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Lootsma J, Wuite S, Hoekstra H, Matricali GA. Surgical treatment options for chronic instability of the peroneal tendons: a systematic review and proportional meta-analysis. Arch Orthop Trauma Surg 2023; 143:1903-1913. [PMID: 35260916 DOI: 10.1007/s00402-022-04395-4] [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: 11/30/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Several surgical techniques for chronic instability of the peroneal tendons have been reported. Yet, the most optimal technique has not been clarified. This study aims to perform a systematic review and meta-analysis of all existing evidence and compare all published surgical techniques in both the athletic as the nonathletic population. MATERIALS AND METHODS A systematic review and a proportional meta-analysis, with a random-effects model, were carried out according to the PRISMA guidelines, using the keywords "chronic luxation" OR "instability" AND "peroneal tendon" AND "treatment" OR "treatment protocol". Four surgical techniques were compared in patients with chronic peroneal instability, comprising superior peroneal retinaculum (SPR) repair or replacement, groove deepening procedures (primarily with additional SPR operations), rerouting procedures, and bony procedures (respectively group S, G, R and B). Outcomes of interest include the pre- and postoperative American orthopedic foot and ankle society hindfoot score, return to sports, postoperative redislocation and complications. Pooled estimates of the last two outcomes were obtained. RESULTS For the systematic review, 31 studies were eligible. Of these, 25 papers met the criteria for inclusion in the meta-analysis. All techniques demonstrated a clinical improvement postoperatively. Group B, however, demonstrated overall more unsatisfactory results, and higher complication rates were observed for both group R and group B. The latter was established by the proportional meta-analysis as well [95% confidence interval group S: (0.01-0.10); group G: (0.02-0.10); group R: (0.13-0.57); group B: (0.24-0.40)]. Concerning surgical efficacy (= no postoperative redislocation), no significant difference was statistically observed. Finally, considerable differences in study quality were identified. CONCLUSION Surgical treatment results in excellent clinical and functional outcomes in patients with chronic peroneal instability. More inferior results were demonstrated for rerouting and bony procedures. However, no high-quality studies are available and future randomized controlled trials are necessary to advocate for the most advantageous approach.
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Affiliation(s)
- Joline Lootsma
- Faculty of Medicine, KU Leuven-University of Leuven, Leuven, Belgium.
- Center for Orthopedics, Trauma and Reconstructive Surgery, Rhein-Maas Klinikum, Würselen, Germany.
- , Boulevard du Midi 118, 1000, Brussels, Belgium.
| | - Sander Wuite
- Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Orthopaedic Research and Training, KU Leuven-University of Leuven, Leuven, Belgium
| | - Harm Hoekstra
- Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni A Matricali
- Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Orthopaedic Research and Training, KU Leuven-University of Leuven, Leuven, Belgium
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Howard A, John A, Theiss R. Peroneus Tendon Disorders: Evaluation and Non-operative Management. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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Mostovoy A, Chang T. Peroneal Pathology in the Athlete. Clin Podiatr Med Surg 2023; 40:139-155. [PMID: 36368839 DOI: 10.1016/j.cpm.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The peroneal tendons play a critical role in stabilizing the foot and ankle especially in athletes with high demands on lateral ankle strength. A complete understanding of the anatomy of the lateral ankle as well as a careful physical examination is imperative to diagnosing peroneal pathology, which is commonly misdiagnosed and can lead to chronic pain and inability to perform high level sport. Although low-demand patients do well with a conservative approach, most high-demand athletes will benefit from surgical intervention.
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Affiliation(s)
- Amelia Mostovoy
- St. Mary's Medical Center, Graduate Medical Office, 450 Stanyan Street, San Francisco, CA 94117, USA.
| | - Thomas Chang
- Redwood Orthopedic Surgery Associates, 208 Concourse Boulevard #1, Santa Rosa, CA 95403, USA
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Smoker BA, Giakas AM, Mills FB, Williams KA, Bornemann PH, Benjamin Jackson J. Prevalence of Abnormal Ultrasonographic Findings in Asymptomatic Peroneal Tendons. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231164146. [PMID: 37009419 PMCID: PMC10052504 DOI: 10.1177/24730114231164146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: The peroneus longus (PL) and peroneus brevis (PB) tendons comprise the lateral compartment of the leg and stabilize the foot during weightbearing. Peroneal tendinopathy can precipitate lateral ankle pain and induce functional disability. The progression of peroneal pathology to lateral ankle dysfunction is thought to stem from asymptomatic, subclinical peroneal tendinopathy. There may be clinical benefit to identifying asymptomatic patients with this condition before progression to disability. Various ultrasonographic characteristics have been observed in peroneal tendinopathy. The purpose of this study is to identify the frequency of subclinical tendinopathic characteristics in asymptomatic peroneal tendons. Methods: One hundred seventy participants underwent bilateral foot and ankle ultrasonographic examination. Images were assessed for abnormalities of the PL and PB tendons by a group of physicians who recorded frequencies of abnormalities. This team consisted of an orthopaedic surgeon specializing in foot and ankle surgery, a fifth-year orthopaedic surgery resident, and a family medicine physician with musculoskeletal sonographer certification. Results: A total of 340 PL and 340 PB tendons were assessed. Sixty-eight (20%) PL and 41 (12.1%) PB tendons had abnormal traits. Twenty-four PLs and 22 PBs had circumferential fluid, 16 PLs and 9 PBs had noncircumferential fluid, 27 PLs and 6 PBs had thickening, 36 PLs and 12 PBs had heterogenicity, 10 PLs and 2 PBs had hyperemia, and 1 PL had calcification. In Caucasian participants, male gender was associated with increased frequency of abnormal findings, but there were no other significant differences based on age, body mass index, or ethnicity. Conclusion: In our studied population of 170 patients who had no complaints of associated symptoms, we found that 20% of PLs and 12% of PBs displayed ultrasonographic abnormalities. When we included all unusual findings within and around the tendons, prevalence rates of ultrasonographic abnormalities were 34% for PLs and 22% for PBs. Level of Evidence: Level II, prospective cohort study.
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Affiliation(s)
- Brice A. Smoker
- Department of Orthopedic Surgery, Prisma Health-USC Medical Center, Columbia, SC, USA
- Brice A. Smoker, BS, BA, Department of Orthopedic Surgery, Prisma Health-USC Medical Center, 302 S Prospect St, Columbia, SC 29205, USA.
| | - Alec M. Giakas
- Department of Orthopedic Surgery, Prisma Health-USC Medical Center, Columbia, SC, USA
| | - F. Baker Mills
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kevin A. Williams
- Department of Orthopedic Surgery, Children’s of Alabama/UAB, Birmingham, AL, USA
| | - Paul H. Bornemann
- Department of Family Medicine, Prisma Health-USC Medical Center, Columbia, SC, USA
| | - J. Benjamin Jackson
- Department of Orthopedic Surgery, Prisma Health-USC Medical Center, Columbia, SC, USA
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Nishimura A, Nakazora S, Senga Y, Fukuda A, Kato K, Sudo A. Knotless Tendoscopic Peroneal Retinaculum Repair Technique for Recurrent Peroneal Tendon Dislocation. Arthrosc Tech 2022; 11:e1395-e1401. [PMID: 36061466 PMCID: PMC9437467 DOI: 10.1016/j.eats.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/12/2022] [Indexed: 02/03/2023] Open
Abstract
Peroneal tendon dislocation (PTD) is sometimes diagnosed as a sports-related injury, of which many cases lead to recurrent PTD (RPTD). Superior retinaculum repair is the major operative treatment of RPTD. The technique described herein comprises 8 steps: (1) Standard tendoscopic examination, (2) debridement of the pseudo-pouch base, (3) first anchor insertion, (4) suture relay, (5) second anchor insertion and suture relay, (6) third anchor insertion and suture relay, (7) suture tightening, and (8) suture bridge. Although this tendoscopic peroneal retinaculum repair technique is complicated, expensive, and requires a longer operation time, it incorporates a double-row suture bridge. Therefore, it has a wider contact surface between the superior retinaculum repair and fibula bone and tighter fixation than does a single-row technique. Moreover, our technique is knotless and thereby avoids knot-related complications. Tendoscopy has additional advantages in terms of less postoperative pain, fewer complications, and better cosmesis. In conclusion, this knotless tendoscopic peroneal retinaculum repair technique for RPTD is a patient-friendly surgery compared with previous procedures.
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Affiliation(s)
- Akinobu Nishimura
- Address correspondence to Akinobu Nishimura, M.D., Ph.D., Department of Orthopaedic and Sports Medicine, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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Pitarini A, Anastasia M, Kennedy D, Sumargono E, Kholinne E. The Surgical Procedure in Managing Peroneal Tendon Injury: A Case Series. Orthop Res Rev 2022; 14:255-262. [PMID: 35923302 PMCID: PMC9342706 DOI: 10.2147/orr.s351356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Astuti Pitarini
- St. Carolus Bone & Joint Center, St. Carolus Hospital, Jakarta, Indonesia
| | - Maria Anastasia
- Faculty of Medicine, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia
| | - Dave Kennedy
- Faculty of Medicine, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia
| | - Endrotomo Sumargono
- St. Carolus Bone & Joint Center, St. Carolus Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia
| | - Erica Kholinne
- St. Carolus Bone & Joint Center, St. Carolus Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
- Correspondence: Erica Kholinne, Email
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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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