvania (EMM, ADM)
| | - Nicole M Protzman
- Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, Pennsylvania (MMG, GMW)Foot and Ankle Department, Coordinated Health, Bethlehem, Pennsylvania (ES, SAB)Clinical Education and Research Department, Coordinated Health, Bethlehem, Pennsylvania (NMP)Imaging Department, Coordinated Health, Allentown, Pennsylvania (EMM, ADM)
| | - Eiran M Mandelker
- Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, Pennsylvania (MMG, GMW)Foot and Ankle Department, Coordinated Health, Bethlehem, Pennsylvania (ES, SAB)Clinical Education and Research Department, Coordinated Health, Bethlehem, Pennsylvania (NMP)Imaging Department, Coordinated Health, Allentown, Pennsylvania (EMM, ADM)
| | - Amit D Malhotra
- Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, Pennsylvania (MMG, GMW)Foot and Ankle Department, Coordinated Health, Bethlehem, Pennsylvania (ES, SAB)Clinical Education and Research Department, Coordinated Health, Bethlehem, Pennsylvania (NMP)Imaging Department, Coordinated Health, Allentown, Pennsylvania (EMM, ADM)
| | - Garrett M Wobst
- Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, Pennsylvania (MMG, GMW)Foot and Ankle Department, Coordinated Health, Bethlehem, Pennsylvania (ES, SAB)Clinical Education and Research Department, Coordinated Health, Bethlehem, Pennsylvania (NMP)Imaging Department, Coordinated Health, Allentown, Pennsylvania (EMM, ADM)
| | - Edward Schwartz
- Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, Pennsylvania (MMG, GMW)Foot and Ankle Department, Coordinated Health, Bethlehem, Pennsylvania (ES, SAB)Clinical Education and Research Department, Coordinated Health, Bethlehem, Pennsylvania (NMP)Imaging Department, Coordinated Health, Allentown, Pennsylvania (EMM, ADM)
| | - Stephen A Brigido
- Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, Pennsylvania (MMG, GMW)Foot and Ankle Department, Coordinated Health, Bethlehem, Pennsylvania (ES, SAB)Clinical Education and Research Department, Coordinated Health, Bethlehem, Pennsylvania (NMP)Imaging Department, Coordinated Health, Allentown, Pennsylvania (EMM, ADM)
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Abstract
The key to successful management of the cavovarus foot is identifying the pathoanatomy and dysfunction that are driving the deformity and producing the symptoms. There is no substitute for a thorough clinical evaluation of the foot, evaluating the static alignment and dynamic function. Plain films alone are not sufficient to determine the diagnosis, but they are necessary for procedure selection and correction planning. This is especially true for assessing the degree of hindfoot varus. Some issues are difficult to diagnose, and imaging plays an important role.
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Affiliation(s)
- Anthony Perera
- University Hospital of Wales and Spire Cardiff Hospital, 18 Melbourne Road, Llanishen, Cardiff CF145NH, UK.
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