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Mendez-Rebolledo G, Guzmán-Venegas R, Orozco-Chavez I, Cruz-Montecinos C, Watanabe K, Martinez-Valdes E. Task-related differences in peroneus longus muscle fiber conduction velocity. J Electromyogr Kinesiol 2023; 71:102795. [PMID: 37269804 DOI: 10.1016/j.jelekin.2023.102795] [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: 09/27/2022] [Revised: 01/27/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023] Open
Abstract
It has been identified that the peroneus longus presents a regional activity. Specifically, a greater activation of the anterior and posterior compartments has been observed during eversion, whereas a lower activation of the posterior compartment has been reported during plantarflexion. In addition to myoelectrical amplitude, motor unit recruitment can be inferred indirectly from muscle fiber conduction velocity (MFCV). However, there are few reports of MFCV of the regions that make up a muscle, and even less, MFCV of the peroneus longus compartments. This study aimed to analyze the MFCV of peroneus longus compartments during eversion and plantarflexion. Twenty-one healthy individuals were assessed. High-density surface electromyography was recorded from the peroneus longus during eversion and plantarflexion at 10%, 30%, 50%, and 70% of maximal voluntary isometric contraction. The posterior compartment presented a lower MFCV than the anterior compartment during plantarflexion, and both compartments did not show differences in MFCV during eversion; however, the posterior compartment showed an increase in MFCV during eversion compared to plantarflexion. Differences observed in the MFCV of the peroneus longus compartments could support a regional activation strategy and, to some extent, explain different motor unit recruitment strategies of the peroneus longus during ankle movements.
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Affiliation(s)
- Guillermo Mendez-Rebolledo
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile.
| | - Rodrigo Guzmán-Venegas
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo (LIBFE), Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Ignacio Orozco-Chavez
- Departamento de Ciencias del Movimiento Humano, Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Kohei Watanabe
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University, Toyota, Japan
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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2
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Moon J, Graham R, Kushner D, Ling S, Jonnagaladda P, Ali S. Symptomatic Accessory Ossicles of the Foot and Ankle. Curr Probl Diagn Radiol 2023; 52:300-311. [PMID: 37085336 DOI: 10.1067/j.cpradiol.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 04/23/2023]
Abstract
Accessory ossicles are small noncalcified, calcified or ossified structures found throughout the body, often noted as incidental findings. Specifically in the foot and ankle, there are at least 24 different ossicles described the majority of which are incidental. However, there are accessory ossicles that can be symptomatic, leading to significant pain and discomfort. While many of the symptomatic ossicles have been described in the literature, there are several that are under-recognized or under-reported for example, os interphalangeus and os calcaneus secundarius syndromes. This manuscript will review common and uncommon accessory ossicles including painful os peroneum, os naviculare, os calcaneus secundarius, os trigonum and os interphalangeus syndromes as well as medial sesamoiditis, with attention to the clinical and imaging findings and with an outline of the current management.
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Affiliation(s)
- Jee Moon
- Department of Radiology, Temple University Hospital, Philadelphia, PA..
| | - Ryan Graham
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Daniel Kushner
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Stephen Ling
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | | | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, PA
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3
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Lui TH, Li CCH. Endoscopic Superior Peroneal Retinaculum Reconstruction Using Q-FIX MINI Suture Anchor. Arthrosc Tech 2023; 12:e233-e240. [PMID: 36879874 PMCID: PMC9984787 DOI: 10.1016/j.eats.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/01/2022] [Indexed: 01/20/2023] Open
Abstract
Post-traumatic peroneal tendon subluxation or dislocation is most commonly caused by injury to the superior peroneal retinaculum. Classic open surgeries usually require extensive soft-tissue dissection and have potential risks of peritendinous fibrous adhesions, sural nerve injury, limited range of movement, recurrent or persistent peroneal tendon instability, and tendon irritation. The purpose of this Technical Note is to describe the details of endoscopic superior peroneal retinaculum reconstruction using Q-FIX MINI suture anchor. This endoscopic approach has the advantages of minimally invasive surgery, including better cosmesis, less soft-tissue dissection, less postoperative pain, less peritendinous fibrosis, and less subjective tightness at peroneal tendons. Insertion of the Q-FIX MINI suture anchor can be performed inside a drill guide, and trapping of the surrounding soft tissue can be avoided.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, Hong Kong SAR, China
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4
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Cates NK, Salerno ND, Kavanagh AM, Schuberth JM, Rubin LG. Peroneal Stabilization Via Tightening of the Peroneal Tendon Sheath. Foot Ankle Spec 2022; 15:566-572. [PMID: 35016564 DOI: 10.1177/19386400211068240] [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: 11/15/2022]
Abstract
Peroneal subluxation is a rare but debilitating pathology that can be the result of a superior peroneal retinaculum tear or intrasheath laxity. On clinical examination of both cases, the pathology is observed when the ankle is circumducted in eversion and dorsiflexion. With a superior peroneal retinaculum tear, the tendons dislocate from the peroneal groove, whereas with intrasheath laxity the tendons remain in the groove. In the present case series, peroneal stabilization was performed for both superior peroneal retinaculum tear and intrasheath laxity. With our technique, the fibro-osseous connections of the peroneal tendon sheath are detached from the distal one third of the fibula. Drill holes are made through the fibula for suture to be passed through and the peroneal tendon sheath is reattached to the fibula through horizontal mattress sutures via pants over vest technique to restore tension to the sheath. A total of 5 patients underwent peroneal stabilization, 100% (5/5) of which had preoperative pain with palpation along the peroneal tendons and a palpable click with range of motion of the ankle joint. Postoperatively, 100% (5/5) of the patients were fully weight-bearing, compared to 60% (3/5) preoperatively. No patients had residual subluxation of the peroneal tendons postoperatively or a need for revisional surgery. Residual peroneal tendonitis was present in 20% (1/5) of patients and sural neuritis occurred in 20% (1/5) of patients. The peroneal tendons are physiologically tightened within the peroneal tendon sheath to mitigate the pathologic subluxation, without sacrificing tendons for transfer or using allograft material.Clinical Level of Evidence: Therapeutic, Case Series, Level 4.
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Affiliation(s)
- Nicole K Cates
- Hand & Microsurgery Medical Group, San Francisco, California
| | - Nicholas D Salerno
- Division of Vascular & Endovascular Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Amber M Kavanagh
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | | | - Laurence G Rubin
- Medstar Washington Hospital Center Podiatric Surgery Residency, Mechanicsville, Virginia)
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5
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Fifth Metatarsal Base Fracture Combined With Fracture of the Os Peroneum. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202210000-00001. [PMID: 36201675 PMCID: PMC9542830 DOI: 10.5435/jaaosglobal-d-22-00172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/29/2022] [Indexed: 11/15/2022]
Abstract
Fracture of the os peroneum is rare, and displacement of the fracture can be indicative of a tear in the peroneal longus tendon. A fifth metatarsal base fracture is a common injury caused by sudden inversion and plantar flexion of the hindfoot. We observed a rare case of a fifth metatarsal base zone I fracture combined with a displaced os peroneum fracture in a 34-year-old woman. The patient was treated with resection of the os peroneum and repair of the peroneal longus tendon, as well as open reduction and internal fixation of the fifth metatarsal base. After exposing the fragment of the fifth metatarsal base, the distal part of the fractured os peroneum was found to be located just under the fracture site. There were no complications or discomfort of the foot or ankle at 2 years postoperatively. Resection of the os peroneum and direct repair of the peroneal longus tendon were easily performed after the fifth metatarsal base fragment was exposed. This was an innovative method for performing peroneal longus tendon repair in the deep portion of the midfoot.
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6
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Kim J, Kang S, Kim SJ. A smart insole system capable of identifying proper heel raise posture for chronic ankle instability rehabilitation. Sci Rep 2022; 12:10796. [PMID: 35750787 PMCID: PMC9232603 DOI: 10.1038/s41598-022-14313-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Heel raise is widely prescribed to patients with chronic ankle instability in order to strengthen the Peroneus Longus muscle (PL) which supports the weakened lateral collateral ligaments. While the exercise itself is intuitive, ankle orientation is of particular importance because heel raises performed with inversion do not well recruit the PL. This implies that proper execution is imperative and a means to assess heel raise training sessions is needed. In this study we present a smart insole system capable of identifying heel raise events and its corresponding rise, hold and drop phases, which allows for a more descriptive analysis. The results from our heel raise sessions, which consist of four different variants performed by five healthy subjects, suggest that medial–lateral foot pressure distribution and foot orientation are needed to differentiate heel raises performed with ankle eversion and inversion. We go further and substantiate that proper execution, detected by our system, indeed leads to increased PL activation by analyzing the electromyography signals. We believe that the proposed system may provide clinicians with invaluable information regarding onsite as well as at-home training and possibly, with biofeedback, serve as foundation for software as a medical device.
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Affiliation(s)
- Jaewook Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, South Korea
| | - Seonghyun Kang
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, South Korea
| | - Seung-Jong Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, South Korea.
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7
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Abstract
Ankle sprains are a common injury among physically active populations and occur with an incidence of around 2.15 per 1000 person-years. This article discusses various surgical procedures used to treat chronic lateral ankle instability, including direct ligament repair, anatomic reconstruction, and nonanatomic reconstruction. We focus our discussion on the most common and challenging complications of ankle stabilization, both in our experience and as supported by the existing literature, including recurrent instability, superficial peroneal nerve injury, and unaddressed pathology that continues to cause symptoms and limit function. We offer possible methods to manage these conditions as well as available outcome data.
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Affiliation(s)
- Mark Drakos
- Hospital for Special Surgery, 523 East 72nd st, New York, NY 10021, USA.
| | - Oliver Hansen
- Hospital for Special Surgery, 523 East 72nd st, New York, NY 10021, USA
| | - Saanchi Kukadia
- Hospital for Special Surgery, 523 East 72nd st, New York, NY 10021, USA
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8
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Flevas DA, Pappas E, Ristanis S, Giakas G, Vekris M, Georgoulis AD. Effect of laterality and fatigue in peroneal electromechanical delay. SICOT J 2022; 8:22. [PMID: 35616599 PMCID: PMC9135018 DOI: 10.1051/sicotj/2022018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Extremity dominance is one of the intrinsic factors that have been identified for ankle sprains. Electromechanical delay (EMD) is an integral part of the peroneal motor response and, therefore, substantial in preventing ankle sprains. This study aimed to investigate the effect of laterality on EMD times before and after fatigue. Methods: Fifteen healthy male volunteers participated in the study. Measurements were taken with the ankle in a neutral (0°) position, and all subjects followed an isokinetic fatigue protocol. Repeated ANOVA was used for statistical analysis, and the α level was set a priori at p ≤ 0.05. Results: No significant difference was noted in EMD times between the dominant and non-dominant legs of the volunteers (p = 0.940). Fatigue caused a significant increase in EMD by 10–15 ms (p = 0.003), while the leg × fatigue interaction was not significant (p = 0.893). Conclusions: In a non-injured athlete, both ankles seem to be under the same protection of the reactive response of the peroneal muscles. Therefore, athletes should be aware that both their extremities are equally exposed to the danger of an ankle injury. Also, fatigued ankles demonstrate longer EMD times, implying that improving resistance to fatigue may add another layer of protection that has the potential to prevent ankle sprain recurrence.
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Affiliation(s)
- Dimitrios A Flevas
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina 45110, Greece - Department of Arthroscopy and Orthopaedic Surgery, Metropolitan Hospital, Neo Faliro, Athens 18547, Greece
| | - Evangelos Pappas
- School of Medicine and Illawarra Health and Medical Research Institute, The University of Wollongong, Wollongong, NSW 2522, Australia
| | - Stavros Ristanis
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina 45110, Greece - Department of Arthroscopy and Orthopaedic Surgery, Metropolitan Hospital, Neo Faliro, Athens 18547, Greece
| | - Giannis Giakas
- Department of Physical Education and Sport Science, Institute of Kinesiology, Research Centre Iason, University of Thessaly, Trikala 4100, Greece
| | - Marios Vekris
- Department of Orthopaedic Surgery, University of Ioannina, Ioannina 45110, Greece
| | - Anastasios D Georgoulis
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina 45110, Greece
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9
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Sanchez-Gomez R, Gomez-Carrion A, Martinez-Sebastian C, Alou L, Sevillano D, Nuñez-Fernandez A, Sanz-Wozniak P, de la Cruz-Torres B. Innovative Medial Cushioning Orthoses Affect Peroneus Longus Electromyographic Activity during Running. J Clin Med 2022; 11:1339. [PMID: 35268430 PMCID: PMC8911408 DOI: 10.3390/jcm11051339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 12/26/2022] Open
Abstract
Background: Over-supination processes of the foot and ankle involving peroneus longus (PL) damage during running sports have been treated conservatively with passive control tools, such as tapes, braces, or external ankle supports, but the effect of orthoses with typical lateral wedging orthoses (TLWO) on the muscular activity of PL during running remains unclear. Here we investigate the effects of innovative medial cushioning orthoses (IMCO) on PL activity during the full running gait cycle. In addition, we wished to ascertain the effects of innovative medial cushioning orthoses (IMCO) on PL activity during running. Methods: Thirty-one healthy recreational runners (mean age 34.5 ± 3.33) with neutral foot posture index scores, were selected to participate in the present study. They ran on a treadmill at 9 km/h wearing seven different orthoses (NRS, IMCO 3 mm, IMCO 6 mm, IMCO 9 mm, TLWO 3 mm, TLWO 6 mm and TLWO 9 mm), randomly performed on the same day while electromyographic activity of the PL muscle was recorded. Statistical intraclass correlation coefficient (ICC) to test reliability was carried out and the Wilcoxon test with Bonferroni’s correction was developed to analyze the differences between the conditions. Results: the reliability of all assessments showed data higher than 0.81, that is, “almost perfect reliability”; all EMG PL values wearing either TLWO or IMCO showed a statistically significant reduction versus NRS during the fully analyzed running gait cycle; the highest difference was set on NRS 23.08 ± 6.67 to TLWO 9 mm 17.77 ± 4.794 (p < 0.001). Conclusions: Muscular EMG activity of the PL during the full running gait cycle decreases when wearing either TLWO or IMCO relative to NRS; therefore, these orthoses could be prescribed to treat the strain and overload pathologies of PL. In addition, IMCO—as it less thick, compared with TLWO—can be used when aiming to achieve better running economy.
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Affiliation(s)
- Ruben Sanchez-Gomez
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.G.-C.); (C.M.-S.); (A.N.-F.); (P.S.-W.)
| | - Alvaro Gomez-Carrion
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.G.-C.); (C.M.-S.); (A.N.-F.); (P.S.-W.)
| | - Carlos Martinez-Sebastian
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.G.-C.); (C.M.-S.); (A.N.-F.); (P.S.-W.)
| | - Luis Alou
- Microbiology Division, Department of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.A.); (D.S.)
| | - David Sevillano
- Microbiology Division, Department of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.A.); (D.S.)
| | - Almudena Nuñez-Fernandez
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.G.-C.); (C.M.-S.); (A.N.-F.); (P.S.-W.)
| | - Paola Sanz-Wozniak
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.G.-C.); (C.M.-S.); (A.N.-F.); (P.S.-W.)
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10
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Chrea B, Eble SK, Day J, Hansen OB, Ellis SJ, O'Malley MJ, Drakos MC. Clinical and Patient-Reported Outcomes Following Peroneus Brevis Reconstruction With Hamstring Tendon Autograft. Foot Ankle Int 2021; 42:1391-1398. [PMID: 34109840 DOI: 10.1177/10711007211015186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneal tendon injuries are a common cause of lateral ankle pain and instability. While the use of hamstring autograft has been proposed as a viable surgical option for peroneus brevis reconstruction, reported outcomes with this technique are limited in the literature. We present patient-reported and clinical outcomes for patients who underwent peroneus brevis reconstruction with hamstring autograft. METHODS Thirty-one patients were retrospectively identified who underwent a procedure including peroneus brevis reconstruction with hamstring autograft for peroneal tendinopathy between February 2016 and May 2019. All patients who had a peroneus brevis reconstruction were included, and all concomitant procedures were noted. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were prospectively collected preoperatively and at a minimum of 1 year postoperatively (mean, 24.3; range, 12-52.7) months. Retrospective chart review was performed to evaluate the incidence of postoperative complications and reoperations. RESULTS When evaluating pre- and postoperative patient-reported outcome surveys (n = 26; 84%), on average, patients reported improvement in every PROMIS domain evaluated, with significant improvement in Physical Function (+5.99; P = .006), Pain Interference (-8.11; P < .001), Pain Intensity (-9.02; P < .001), and Global Physical Health (+7.29; P = .001). Three patients reported persistent pain at a minimum of 1 year postoperatively, of whom 2 required reoperation. No patient reported persistent pain or discomfort at the harvest site of the hamstring autograft. CONCLUSION Patients undergoing peroneus brevis reconstruction with hamstring autograft experienced clinically significant improvement in patient-reported and clinical outcomes. Few postoperative complications were observed, and patients reported improvements across all patient-reported outcome domains, with significant improvements for pain and function domains. Reconstruction with hamstring autograft represents a viable surgical option in the setting of peroneal tendinitis or tears. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Bopha Chrea
- Hospital for Special Surgery, New York, NY, USA
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11
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Park SH, Choi YR, Lee J, Seo J, Lee HS. Treatment of Recurrent Peroneal Tendon Dislocation by Peroneal Retinaculum Reattachment Without Fibular Groove Deepening. J Foot Ankle Surg 2021; 60:994-997. [PMID: 34275719 DOI: 10.1053/j.jfas.2020.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 02/03/2023]
Abstract
There are numerous studies recommending fibular groove deepening in the surgical treatment of peroneal tendon dislocation; however, there are some disadvantages to fibular groove deepening procedures. In this study, we evaluated the results of anatomic reattachment of the peroneal retinaculum without fibular groove deepening as a treatment for traumatic peroneal tendon dislocation. Thirty-six patients with recurrent peroneal tendon dislocation, who underwent retinaculum repair without a fibular groove deepening procedure performed by 2 surgeons between March 2004 and March 2017, were enrolled in this study. Resubluxation of tendon, pain on inversion and eversion power of the ankle were monitored. The range of motion of inversion and eversion were measured and then compared to that of the contralateral side. American Orthopedic Foot and Ankle Society (AOFAS), visual analog scale (VAS), Foot Function Index (FFI) scores were obtained for all patients preoperatively and at the final follow-up. Postoperative complications such as infection, sural nerve injury, and recurrence were monitored. Thirty-four patients fully recovered without resubluxation of tendon. Two patients were injured again while playing soccer 6 months after the surgery and fast running 20 months after the surgery respectively. One patient had sural nerve injury. But the symptom was relieved at 6 months after the surgery. None of the patients had weakness of evertor. None of the patients had limited ankle motion. Mean AOFAS, VAS, FFI score improved significantly (p = .02, .01, .02). In conclusion, for the treatment of recurrent dislocation of the peroneal tendon reattachment of the superior retinaculum only without groove deepening followed by proper rehabilitation is sufficient.
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Affiliation(s)
- Seung-Hwan Park
- Professor, Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Young Rak Choi
- Professor, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaehyung Lee
- Clinical fellow, Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Jaehyeon Seo
- Resident, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Seong Lee
- Professor, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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12
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Mercer NP, Gianakos AL, Mercurio AM, Kennedy JG. Clinical Outcomes of Peroneal Tendon Tears: A Systematic Review. J Foot Ankle Surg 2021; 60:1008-1013. [PMID: 33785239 DOI: 10.1053/j.jfas.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to provide an overview of the available evidence on peroneal tendon tears and the outcomes after surgical intervention. A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Criteria for inclusion were clinical studies reporting outcomes after treatment for peroneal tendon tear within the last 10 years. Nine studies evaluating 336 patients (146 males/190 females) and 336 ankles were included in this review. The mean age of included patients was 46.3 years (range, 46-56.9 years). The weighted mean follow-up was 23.82 months (range 9.2-78 months. Five surgical interventions were reported: primary repair with tenodesis, primary repair without tenodesis, FDL tendon transfer, FHL tendon transfer, and allograft reconstruction. Four studies recorded the AOFAS score, with a weighted mean preoperative score of 69.58 and a weighted mean postoperative score of 88.82. Six studies measured the VAS score showing an improvement from a mean weighted preoperative score of 4.68 to a mean weighted postoperative score of 1.2. FAAM score was measured in 3 studies, which showed an improvement from 41.1 preoperatively to 84.4 postoperatively. The average overall complication rate was 38.7% (130/336) with the most commonly reported minor complication being ankle pain, which made up 46.2% of all minor complications (56/121). Primary repair without tenodesis was associated with a higher complication rate compared to any other surgical intervention (p=.001176). The current systematic review showed that overall clinical outcomes were positive in lieu of the different modalities of surgical intervention for peroneal tendon tears.
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Affiliation(s)
| | - Arianna L Gianakos
- Department of Orthopedic Surgery, Robert Wood Johnson Barnabas Health, Jersey City Medical Center, Jersey City, NJ
| | - Angela M Mercurio
- Department of Orthopedic Surgery, Robert Wood Johnson Barnabas Health, Jersey City Medical Center, Jersey City, NJ
| | - John G Kennedy
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY.
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13
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Kimura T, Kubota M, Hattori H, Saito M. Nontraumatic Bilateral Recurrent Peroneal Tendon Dislocation with Pes Planovalgus: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00009. [PMID: 34237040 DOI: 10.2106/jbjs.cc.21.00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Peroneal tendon dislocation is a relatively infrequent problem. Most cases are traumatic, and nontraumatic cases are rare. In this case, a 21-year-old man had nontraumatic bilateral recurrent peroneal tendon dislocation on standing and pes planovalgus. We performed medial displacement osteotomy of the calcaneus for the pes planovalgus and reattachment of the retinaculum and groove deepening for the peroneal tendon dislocations. CONCLUSION The dislocations were attributed to the force of the tendon riding up the lateral malleolus on standing because of pes planovalgus. A good outcome was achieved by surgical intervention for both the pes planovalgus and peroneal tendon dislocations.
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Affiliation(s)
- Tadashi Kimura
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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14
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Willegger M, Hirtler L, Schwarz GM, Windhager RH, Chiari C. [Peroneal tendon pathologies : From the diagnosis to treatment]. DER ORTHOPADE 2021; 50:589-604. [PMID: 34160639 PMCID: PMC8241798 DOI: 10.1007/s00132-021-04116-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 02/03/2023]
Abstract
Peronealsehnenpathologien sind selten, jedoch häufig unterdiagnostiziert. Eine Assoziation mit einer chronisch lateralen Sprunggelenkinstabilität sowie mit einer varischen Rückfußachse kann bestehen. Pathologien der Sehnen lassen sich in 3 Kategorien einteilen: Tendinitis und Tenosynovitis, Sehnenrisse und Rupturen sowie Sehnensubluxation und Sehnenluxation. Die Magnetresonanztomographie ist die Standardmethode zur radiologischen Beurteilung. Die Diagnose und Behandlung basieren jedoch in erster Linie auf Anamnese und klinischer Untersuchung. Eine primär konservative Therapie kann versucht werden, ausgenommen bei Peronealsehnenluxationen des professionellen Sportlers. Die chirurgische Therapie sollte gezielt auf die zugrunde liegende Pathologie abgestimmt werden und kann dementsprechend divers von der tendoskopischen Synovektomie bis zur anatomischen Reparatur des superioren peronealen Retinakulums mit Vertiefung der retromalleolären Rinne ausfallen. Die postoperativen Ergebnisse zeigen eine hohe Patientenzufriedenheit und niedrige Reluxationsraten.
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Affiliation(s)
- Madeleine Willegger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Lena Hirtler
- Zentrum für Anatomie und Zellbiologie, Abteilung für Anatomie, Medizinische Universität Wien, Wien, Österreich
| | - Gilbert M Schwarz
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Zentrum für Anatomie und Zellbiologie, Abteilung für Anatomie, Medizinische Universität Wien, Wien, Österreich
| | - Rein Hard Windhager
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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15
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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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16
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Evaluation and Management of Common Accessory Ossicles of the Foot and Ankle in Children and Adolescents. J Am Acad Orthop Surg 2021; 29:e312-e321. [PMID: 33475303 DOI: 10.5435/jaaos-d-20-00218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/30/2020] [Indexed: 02/01/2023] Open
Abstract
Accessory ossicles are a common radiographic finding about the foot and ankle in children and adolescents. They are often noted incidentally during evaluation of foot and ankle injuries, and most can be managed nonsurgically. Although over 20 accessory ossicles have been described around the foot and ankle, five specific structures generate the most concern in pediatric patients. An accessory navicular presents commonly with medial midfoot pain and may require surgical intervention after failure of nonsurgical treatment. Although an accessory navicular can be treated surgically with simple excision, there is some recent evidence that supports concomitant reconstruction of associated flatfoot deformities. Os trigonum, an ossicle posterior to the talus, is also commonly asymptomatic. However, os trigonum may be associated with persistent posterior ankle pain, and open and endoscopic resection techniques are successful. Os subfibulare is an uncommon ossicle that may be associated with recurrent ankle sprains. Recent literature reports successful return to activities after ossicle excision and ligament reconstruction. Os subtibiale may be confused with a medial malleolar fracture in skeletally immature patients. Os peroneum may contribute to lateral midfoot pain.
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17
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Kalaycioglu T, Apostolopoulos NC, Yurt Y, Tunay VB. The effectiveness of different ankle strengthening training programs on performance. J Sports Med Phys Fitness 2021; 62:435-447. [PMID: 33768775 DOI: 10.23736/s0022-4707.21.12130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the effectiveness of different ankle strengthening training programs: eccentric, concentric, and resistance bands, on performance of university level sedentary males. METHODS Sixty-three males between the ages of 18 and 26 years were randomized to either eccentric isokinetic (n=21), concentric isokinetic (n=21), and resistance bands ankle strengthening groups (n=21). Training was performed three days a week, for eight weeks for both sides of ankle. Each program was made progressively harder by increasing the number of repetitions or sets. Measurements evaluating strength, balance and jumping performance were repeated pre, post and at one month (follow-up) after training. RESULTS Statistical significance was observed for concentric evertor strength for both sides of the ankle for all groups after training (p<0.05). In addition, statistically significant increases were seen in jumping performance for all groups and dynamic balance for eccentric and concentric groups (p<0.05), with the concentric being statistically higher compared to the resistance bands group for all parameters (p<0.05). CONCLUSIONS Ankle isokinetic strength (eccentric, concentric) training is more effective than resistance bands regarding improvement on strength, explosive strength, and dynamic balance. Ankle isokinetic strength training, which includes evertor and invertor muscles, improves performance, especially when applied concentrically. Therefore, the proper strengthening of ankle muscles will prevent the re-injury of ankles with individuals returning to activities.
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Affiliation(s)
- Tugce Kalaycioglu
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Cyprus Health and Social Sciences University, Morphou, North Cyprus via Mersin, Turkey -
| | - Nikos C Apostolopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Yasin Yurt
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, North Cyprus via Mersin, Turkey
| | - Volga B Tunay
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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18
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Tiny but mighty: a rare case of os peroneum fracture. CAN J EMERG MED 2021; 23:254-256. [PMID: 33709362 DOI: 10.1007/s43678-020-00074-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
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Abd-Rasid AF, Bajuri MY. Isolated Peroneus Longus Tear - Commonly Missed Diagnosis of Lateral Ankle Pain: A Case Report. Malays Orthop J 2020; 14:130-133. [PMID: 32983388 PMCID: PMC7513650 DOI: 10.5704/moj.2007.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Peroneal tendon tear is a relatively common cause of lateral ankle pain but often missed due to mixed presentation or low index of suspicion. Left untreated, peroneal injuries can lead to persistent ankle pain, instability and ultimately substantial functional disabilities. An isolated peroneus longus tear is rare with the lowest incidence rate compared to isolated peroneus brevis tear and mixed tear of both peroneal tendon. This is a case report of a 49-year-old lady with a chronic left ankle pain who ultimately underwent surgery for an isolated peroneus longus tear.
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Affiliation(s)
- A F Abd-Rasid
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical, Kuala Lumpur, Malaysia
| | - M Y Bajuri
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical, Kuala Lumpur, Malaysia
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20
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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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21
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Nelson SC. Revision Surgery for Peroneal Tendon Tears. Clin Podiatr Med Surg 2020; 37:569-576. [PMID: 32471619 DOI: 10.1016/j.cpm.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Peroneal tendon tears that require revision are rare and often present a unique challenge for foot and ankle surgeons. Biomechanical issues that may be present or missed initially need to be addressed and evaluated thoroughly for an optimized outcome. Tendon degeneration is usually present, and planning for tendon transfer or tendon graft is necessary to improve mechanical strength. The use of MRI can aid in preoperative planning and identification of concomitant disorders that may be present. The postoperative rehabilitation is often longer and patient education is imperative to manage expectations of outcomes.
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Affiliation(s)
- Scott C Nelson
- Department of Orthopedics, Catholic Health Initiatives (CHI Health), 16909 Lakeside Hills Court Suite 208, Omaha, NE 68130, USA.
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22
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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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23
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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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24
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Olewnik Ł, Podgórski M, Ruzik K, Polguj M, Topol M. New classification of the distal attachment of the fibularis brevis - Anatomical variations and potential clinical implications. Foot Ankle Surg 2020; 26:308-313. [PMID: 31031151 DOI: 10.1016/j.fas.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the lateral compartment of the leg is characterized by a high degree of morphological variation, very little information exists on the morphological variability of the fibularis brevis muscle (FBM) and fibularis digiti quinti (FDQ). The main aim of the study was to characterize the morphology of the FBM tendon and its accessory bands, to classify them and to determine the incidence of FDQ. The work attempts to determine the relationship between the types of the insertion of the FBM tendon and the occurrence of FDQ. METHODS Classical anatomical dissection was performed on 102 lower limbs fixed in 10% formalin solution. The morphology of the insertion of the FBM and of the FDQ was evaluated. RESULTS The FBM was present in all specimens. Two types of insertion were observed, the most common being Type I (70.6%): a single distal attachment in which the tendon inserts into the tuberosity at the base of the fifth metatarsal bone. The second most common was Type II (29.4%); this group was divided into three subtypes (A-C). The FDQ was present in 17.7% of specimens and always with Type I FBM. CONCLUSION Both the FBM tendon and FDQ present significant morphological variation. Two main types of the FBM tendon determine the presence of the FDQ. LEVEL OF EVIDENCE II Basic Science Research.
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Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland.
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute, Department of Diagnostic Imaging Lodz, Poland
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
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25
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Peroneal groove deepening as the treatment of peroneal tendon subluxation: A case report. Int J Surg Case Rep 2019; 65:333-338. [PMID: 31770709 PMCID: PMC6879996 DOI: 10.1016/j.ijscr.2019.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 11/21/2022] Open
Abstract
Subluxation of the peroneal tendon is relatively infrequent. Subluxation of the peroneal tendon often misdiagnosed as ankle sprain. Avulsion of the superior peroneal retinaculum from is the main cause of peroneal tendon subluxation. Good outcomes can be achieved by peroneal groove deepening and retinaculum ligament repair.
Introduction Peroneal tendon subluxation is a relatively rare disorder that is often misdiagnosed as an ankle sprain. It affects mainly young adults, usually during sports activities. It is mostly caused by avulsion of the superior peroneal retinaculum (SPR) from its fibular insertion, which requires surgical intervention, especially for cases of symptomatic chronic peroneal tendon subluxation and/or dislocation. We reported a case of peroneal tendon subluxation of left ankle treated with peroneal groove deepening and retinaculum ligament repair, the objective of which is to illustrate the effectiveness of this procedure. Case presentation We present a case of a thirty-four-year old male with peroneal tendon subluxation of left ankle. The patient was injured while exercising two years prior to admission. He now reported pain and instability on the left ankle. We performed peroneal groove deepening and retinaculum ligament repair to treat this patient. Discussion Peroneal groove deepening and retinaculum ligament repair shows an excellent clinical outcome; after the procedure, there are no major complications such as infections, wound problems or permanent discomfort. Overall, the result of surgery had been considered satisfactory. Postoperatively, the ankle was placed in a below-knee, non–weight-bearing temporary cast in semi-equinus position for two weeks. Conclusion The incidence rate of peroneal tendon subluxation is relatively low, and surgery is the primary treatment of this type of injury, with various available surgical methods available for the performing surgeon. Peroneal groove deepening and retinaculum ligament repair offers a satisfactory outcome.
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Lau BC, Moore LK, Thuillier DU. Evaluation and Management of Lateral Ankle Pain Following Injury. JBJS Rev 2019; 6:e7. [PMID: 30153244 DOI: 10.2106/jbjs.rvw.17.00143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Brian C Lau
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Laura K Moore
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Daniel U Thuillier
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
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27
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Anteroposterior Radiograph of the Ankle with Cross-Sectional Imaging Correlation. Magn Reson Imaging Clin N Am 2019; 27:701-719. [PMID: 31575401 DOI: 10.1016/j.mric.2019.07.001] [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: 11/21/2022]
Abstract
The focus of this article is to illustrate various pathologic entities and variants, heralding disease about the ankle, based on scrutiny of AP radiographs of the ankle, with correlative findings on cross-sectional imaging. Many of these entities can only be detected on the AP ankle radiograph and, if not recognized, may lead to delayed diagnosis and persistent morbidity to the patient. However, a vigilant radiologist, equipped with the knowledge of the characteristic appearance and typical locations of the imaging findings, should be able to make the crucial initial diagnosis and surmise additional findings to be confirmed on cross-sectional imaging.
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28
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The peroneus longus muscle and tendon: a review of its anatomy and pathology. Skeletal Radiol 2019; 48:1329-1344. [PMID: 30770941 DOI: 10.1007/s00256-019-3168-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/10/2019] [Accepted: 01/16/2019] [Indexed: 02/02/2023]
Abstract
This article will review the anatomy and common pathologies affecting the peroneus longus muscle and tendon. The anatomy of the peroneus longus is complex and its long course can result in symptomatology referable to the lower leg, ankle, hindfoot, and plantar foot. Proximally, the peroneus longus muscle lies within the lateral compartment of the lower leg with its distal myotendinous junction arising just above the level of the ankle. The distal peroneus longus tendon has a long course and makes two sharp turns at the lateral ankle and hindfoot before inserting at the medial plantar foot. A spectrum of pathology can occur in these regions. At the lower leg, peroneus longus muscle injuries (e.g., denervation) along with retromalleolar tendon instability/subluxation will be discussed. More distally, along the lateral calcaneus and cuboid tunnel, peroneus longus tendinosis and tears, tenosynovitis, and painful os peroneum syndrome (POPS) will be covered. Pathology of the peroneus longus will be illustrated using clinical case examples along its entire length; these will help the radiologist understand and interpret common peroneus longus disorders.
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29
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Sherman TI, Koury K, Orapin J, Schon LC. Lateral Transfer of the Flexor Digitorum Longus for Peroneal Tendinopathy. Foot Ankle Int 2019; 40:1012-1017. [PMID: 31203651 DOI: 10.1177/1071100719853297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have reported midterm outcomes after single-stage flexor digitorum longus (FDL) tendon transfer to the lateral foot for irreparable rupture of the peroneal tendons. METHODS Over a 7-year period (2008-2015), 25 consecutive patients underwent transfer of the FDL to the fifth metatarsal for irreparable peroneal tendon tears. Of these, 15 patients were available for inclusion with a mean follow-up of 53.7 ± 23.3 months, mean age at surgery of 48.4 years, and mean body mass index (BMI) of 29.8 kg/m2. Patients completed the pain visual analog scale (VAS), Foot Function Index (FFI), Short Musculoskeletal Function Assessment (SMFA), and Foot and Ankle Ability Measure (FAAM) and participated in range of motion, peak force, and peak power testing. RESULTS All 15 patients were satisfied with their surgery and reported a reduction in their pain level with a decreased VAS of 5.6 ± 2.5. The mean FFI was 12.8 ± 9.2, the SMFA Function Index was 12.4 ± 8, and the mean SMFA Bothersome Index was 11.5 ± 11. The mean FAAM was 86.4 ± 9.7. Patients had on average 58% less eversion and 28% less inversion compared with the nonoperative side. Isometric peak torque and isotonic peak velocity were 38.4% and 28.8% less compared with the contralateral side, respectively. The average power in the operative limb was diminished by 56% compared with the nonoperative limb. CONCLUSION In this small case series with midterm follow-up, FDL transfer to the lateral foot for significant, irreparable peroneal tendinopathy was an effective and durable treatment option. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Thomas I Sherman
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Kimberly Koury
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Jakrapong Orapin
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lew C Schon
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Abstract
Chronic disorders of the peroneal tendons are a common cause of posterolateral ankle pain, including tendinopathy, tendon instability, and chronic tendon tears. They are often preceded by ligamentous instability or predisposing anatomic abnormalities such as a shallow fibular groove or a cavovarus foot deformity. Given the substantial disability associated with chronic peroneal tendon disorders, it is important for orthopaedic surgeons to optimize the diagnostic and treatment strategies of these entities based on contemporary studies. This article reviews both classic and recent scientific evidence regarding the diagnosis and treatment of patients with chronic peroneal tendon disorders.
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31
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Reconstruction of the Peroneus Brevis Tendon Tears with Semitendinosus Tendon Autograft. Case Rep Orthop 2019; 2019:5014687. [PMID: 31285931 PMCID: PMC6594286 DOI: 10.1155/2019/5014687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/28/2019] [Indexed: 11/25/2022] Open
Abstract
Peroneal tendon disorders are common causes of lateral and retromalleolar ankle pain. For irreparable tears of the tendon, a salvage procedure is indicated with segmental resection followed by reconstruction with tenodesis, tendon transfer, or bridging the defect using allograft or autograft. Although there is insufficient evidence to guide which of these treatment options provides the best outcomes, reconstruction with tendon allograft has provided satisfactory clinical results and is effective for pain relief and restoration of tendon function. However, there are concerns about the use of tendon allografts which include its cost and availability, disease transmission, delayed incorporation, and stretching of the graft. The aim of this study is to present the surgical technique for the reconstruction of the peroneus brevis tendon tears using semitendinosus tendon autograft as an alternative to the allograft and report the short-term results of three cases.
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Hayden SR. Pop in the Foot Causing POPS: The Painful Os Peroneum Syndrome. J Emerg Med 2019; 56:337-339. [PMID: 30594352 DOI: 10.1016/j.jemermed.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 11/15/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Stephen R Hayden
- Department of Emergency Medicine, UC San Diego Health Systems, San Diego, California
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Abstract
CLINICAL ISSUE Injuries of the peroneal tendons are rare and often overlooked. Typical pathologies are tendinitis, tears and dislocation. Accompanying injuries are fractures. They are often associated with instability in the ankle and rearfoot deformities; therefore, these pathologies should be excluded or taken into consideration in the treatment. The clinical examination is crucial for the diagnosis. DIAGNOSTIC WORK-UP Ultrasound and magnetic resonance imaging (MRI) examinations are very helpful; however, the true extent of the tendon pathology is often first seen during surgery. Bony injuries and deformities are assessed radiographically and by computed tomography (CT). PERFORMANCE Although conservative treatment is generally used at the beginning of therapy, progression is more likely to occur in the case of tears; therefore, the correct timing for an operative therapy should not be missed. Dislocations are the domain of operative therapy. Acute tendinitis, on the other hand, is usually accessible to conservative therapy if it is not the result of a gross deformity. ACHIEVEMENTS Rehabilitation after operative treatment is demanding and prolonged especially after operative therapy of peroneal tendon tears. The results to be expected appear promising.
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Lateral ankle anatomical variants predisposing to peroneal tendon impingement. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
INTRODUCTION The purpose of this study was to determine whether tears of the peroneus brevis (PB) tendon correlate with increased fatty infiltration of the PB muscle on MRI compared with musculature without clinical evidence of peroneal pathology. METHODS Ankle MRI scans of patients with PB tendon tearing (tear group) were compared with those of patients without clinical evidence of peroneal pathology (control group). Two reviewers graded the PB muscle belly according to the Goutallier classification. RESULTS Thirty patients were included in each group. The mean Goutallier scores for the tear and control groups were 0.52 (±0.72) and 0.05 (±0.15), respectively (P = 0.0019). The level of interobserver agreement between reviewers was moderate (intraclass correlation coefficient = 0.75; 95% confidence interval, 0.57 to 0.85). DISCUSSION Patients with PB tendon tear demonstrate markedly higher grades of fatty degeneration compared with patients without peroneal pathology. The Goutallier classification may become a valuable instrument for assessing the severity of a PB tear. LEVEL OF EVIDENCE Level III-diagnostic study.
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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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Mahmoud K, Mekhaimar MM, Alhammoud A. Prevalence of Peroneal Tendon Instability in Calcaneus Fractures: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2018; 57:572-578. [PMID: 29548632 DOI: 10.1053/j.jfas.2017.11.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Indexed: 02/03/2023]
Abstract
Peroneal tendon instability associated with an intraarticular calcaneal fracture is a common injury that still often passes undiscovered by both radiologists and orthopedic surgeons. Timely identification of this injury will guide the choice of surgical technique used and treatment of patients. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, several databases were searched through June 2017 for any observational or experimental studies that reported the prevalence/incidence of peroneal tendon subluxation/dislocation with a calcaneus fracture with regard to fracture classifications and the significance of the fleck sign. Nine studies were included, with 1027 patients and 1050 calcaneus fractures. The overall prevalence of peroneal instability (PI) in association with a calcaneus fracture was 29.3%. An increasing prevalence of PI increased the severity of the calcaneus fractures, 5.4% in Sanders I, 19% in Sanders II, 39.4% in Sanders III, and 49.5% in Sanders IV. The presence of a fleck sign is a strong indicator of PI, with a prevalence of 54.7%. The computed tomography findings can overestimate the presence of PI compared with the intraoperative findings. The global reported prevalence of peroneal tendon instability associated with intraarticular calcaneal fractures is high and increases with increasing severity of the calcaneus fracture.
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Affiliation(s)
- Karim Mahmoud
- Orthopedics Resident, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Maged Mekhaimar
- Senior Consultant Orthopedics, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abduljabbar Alhammoud
- Orthopedics Resident, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
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The Effect of Static Stretching of Peroneal and Tibialis Anterior Muscles on Reaction Time: A Randomized Controlled Study. Am J Phys Med Rehabil 2018; 98:136-146. [PMID: 30198912 DOI: 10.1097/phm.0000000000001036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the acute and chronic effects of static stretching on peroneal and tibialis anterior reaction characteristics. DESIGN All 23 participants who volunteered for this study were randomly divided into static (n = 12) and control (n = 11) groups. The subjects in the static stretching group performed stretching exercises for the ankle evertor and dorsiflexor muscles 5 days a week for 6 wks. Peroneal and tibialis anterior muscle reaction characteristics were evaluated at the beginning (2 times for acute effect) and end of this period. Electromyographic activity parameters of the muscles were measured using an ankle inversion tilting platform that simulated a sudden ankle inversion. The following were the four different ankle inversion conditions: (a) ankle-neutral, 15-degree inversion; (b) ankle-neutral, 30-degree inversion; (c) ankle-20-degree plantarflexion, 15-degree inversion; and (d) ankle-20-degree plantarflexion, 30-degree inversion. RESULTS Either in terms of acute or chronic effects, no significant differences were found after static stretching exercises for peroneal and tibialis anterior muscle reaction time, reaction duration, and muscle activity evaluated in four positions on the ankle inversion simulation platform (P > 0.05). CONCLUSIONS In light of these results, it is possible to state that the short duration of static stretching exercises can still be applied before sports activities.
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Clinical results of peroneal tendon repair in a retrospective series of 30 patients. Orthop Traumatol Surg Res 2018; 104:511-517. [PMID: 29625184 DOI: 10.1016/j.otsr.2018.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 01/09/2018] [Accepted: 01/19/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Peroneal tendinopathy is an under-diagnosed pathology, mainly triggered by ankle sprain. Failure of medical treatment often leads to surgery, with modalities adapted to the lesion type. The present study aimed to assess clinical and functional results of tendon repair and to analyze the influence of hindfoot alignment on quality of outcome. The study hypothesis was that hindfoot varus impairs medium-term results. MATERIALS AND METHODS A retrospective series of 30 patients undergoing peroneal tendon repair or tenodesis was analyzed at a mean 20 months' follow-up. All patients had preoperative ultrasound scan or NMRI. Clinical assessment was based on AOFAS and FAAM scores. Hindfoot alignment was assessed on Méary view; 2 groups were distinguished: valgus (n=11) and varus (n=17). RESULTS Mean AOFAS score improved, from 74.5±11.2 preoperatively to 86.7±9.4 at follow-up. There was a significant intergroup difference (p=0.0003) in AOFAS at follow-up: valgus, 93/100; varus, 82/100. There was no significant intergroup difference in FAAM score. Time to surgery, lesion type and surgical technique did not influence clinical results. DISCUSSION/CONCLUSION Clinical results for surgical repair of peroneal tendons were satisfactory and in line with literature reports. However, hindfoot varus was associated with poorer results, raising the possibility of correction by opening wedge calcaneal osteotomy. LEVEL OF EVIDENCE IV, retrospective case series.
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The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2018. [PMID: 29767272 DOI: 10.1007/s00167-018-4971-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
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Hau WWS, Lui TH, Ngai WK. Endoscopic Superior Peroneal Retinaculum Reconstruction. Arthrosc Tech 2018; 7:e45-e51. [PMID: 29552468 PMCID: PMC5852255 DOI: 10.1016/j.eats.2017.08.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 08/10/2017] [Indexed: 02/06/2023] Open
Abstract
Post-traumatic peroneal tendon subluxation or dislocation is most commonly due to injury to the superior peroneal retinaculum. Acute repair of the retinaculum is an option for active athletes who desire quick return of sport activity. In general, conventional open surgeries require extensive exposure of the injured superficial peroneal retinaculum and have potential risks of scar formation, sural nerve injury, limited range of movement, peroneal tendon re-subluxation, and tendon irritation. The purpose of this Technical Note is to describe the details of endoscopic superior peroneal retinaculum reconstruction. This has the advantages of minimally invasive surgery of better cosmesis, less soft tissue dissection, less postoperative pain, less peritendinous fibrosis, and less subjective tightness at peroneal tendons. The endoscopic view allows better assessment of retinaculum integrity, grading of injury, and detection of coexisting pathology.
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Affiliation(s)
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China
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The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surg Sports Traumatol Arthrosc 2018; 26:3096-3107. [PMID: 29767272 PMCID: PMC6154028 DOI: 10.1007/s00167-018-4971-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
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Calcaneofibular Ligament Transfer for Recurrent Peroneal Tendon Subluxation in Pediatric and Young Adult Patients. J Pediatr Orthop 2018; 38:44-48. [PMID: 26866644 DOI: 10.1097/bpo.0000000000000731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peroneal tendon subluxation is an uncommon cause of lateral ankle pain and instability but can be disabling for some young patients. Surgical management may be required to restore function for patients who fail nonoperative management. The purpose of this study was to determine the functional outcomes after surgical management of peroneal tendon subluxation in pediatric and adolescent patients. METHODS A retrospective review of patients presenting to our institution over a 10-year period yielded 18 cases of recurrent subluxation refractory to nonoperative management in 14 children or young adults (mean age 15.0 y). All patients failed nonoperative management and were treated operatively with isolated calcaneofibular ligament transfer to construct a new soft tissue restraint for the peroneal tendons. Patients were evaluated clinically and sent validated questionnaires, including the Foot and Ankle Ability Measure (FAAM) and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. RESULTS All 18 ankles of 14 patients had minimum 2-year follow-up. Ten of 18 ankles (55.6%) returned the outcome surveys at an average of 5.7 years after the index procedure (range, 2. 0 to 9.7 y). The average FAAM activities of daily living score was 93.5 (±2.9) and the sports subscale was 77.8 (±6.1). The mean AOFAS subjective scaled score was 84.3 (±4.5). All patients returned to sports and recreational activity. Complications included 1 case of recurrent subluxation (1/18, 5.5%) treated with revision to a Chrisman-Snook procedure and 4 ankles (4/18, 22.2%) with stiffness or arthrofibrosis treated with a secondary procedure of peroneal tendon release or lysis of adhesions. CONCLUSIONS Surgical management with rerouting of the peroneal tendons under the calcaneofibular ligament appears to be safe and effective for young patients with chronic peroneal tendon subluxation. It provides a low rate of recurrent subluxation, excellent stability, and good long-term functional outcomes. However, the potential for postoperative stiffness appears to be a limitation to the procedure and necessitates aggressive physical therapy to maintain ankle motion. LEVEL OF EVIDENCE Level IV- retrospective case series.
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Federer AE, Steele JR, Dekker TJ, Liles JL, Adams SB. Tendonitis and Tendinopathy: What Are They and How Do They Evolve? Foot Ankle Clin 2017; 22:665-676. [PMID: 29078821 DOI: 10.1016/j.fcl.2017.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The development of tendinitis and tendinopathy is often multifactorial and the result of both intrinsic and extrinsic factors. Intrinsic factors include anatomic factors, age-related factors, and systemic factors, whereas extrinsic factors include mechanical overload and improper form and equipment. Although tendinitis and tendinopathy are often incorrectly used interchangeably, they are in 2 distinct pathologies. Due to their chronicity and high prevalence in tendons about the ankle, including the Achilles tendon, the posterior tibialis tendon, and the peroneal tendons, tendinitis and tendinopathies cause significant morbidity and are important pathologies for physicians to recognize.
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Affiliation(s)
- Andrew E Federer
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - John R Steele
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Travis J Dekker
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Jordan L Liles
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Samuel B Adams
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA.
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Pereira H, Vuurberg G, Stone J, Lui TH. Ankle tendoscopy: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2017-000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lui TH. Endoscopic Synovectomy of Peroneal Tendon Sheath. Arthrosc Tech 2017; 6:e887-e892. [PMID: 28706847 PMCID: PMC5496000 DOI: 10.1016/j.eats.2017.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/24/2017] [Indexed: 02/03/2023] Open
Abstract
Peroneal tenosynovitis usually responds to conservative therapy. Early diagnosis and management are imperative because improper or delayed diagnosis and treatment of peroneal tenosynovitis may lead to progression of the tenosynovitis to peroneal tendon rupture, ultimately limiting the benefit of nonoperative treatment. For refractory cases, endoscopic tenosynovectomy is indicated. The purpose of this Technical Note is to report a minimally invasive approach to perform a synovectomy of zones 1 and 2 of the peroneal tendon sheath.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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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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48
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Incidence and Association of CT Findings of Ankle Tendon Injuries in Patients Presenting With Ankle and Hindfoot Fractures. AJR Am J Roentgenol 2017; 208:373-379. [DOI: 10.2214/ajr.16.16657] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Evers J, Wähnert D, Grüneweller N, Raschke MJ, Ochman S. Delayed Surgical Reconstruction of a Peroneal Tendon Rupture in an Accessory Os Peroneum A Rare Differential Diagnosis in Chronic Ankle Pain. J Am Podiatr Med Assoc 2016; 106:439-444. [PMID: 28033048 DOI: 10.7547/15-092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A fracture of the os peroneum is a rare cause of ankle and foot pain and is often overlooked and not assumed. Only a few case reports have discussed the different etiologies, options for diagnosis, and therapeutic interventions for acute cases. We present a case of delayed diagnosis of an os peroneum fracture due to a distortion of the ankle that occurred during air sports. Initial diagnostic testing with magnetic resonance imaging demonstrated a rupture of the peroneus longus tendon with no pathologic abnormalities at the peroneus brevis tendon. During surgery, a combination of an os peroneum fracture and a peroneus brevis tendon split was found and was successfully treated with bone and tendon repair using a lasso stich technique.
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Affiliation(s)
- Julia Evers
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Dirk Wähnert
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Niklas Grüneweller
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Sabine Ochman
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
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Pellegrini MJ, Glisson RR, Matsumoto T, Schiff A, Laver L, Easley ME, Nunley JA. Effectiveness of Allograft Reconstruction vs Tenodesis for Irreparable Peroneus Brevis Tears: A Cadaveric Model. Foot Ankle Int 2016; 37:803-8. [PMID: 27480963 DOI: 10.1177/1071100716658469] [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 Irreparable peroneus brevis tendon tears are uncommon, and there is scant evidence on which to base operative treatment. Options include tendon transfer, segmental resection with tenodesis to the peroneus longus tendon, and allograft reconstruction. However, the relative effectiveness of the latter 2 procedures in restoring peroneus brevis function has not been established. METHODS Custom-made strain gage-based tension transducers were implanted into the peroneus longus and brevis tendons near their distal insertions in 10 fresh-frozen cadaver feet. Axial load was applied to the foot, and the peroneal tendons and antagonistic tibialis anterior and posterior tendons were tensioned to 50% and 100% of physiologic load. Distal tendon tension was recorded in this normal condition and after sequential peroneus brevis-to-longus tenodesis and peroneus brevis allograft reconstruction. Measurements were made in 5 foot inversion/eversion and plantarflexion/dorsiflexion positions. RESULTS Distal peroneus brevis tendon tension after allograft reconstruction significantly exceeded that measured after tenodesis in all tested loading conditions (P ≤ 0.022). With 50% of physiologic load applied, peroneus brevis tension was 1% to 28% of normal (depending on foot position) after tenodesis and 73% to 101% of normal after allograft reconstruction. Under the 100% loading condition, peroneus brevis tension was 6% to 43% of normal after tenodesis and 88% to 99% of normal after reconstruction with allograft. Distal peroneus longus tension remained within 20% of normal under all operative and loading conditions. CONCLUSION Allograft reconstruction of a peroneus brevis tendon tear in this model substantially restored distal tension when the peroneal tendons and their antagonists were loaded to 50% and 100% of physiologic load. Tenodesis to the peroneus longus tendon did not effectively restore peroneus brevis tension under the tested conditions. CLINICAL RELEVANCE Because tenodesis was demonstrated to be ineffective for restoration of peroneus brevis function, this procedure may result in an imbalanced foot clinically.
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Affiliation(s)
- Manuel J Pellegrini
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Richard R Glisson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Takumi Matsumoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Adam Schiff
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Lior Laver
- Department of Orthopaedics, Tel-Aviv University Hospital, Tel-Aviv, Israel
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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