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Hosack T, Perkins O, Bleibleh S, Singh R. Snapping ankles: peroneal tendon subluxation and dislocation. Br J Hosp Med (Lond) 2023; 84:1-7. [PMID: 37906073 DOI: 10.12968/hmed.2022.0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Peroneal tendon dislocation or subluxation is an orthopaedic condition that usually occurs as a result of injury to the superior peroneal retinaculum. The peroneal muscles are located in the lateral compartment of the leg, and their tendons run in the retromalleolar groove anchored by the superior peroneal retinaculum. Peroneal instability is usually classified using the Eckert and Davies classification, which was modified by Oden into a four-point grading system. The mechanism of injury is typically sudden forced dorsiflexion, resulting in aggressive tautness of the peroneal tendons, combined with a forced eversion of the hindfoot. Plain X-ray, ultrasound and magnetic resonance imaging are useful for imaging of the injury and in planning for surgery. Operative management has high success rates and there are multiple surgical techniques available, including superior peroneal retinaculum repair, tenoplasty, bone block procedures, groove deepening and endoscopic approaches, with little variation in outcome found between the approaches.
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Affiliation(s)
- Tom Hosack
- Department of Gastroenterology and Hepatology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Oliver Perkins
- Department of Plastic Surgery, East and North Hertfordshire NHS Foundation Trust, Stevenage, UK
- Department of Trauma and Orthopaedics, East and North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Sabri Bleibleh
- Department of Trauma and Orthopaedics, Royal Orthopaedic Hospital Birmingham, Birmingham, UK
| | - Rahul Singh
- Department of Trauma and Orthopaedics, Barts Health NHS Foundation Trust, London, UK
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2
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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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3
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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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4
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Grandberg C, de Oliveira DP, Gali JC. Superior peroneal retinaculum reattachment for an atraumatic peroneus brevis tendon subluxation: a case report. J Med Case Rep 2022; 16:239. [PMID: 35705971 PMCID: PMC9202114 DOI: 10.1186/s13256-022-03455-y] [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] [Received: 05/12/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Peroneal tendon subluxation is a rare pathology, generally associated with sport-induced trauma, that occurs due to the rupture of the superior peroneal retinaculum. The diagnosis is mainly clinical, but the use of imaging techniques, such as dynamic ultrasound and magnetic resonance imaging, may contribute to its clarification. Treatment may be conservative or surgical, although there is no consensus on the most appropriate technique to be employed. We report a case of subluxation of the peroneus brevis tendon, with no apparent traumatic cause, in which there was a need for a surgical approach after the failure of conservative treatment. Case presentation A 25-year-old White woman presented pain and locking of the lateral side of the left foot 2 years earlier, with no history of trauma. The patient felt pain upon palpation and presented snapping during flexion–extension of the left ankle. On dynamic ultrasonography, an anterior subluxation of the peroneus brevis tendon occurred when the ankle was in dorsiflexion, suggesting superior peroneal retinaculum injury. Surgical correction was recommended after 2 months of conservative treatment with no improvement. The chosen surgical technique was isolated reattachment of the superior peroneal retinaculum, which proved successful. Conclusions Peroneal tendon subluxation has no established preferred surgical technique. This case demonstrates superior peroneal retinaculum repair as an efficient surgical approach for this condition. Furthermore, the atraumatic mechanism of injury in this case, along with the unknown true incidence of peroneal tendon subluxation, highlights the need to consider this pathology in cases of ankle injuries.
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Affiliation(s)
- Camila Grandberg
- Faculty of Medical and Health Sciences, Pontifical Catholic University of São Paulo, Rua Joubert Wey, 290, Sorocaba, SP, Brazil.
| | | | - Julio Cesar Gali
- Department of Surgery, Faculty of Medical and Health Sciences, Pontifical Catholic University of São Paulo, Rua Joubert Wey, 290, Sorocaba, SP, Brazil
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5
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Trache T, Camenzind RS, Bachmann E, Viehöfer A, Jud L, Wirth S, Imhoff FB. A Biomechanical Analysis of Peroneus Brevis Split Lesions, Repair, and Partial Resection. Foot Ankle Int 2022; 43:710-716. [PMID: 35073766 DOI: 10.1177/10711007211069558] [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: 02/01/2023]
Abstract
BACKGROUND Peroneus brevis tendon tears are associated with chronic ankle pain and instability following sprain injuries. The aim of this study is to elucidate the biomechanical changes induced by a peroneus brevis split and surgical treatment by tubularizing suture or partial resection. METHODS Nine human lower leg specimens were biomechanically tested. Preexisting tendon pathology was ruled out by magnetic resonance imaging and histology. Specimens were subjected to sequential testing of 4 conditions of the peroneus brevis tendon: (1) native, (2) longitudinal lesion, (3) tubularizing suture, and (4) 50% resection. The outcome parameters were the tendon stiffness (N/mm) and the length variation of the split portion at 5 N load. RESULTS The median specimen age at death was 55.8 years (range 50-64 years). The longitudinal tendon split led to an elongation by 1.21 ± 1.15 mm, which was significantly reduced by tubularizing suture to 0.24 ± 0.97 mm (P = .021). Furthermore, 50% resection of the tendon elongated it by a mean 2.45 ± 1.9 mm (P = .01) and significantly reduced its stiffness compared to the intact condition (4.7 ± 1.17 N/mm, P = .024) and sutured condition (4.76 ± 1.04 N/mm, P = .011). CONCLUSION Longitudinal split and 50% resection of the peroneus brevis tendon led to elongation and loss of tendon stiffness. These properties were improved by tubularizing suture. The significance of these changes in the clinical setting needs further investigation. CLINICAL RELEVANCE Tubularizing suture of a peroneus brevis split can restore biomechanical properties to almost native condition, potentially aiding ankle stability in symptomatic cases. A split lesion and partial resection of the tendon showed reduced stiffness and increased elongation.
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Affiliation(s)
- Tudor Trache
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Roland S Camenzind
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Elias Bachmann
- Institute for Biomechanics, Balgrist Campus, University of Zurich, Zurich, Switzerland
| | - Arnd Viehöfer
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Lukas Jud
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Stephan Wirth
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Florian B Imhoff
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
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Hwang IM, Rayos del Sol S, Jenkins SM, Bryant SA, Gardner BB, McGahan P, Chen J. Open Peroneal Tendon Stabilization With Fibular Groove Deepening. Arthrosc Tech 2022; 11:e347-e352. [PMID: 35256974 PMCID: PMC8897588 DOI: 10.1016/j.eats.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/31/2021] [Indexed: 02/03/2023] Open
Abstract
Peroneal tendon subluxation often occurs because of sudden dorsiflexion of the ankle, leading to a traumatic rupture of the superior peroneal retinaculum. Currently, there are several surgical techniques to deepen the fibular groove, but there is no universally accepted gold standard. This technique article describes a fibular groove deepening with preservation of the fibrocartilage in conjunction with repair of the superior peroneal retinaculum. Addressing the main pathologies that may be leading to subluxation of the peroneal tendons, we offer an approach that avoids many of the common pitfalls from previously proposed techniques while preserving the natural fibrocartilage within the malleolar groove and repairing the retinaculum.
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Affiliation(s)
- Inga M. Hwang
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A.,Address correspondence to Inga Hwang, B.S., Advanced Orthopedics and Sports Medicine, San Francisco, CA, 94108, U.S.A.
| | | | - Sarah M. Jenkins
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Stewart A. Bryant
- Department of Orthopaedic Surgery, University of Hawaii Honolulu, Hawaii, U.S.A
| | - Brandon B. Gardner
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Patrick McGahan
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - James Chen
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
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7
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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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8
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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: 2] [Impact Index Per Article: 0.7] [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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9
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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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10
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Bakker D, Schulte JB, Meuffels DE, Piscaer TM. Non-operative treatment of peroneal tendon dislocations: A systematic review. J Orthop 2020; 18:255-260. [PMID: 32082036 DOI: 10.1016/j.jor.2019.08.031] [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: 06/28/2019] [Accepted: 08/28/2019] [Indexed: 01/23/2023] Open
Abstract
Purpose This study evaluated the clinical outcome of non-operative treatment of peroneal tendon dislocations. Methods A systematic review of literature was performed. Results Six studies were included. Redislocation rates differed between treatments: taping ≥ 3 weeks; 18/30 (60%) patients. Plaster cast ≥ 4 weeks; 5/13 (32%) plaster cast ≥ 6 weeks; 1/6 (17%). Strapping or taping treatment indicated a higher rate of pain and instability and a lower rate of ability to return to former activity. Conclusions A non-weight bearing cast ≥ 6 weeks was successful in 5/6 patients. A non-weight bearing cast might be a good alternative for surgical intervention.Level of Clinical Evidence: Level IV, systematic review of level IV studies.
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Affiliation(s)
- Daniel Bakker
- Department of Orthopaedic Surgery, Erasmus MC Rotterdam, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Jan B Schulte
- Department of Orthopaedic Surgery, Erasmus MC Rotterdam, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC Rotterdam, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Tom M Piscaer
- Department of Orthopaedic Surgery, Erasmus MC Rotterdam, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
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11
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Bahad SR, Kane JM. Peroneal Tendon Pathology: Treatment and Reconstruction of Peroneal Tears and Instability. Orthop Clin North Am 2020; 51:121-130. [PMID: 31739875 DOI: 10.1016/j.ocl.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Peroneal tendon pathology is becoming an increasingly recognized source of lateral-sided ankle pain. High clinical suspicion, along with judicious physical examination coupled with confirmatory advanced imaging modalities, are necessary to make an accurate diagnosis and aid in guiding treatment. Peroneal pathology encompasses several distinct conditions. Peroneal tendon tears and injuries to the peroneal retinaculum must be identified to guide treatment. Patients with peroneal pathology report high levels of satisfaction after surgical management with most returning to their preinjury level of function. An early and accurate diagnosis, along with treatment tailored to the individual, is necessary to obtain optimal outcomes.
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Affiliation(s)
- Sophia R Bahad
- The Orthopedic Institute of North Texas, PA, Baylor Frisco - Professional Building #1, 5575 Warren Parkway, #115, Frisco, TX 75034, USA
| | - Justin M Kane
- Foot and Ankle Surgery Division; The Orthopedic Institute of North Texas, PA, Baylor Frisco - Professional Building #1, 5575 Warren Parkway, #115, Frisco, TX 75034, USA; Orthopaedics, Texas A&M University HSC, College of Medicine.
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12
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Sukerkar PA, Fast AM, Riley G. Extreme Sports Injuries to the Pelvis and Lower Extremity. Radiol Clin North Am 2018; 56:1013-1033. [PMID: 30322484 DOI: 10.1016/j.rcl.2018.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Extreme sports are growing in popularity, and physicians are becoming increasingly aware of injuries related to these activities. Imaging plays a key role in diagnosing and determining clinical management of many of these injuries. This article describes general imaging techniques and findings in various injuries specific to multiple extreme sports.
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Affiliation(s)
- Preeti Arun Sukerkar
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Angela M Fast
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Geoffrey Riley
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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13
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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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14
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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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van Dijk PAD, Vopat BG, Guss D, Younger A, DiGiovanni CW. Retromalleolar Groove Deepening in Recurrent Peroneal Tendon Dislocation: Technique Tip. Orthop J Sports Med 2017; 5:2325967117706673. [PMID: 28540318 PMCID: PMC5431455 DOI: 10.1177/2325967117706673] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Peroneal tendon dislocations are most prevalent in the active and athletic population, so accurate diagnosis and management are essential for optimal return of function. Although many nonoperative and surgical management options have been described, the optimal treatment method continues to be debated. In this technique article, a modified retromalleolar groove-deepening technique is described for addressing all anatomic variations of the posterior distal fibula and retromalleolar groove without unduly disturbing the important anatomic facets meant for retention in this region. This technique is indicated for chronic dislocated peroneal tendons, recurrent dislocating peroneal tendons, and dislocation of the tendons after acute injury with a shallow fibular peroneal groove. Although it remains unclear what effect a cortically abraded fibular gliding surface or forceful cortical impaction on the fibrocartilage gliding surface might have on peroneal tendon integrity and function long term, it would seem preferable to avoid such techniques if reliable alternatives are available.
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Affiliation(s)
- Pim A D van Dijk
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery and Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Bryan G Vopat
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Guss
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Foot and Ankle Service, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Alastair Younger
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher W DiGiovanni
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Foot and Ankle Service, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts, USA
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VanPelt MD, Landrum MR, Igbinigie M, Wadhwa V, Chhabra A. Kinematic Magnetic Resonance Imaging of Peroneal Tendon Subluxation with Intraoperative Correlation. J Foot Ankle Surg 2017; 56:395-397. [PMID: 28089129 DOI: 10.1053/j.jfas.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Indexed: 02/03/2023]
Abstract
Magnetic resonance imaging (MRI) is a noninvasive modality of choice for the detection of static peroneal tendon pathologic features. The depiction of peroneal tendon subluxation using real-time kinematic MRI has not been previously reported. We describe the MRI and intraoperative correlation of peroneal tendon and retinacular pathologic findings, and the novel use of kinematic MRI in the illustration of peroneal tendon subluxation.
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Affiliation(s)
- Michael D VanPelt
- Associate Professor, Department of Orthopedics Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Matthew R Landrum
- Associate Professor, Department of Orthopedics Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Vibhor Wadhwa
- Associate Professor, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX; Resident, Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Avneesh Chhabra
- Associate Professor, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
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van Dijk PAD, Gianakos AL, Kerkhoffs GMMJ, Kennedy JG. Return to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:1155-64. [PMID: 26519186 PMCID: PMC4823328 DOI: 10.1007/s00167-015-3833-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/06/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study was to determine the outcome following different surgical treatment techniques in the treatment of peroneal tendon dislocation and to establish whether return to sports was achieved universally following the procedures. METHODS A systematic review and best-evidence synthesis was performed. PubMed and EMBASE were searched for eligible studies. The last search was done in March 2015. Quality assessment of pooled data was performed using a modified Macleod scale and a best-evidence synthesis was performed. In total, 14 studies were included. RESULTS Surgical treatment provides improvement in the post-operative AOFAS score (p < 0.0001) and high satisfaction rates. The redislocation rate is less than 1.5% at long-term follow-up. Patients treated with both groove deepening and SPR repair have higher rates of return to sports than patients treated with SPR repair alone (p = 0.022). CONCLUSIONS Surgical treatment of peroneal tendon dislocation provides good outcomes, high satisfaction and a quick return to sports. Rates in return to sports are significantly higher in patients treated with both groove deepening and SPR repair. To optimize treatment, the surgical management should involve increasing the superior peroneal tunnel volume by groove deepening and stabilizing the tendons by SPR repair. LEVEL OF EVIDENCE Level IV, systematic review of level IV studies.
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Affiliation(s)
- Pim A. D. van Dijk
- />Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Rm 507, New York, NY 10021 USA , />Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands , />Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Arianna L. Gianakos
- />Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Rm 507, New York, NY 10021 USA
| | - Gino M. M. J. Kerkhoffs
- />Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands , />Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - John G. Kennedy
- />Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Rm 507, New York, NY 10021 USA
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Dynamic Ultrasound Imaging for Type A Intrasheath Subluxation of the Peroneal Tendons. Am J Phys Med Rehabil 2015; 94:e53-4. [DOI: 10.1097/phm.0000000000000297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hassani ZA, Aman B, Mahfoud M, Berrada MS, El yaacoubi M. [When ankle sprain hides a dislocation of peroneal tendons]. Pan Afr Med J 2014; 17:139. [PMID: 25374644 PMCID: PMC4218640 DOI: 10.11604/pamj.2014.17.139.3681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/16/2014] [Indexed: 12/05/2022] Open
Abstract
La luxation aiguë des tendons fibulaires est souvent diagnostiquée à tort comme entorse de la cheville. Nous rapportons un cas rare de luxation chronique des fibulaires chez un jeune patient suite à un accident de sport ayant bénéficié d'une réinsertion du rétinaculum supérieur. L’évolution à 6 mois a été bonne avec disparition de la sensation d'instabilité et la reprise des activités sportives.
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Affiliation(s)
| | - Bessam Aman
- Service de Traumatologie Orthopédie, Hôpital Avicenne, CHU IBN SINA, Rabat, Maroc
| | - Mustapha Mahfoud
- Service de Traumatologie Orthopédie, Hôpital Avicenne, CHU IBN SINA, Rabat, Maroc
| | | | - Moradh El yaacoubi
- Service de Traumatologie Orthopédie, Hôpital Avicenne, CHU IBN SINA, Rabat, Maroc
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Cho J, Kim JY, Song DG, Lee WC. Comparison of Outcome After Retinaculum Repair With and Without Fibular Groove Deepening for Recurrent Dislocation of the Peroneal Tendons. Foot Ankle Int 2014; 35:683-9. [PMID: 24709746 DOI: 10.1177/1071100714531233] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study compared the operative outcome between retinaculum repair with and without fibular groove deepening for the treatment of recurrent traumatic peroneal tendon dislocation in young, active patients. METHODS A consecutive series of 29 patients who underwent operative treatment of recurrent peroneal tendon dislocation were evaluated. Thirteen patients were treated by the superior peroneal retinaculum repair with fibular groove deepening (group A) and 16 patients by superior peroneal retinaculum repair alone (group B). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) score for pain, and overall patient satisfaction were used to evaluate the clinical outcome after a minimum follow-up period of 12 months postoperatively. In addition, mean time to return to sports activity and tourniquet time were compared between groups. RESULTS Mean AOFAS score improved significantly from 59.3 points preoperatively to 92.2 points at the final follow-up in group A and from 58.5 points preoperatively to 91.3 points at the final follow-up in group B. Mean VAS score also improved significantly from 5.0 points preoperatively to 1.0 points at the final follow-up in group A and from 4.9 points preoperatively to 1.2 points at the final follow-up in group B. Improvements in AOFAS and VAS scores at the final follow-up were not significantly different between the 2 groups. Mean time to return to sports activity was approximately 3 months in both groups. Mean tourniquet time in group B was significantly shorter than that in group A (42.2 vs 29.5 min). CONCLUSIONS Isolated retinaculum repair compared to retinaculum repair with fibular groove deepening was a faster and simpler technique, but both techniques had good outcomes for the treatment of recurrent traumatic peroneal tendon dislocation. LEVEL OF EVIDENCE Level II, prospective, nonrandomized, comparative study.
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Affiliation(s)
- Jaeho Cho
- Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, Korea
| | - Jae-Young Kim
- Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, Korea
| | - Dae-Geun Song
- Department of Orthopedic Surgery, Armed Forces Capital Hospital, Gyeonggi-do, Sungnam, Korea
| | - Woo-Chun Lee
- Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, Korea
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Schöffl V, Küpper T. Feet injuries in rock climbers. World J Orthop 2013; 4:218-28. [PMID: 24147257 PMCID: PMC3801241 DOI: 10.5312/wjo.v4.i4.218] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/17/2013] [Accepted: 07/23/2013] [Indexed: 02/06/2023] Open
Abstract
While injuries of the upper extremity are widely discussed in rock climbers, reports about the lower extremity are rare. Nevertheless almost 50 percent of acute injuries involve the leg and feet. Acute injuries are either caused by ground falls or rock hit trauma during a fall. Most frequently strains, contusions and fractures of the calcaneus and talus. More rare injuries, as e.g., osteochondral lesions of the talus demand a highly specialized care and case presentations with combined iliac crest graft and matrix associated autologous chondrocyte transplantation are given in this review. The chronic use of tight climbing shoes leads to overstrain injuries also. As the tight fit of the shoes changes the biomechanics of the foot an increased stress load is applied to the fore-foot. Thus chronic conditions as subungual hematoma, callosity and pain resolve. Also a high incidence of hallux valgus and hallux rigidus is described.
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Staresinic M, Bakota B, Japjec M, Culjak V, Zgaljardic I, Sebecic B. Isolated inferior peroneal retinculum tear in professional soccer players. Injury 2013; 44 Suppl 3:S67-70. [PMID: 24060023 DOI: 10.1016/s0020-1383(13)70202-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Peroneal tendon dislocations are rare injuries that can easily be misdiagnosed. Up to date literature mostly describes proximal peroneal tendon dislocations due to superior peroneal retinaculum (SPR) tear. In this article, we present the assessment, diagnostic algorithm and a new therapeutic option for the distal dislocation of the long peroneal tendon due to isolated inferior peroneal retinaculum (IPR) tear. PATIENTS AND METHODS Between 2001 and 2011 three patients with distal peroneal tendon dislocation were operated. All of them were competitive athletes in the national soccer league. They presented with an ankle sprain and prolonged problems on the lateral side of the foot with no improvement after conservative therapy measures. Coleman block test was performed; ultrasound and MRI showed a tendon dislocation under the IPR. The patients underwent surgical repair that consisted of peroneal tubercle excision, a new lateral calcanear groove formation for both peroneal tendons and IPR plasty. RESULTS At the two year follow up the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score showed a significant increase. The decrease of painful stimuli assessed by a Visual Analogue Scale (VAS) was significant as well. At an average of 12 weeks after the surgery, the patients returned to their level of sport activity before injury and didn't report similar problems later. CONCLUSION Description of distal peroneal tendon dislocations is limited in the literature. This topic should be considered in differential diagnostics of an acute and chronic ankle sprain which leads to chronic ankle pain and instability. The authors recommend surgical treatment as a method of choice especially in professional athletes.
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Affiliation(s)
- Mario Staresinic
- Surgery Clinic, Department of Traumatology, University Hospital Merkur, Zagreb, Croatia
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Vega J, Batista JP, Golanó P, Dalmau A, Viladot R. Tendoscopic groove deepening for chronic subluxation of the peroneal tendons. Foot Ankle Int 2013; 34:832-40. [PMID: 23513032 DOI: 10.1177/1071100713483098] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Recurrent subluxation of the peroneal tendons over the lateral malleolus is an uncommon disabling condition in young people involved in sports. Injury to the superior peroneal retinaculum, sometimes in association with a shallow fibular groove, can lead to this condition. There are several surgical treatments for recurrent peroneal tendon subluxation, but no tendoscopy technique has been reported to date. The aim of this study was to describe a tendoscopic groove-deepening technique and its results for treating patients with recurrent subluxation of the peroneal tendons. METHODS Seven patients (3 women and 4 men; mean age 26.4 [21-32] years) with chronic subluxation of the peroneal tendons were treated with a tendoscopic procedure. All patients experienced pain at the lateral retromalleolar area and recurrent subluxation of the peroneal tendons. The right ankle was affected in 4 patients. Mean follow-up was 15.4 (8-25) months. RESULTS On tendoscopic examination, all patients had a flat fibular groove, and the superior peroneal retinaculum was found to be detached in 4 cases. Three patients had a superficial injury of the peroneus brevis tendon which was debrided. Tendoscopic deepening of the peroneal groove without superior peroneal retinaculum repair was performed in all cases. None of the patients experienced recurrent subluxation during follow-up. The AOFAS score increased from 75 preoperatively to 93 at final follow-up. No complications were reported in any case. CONCLUSION Tendoscopic deepening of the fibular groove was a reproducible, minimally invasive technique that provided a favorable outcome for recurrent subluxation of the peroneal tendons in our limited number of patients. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jordi Vega
- Etzelclinic, Foot and Ankle Surgery Unit, Pfäffikon, Schwyz, Switzerland.
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Jockel JR, Brodsky JW. Single-stage flexor tendon transfer for the treatment of severe concomitant peroneus longus and brevis tendon tears. Foot Ankle Int 2013; 34:666-72. [PMID: 23637234 DOI: 10.1177/1071100712470939] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although peroneal tendon injuries are a common cause of lateral ankle pain, there is a paucity of literature specifically addressing the treatment of severe concomitant peroneus longus and brevis tears. The purpose of this study was to evaluate patient outcomes following a single-stage flexor tendon transfer for the treatment of severe concomitant tears of both peroneal tendons. METHODS Eight patients were treated with a single-stage flexor tendon transfer for severe concomitant peroneus longus and brevis tears over a 15-year period. Mean age at the time of surgery was 54 years (range, 41-67 years), including 4 male and 4 female patients. Tendon transfer of either the flexor hallucis longus (FHL) or flexor digitorum longus (FDL) was performed when both peroneal tendons were found intraoperatively to have severe nonreconstructable tears. Mean follow-up time from surgery was 58 months (range, 12-91 months). Preoperative and postoperative AOFAS hindfoot and visual analog pain scores were prospectively collected, and patient charts were reviewed for complications. A postoperative outcome questionnaire was administered during latest follow-up to assess return to activities, satisfaction, and self-rated patient outcome. RESULTS Mean pre- and postoperative AOFAS hindfoot scores increased from 64 (range, 54-77) to 86 (range, 69-100), whereas mean score for pain on a visual analog scale decreased from 4.2 (range, 0.5-6) to 0.7 (range, 0-3). One surgical complication occurred following FDL transfer in a patient who developed a transient peroneal nerve palsy, and 1 patient underwent a subsequent calcaneal osteotomy. Seven of 8 patients reported a return to preoperative activity levels, and no patient required bracing for activities of daily living. All patients reported satisfaction with surgical results, and 7 rated their outcomes as good or excellent. CONCLUSION Single-stage flexor tendon transfer is an effective surgical option for the treatment of severe concomitant peroneus longus and brevis tendon tears. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jeffrey R Jockel
- New England Baptist Hospital, Division of Foot and Ankle Orthopaedics, Boston Sports and Shoulder Center, Chestnut Hill, MA 02467, USA.
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El Rassi G, Kouvalchouk JF, Mcfarland E. Isolated dislocation of the peroneus longus tendon over the calcaneal tubercle in an ice skater: a case report. J Bone Joint Surg Am 2012; 94:e43. [PMID: 22488627 DOI: 10.2106/jbjs.j.01786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- George El Rassi
- Saint George Hospital, PO Box 166378 Ashrafieh Beirut 1100 2807, Lebanon.
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Morphology of the malleolar fibular groove—implications in peroneal tendon pathology. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31824a08d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ziai P, Sabeti-Aschraf M, Fehske K, Dlaska CE, Funovics P, Wenzel F, Graf A, Buchhorn T. Treatment of peroneal tendon dislocation and coexisting medial and lateral ligamentous laxity in the ankle joint. Knee Surg Sports Traumatol Arthrosc 2011; 19:1004-8. [PMID: 21409464 DOI: 10.1007/s00167-011-1471-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 02/24/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Acute dislocation of the peroneal tendon is caused by massive combined flexion-torsion trauma supported by preexisting ligamentous laxity of the ankle joint. This study aimed to investigate the clinical outcome of combined treatment of peroneal tendon dislocation and lateral and medial ligamentous laxity. METHODS Between 2005 and 2007, forty-two patients with peroneal tendon dislocation and coexisting ligamentous laxity were treated. The superior extensor retinaculum was reconstructed using anchor technique and periosteal flap repair, whereas the preexisting ligamentous laxity with regard to the extensor inferior retinaculum was addressed using anchor reconstruction. All patients underwent arthroscopy prior to surgery. Thirty-eight of a total of 42 patients (aged 17-31) completed the 24-month follow-up. Clinical and arthroscopic examination was accomplished consistently by always the same two surgeons. Postoperative follow-up comprised clinical evaluation after 3, 6, 12 and 24 months. RESULTS Clinical results showed a significant (P<0.0001) increase in the AOFAS-Hindfoot Score as an often used but not validated outcome measure, as well as a significant decrease in the Visual Analogue Scale and in the internal and external rotation, after 3 months. The clinical outcome was confirmed at the 6-, 12- and 24-months measuring points. No dislocation of the peroneal tendon recurred within the 24-month follow-up. Subjective patient satisfaction was stated as high. CONCLUSIONS Combined treatment of peroneal tendon dislocation and coexisting lateral and medial ligamentous laxity in the ankle joint following arthroscopy results in good clinical outcome and high patient satisfaction. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Pejman Ziai
- Sporthopaedicum Straubing, Bahnhofplatz 8, 94315, Straubing, Germany,
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Preliminary results of calcaneofibular ligament transfer for recurrent peroneal subluxation in children and adolescents. J Pediatr Orthop 2010; 30:899-903. [PMID: 21102220 DOI: 10.1097/bpo.0b013e3181fbfcea] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Subluxation of the peroneal tendons over the lateral malleolus is an uncommon condition in both pediatric and adult populations. The primary dislocation is thought to occur with rupture of the superior peroneal retinaculum and may be associated with marginal fractures of the lateral malleolus or a preexisting shallow groove inferiorly. Various operative techniques have been reported earlier, but little data exists regarding surgical management and outcome in a pediatric and adolescent population with open physes. METHODS A retrospective review of patients presenting to our institution over a 5-year period yielded 9 cases of recurrent peroneal subluxation refractory to nonoperative management in 7 children or adolescents (mean age 12 y). Both traumatic and atraumatic etiologies were represented. All patients failed nonoperative treatment and were treated operatively with calcaneofibular ligament (CFL) transfer to reroute the peroneal tendons underneath the CFL. All patients were observed in follow-up and sent validated outcomes questionnaires, including the Foot and Ankle Ability Measure and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. RESULTS Mean clinical follow-up was 20.9 months (range: 12 to 35 mo). At follow-up, all patients had returned to sports and activity and there were no instances of recurrence of subluxation. Complications included 1 postoperative infection and 1 patient requiring revision surgery for fibrosis. Six of 9 ankles (66.6%) returned the outcomes surveys. The average Foot and Ankle Ability Measure activities of daily living score was 90.8 (±4.4) and the sports subscale was 62.5 (±9.3). The mean American Orthopaedic Foot and Ankle Society score was 86 (±3.2). CONCLUSIONS Peroneal subluxation is an uncommon condition in pediatric and adolescent athletes. CFL transfer over the peroneal tendons should be considered as it provides excellent stability, a low rate of recurrent subluxation, and good functional outcomes without risk of injury to the distal fibular physis which can occur with distal fibular osteotomy or groove deepening procedures. LEVEL OF EVIDENCE IV (Case series).
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Tomihara T, Shimada N, Yoshida G, Kaneda K, Matsuura T, Satake S. Comparison of modified Das De procedure with Du Vries procedure for traumatic peroneal tendon dislocation. Arch Orthop Trauma Surg 2010; 130:1059-63. [PMID: 20556617 DOI: 10.1007/s00402-010-1136-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND For peroneal tendon dislocation, various surgical procedures have been described. Das De et al. reported good clinical results using retinaculum repair. However, their reports are limited to case series. We have simplified the Das De procedure since 1996. The purpose of this study is to investigate the clinical outcomes of our modified Das De procedure (MD) and compare these clinical outcomes to those of the Du Vries procedure (DV) that was performed in our hospital until 1996. PATIENTS From 1996 to 2007, 19 patients were treated by MD and from 1988 to 1996, 15 patients were treated by DV. RESULTS A mean preoperative Ankle-Hindfoot Scale was 78.4 points (range: 65-84) in the MD group and 77.2 points (range: 67-87) in the DV group. A mean postoperative Ankle-Hindfoot Scale was 93.4 points in the MD group and 89.4 points in the DV group. Two patients (13.3%) in the DV group suffered postoperative peroneal tendon redislocation. In the MD group, there was no postoperative peroneal tendon redislocation or complication related to skin incision. In athletes, 80.0% in the MD group and 54.5% in the DV group were able to return to their previous sports. The mean duration to return to sports was 2.9 months in the MD group and 3.9 months in the DV group (p < 0.05). CONCLUSIONS MD provided similar or slightly better clinical outcomes with less complication as compared to DV. For athletes, the rate of return to sports was higher and the duration to return to sports was significantly shorter in the MD group.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopedic Surgery, Shimada Hospital, Habikino, Japan.
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Gaulke R, Hildebrand F, Panzica M, Hüfner T, Krettek C. Modified rerouting procedure for failed peroneal tendon dislocation surgery. Clin Orthop Relat Res 2010; 468:1018-24. [PMID: 19548043 PMCID: PMC2835608 DOI: 10.1007/s11999-009-0918-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Accepted: 05/18/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Recurrent dislocation of the peroneal tendons following operative treatment is relatively uncommon, but can be difficult to treat. We asked whether subligamental transposition of the peroneus brevis tendon, fibular grooving, and reattachment of the superior peroneal retinaculum for failed peroneal tendon dislocation surgery would achieve a stable fixation of the peroneal tendons and whether there would be restrictions of ROM or instability of the hindfoot. We reviewed six female patients (mean age, 24.5 years) with general laxity of joints preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. Within 1 year postoperatively no recurrence was found. In two ankles the extension was restricted 5 degrees to 10 degrees . In another pronation and supination was restricted 5 degrees each. Stability of the ankle increased in four patients and stayed unchanged in two. AOFAS score increased from a mean value of 36 +/- 20.6 preoperatively to 90 +/- 7 postoperatively at 1 year. We conclude transposition of the peroneus brevis tendon is a reasonable treatment for failed peroneal tendon dislocation surgery. LEVEL OF EVIDENCE Level IV, therapeutic study (prospective case series). See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- R Gaulke
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
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35
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36
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Abstract
Peroneal tendon injuries are underdiagnosed and should be considered in every patient who presents with chronic lateral ankle pain. Ankle sprains are common, and up to 40% of affected individuals experience subsequent chronic ankle pain. Identifying the source of chronic ankle pain can be difficult because of the large number of possible causes. The peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilizers. A careful physical examination, along with a thorough patient history and imaging studies, are critical in arriving at an accurate diagnosis. Understanding the anatomy of the peroneal tendons and knowledge of current treatment approaches for peroneal tendon tears, subluxation and dislocation of the tendons, and peroneal tenosynovitis are of great importance in achieving a favorable outcome. Low-demand patients do well with a nonsurgical approach; high-demand patients may benefit from surgery.
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Silva HRD, Simão MN, Elias Júnior J, Muglia VF, Nogueira-Barbosa MH. Diagnóstico por imagem nas síndromes do estalido ou do ressalto. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000100011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A síndrome do estalido ou do ressalto ocorre durante a movimentação de várias articulações e pode ser acompanhada de dor local e de crepitação ou de estalido audível. Nem sempre o estalido audível ou a crepitação articular à palpação têm significado patológico ou implicam necessidade de tratamento. Esta síndrome tem causas variadas intra-articulares e extra-articulares e os achados clínicos podem ser pouco precisos, com dificuldade para definir o melhor método de imagem que confirme o diagnóstico. O objetivo deste trabalho é discutir as causas mais comuns da síndrome do estalido em cada articulação e enfatizar a indicação e a limitação de cada um dos diferentes métodos diagnósticos em situações específicas da prática clínica.
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Smith SE, Camasta CA, Cass AD. A simplified technique for repair of recurrent peroneal tendon subluxation. J Foot Ankle Surg 2009; 48:277-80. [PMID: 19232984 DOI: 10.1053/j.jfas.2008.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Indexed: 02/03/2023]
Abstract
Peroneal tendon subluxation or dislocation denotes intermittent or chronic anterior displacement of the peroneus longus and brevis tendons out of their fibro-osseous tunnel at the distal and posterior aspect of the fibula. Numerous surgical techniques have been described to address peroneal tendon subluxation, including isolated or combined soft tissue and osseous reconstructive procedures. The authors present an efficient and simplified approach for addressing this pathology using multiple, nonabsorbable retention sutures without the need for extensive dissection or osteotomy.
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Walther M, Morrison R, Mayer B. Retromalleolar groove impaction for the treatment of unstable peroneal tendons. Am J Sports Med 2009; 37:191-4. [PMID: 18927253 DOI: 10.1177/0363546508324310] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several techniques are published for the treatment of peroneal tendon instability. HYPOTHESIS The fibular retromalleolar groove impaction technique is a simple and reliable surgical procedure with low morbidity for the treatment of peroneal tendon instability. STUDY DESIGN Case series; Level of evidence, 4. METHODS Twenty-three consecutive patients (average age, 34.2 years; range, 16-57 years) with a symptomatic subluxation of the peroneal tendons but no other peroneal tendon injuries were included in the study. All patients were severely limited in sports participation by their symptoms. The mean preoperative American Orthopedic Foot and Ankle Society score was 68.5 (range, 47-78). The reconstruction of the peroneal retromalleolar groove was performed by removing the cancellous bone behind the groove with a 3.5-mm drill. Then the entire peroneal rim was mobilized with small osteotomes at its edges and impacted into the fibula. Using this technique, it was possible to deepen the peroneal retromalleolar groove and to preserve the smooth surface of the peroneal rim at the same time. After the procedure, the patients were kept in a boot cast for 6 weeks with partial weight-bearing of 20 kg. The ankle joint was then mobilized under the supervision of a physical therapist. Linear sports activities were allowed after 7 weeks and unlimited sports after 12 weeks. RESULTS No local wound problems were observed, and no further symptomatic subluxation or dislocation of the peroneal tendons was encountered during the 2-year follow-up. The mean American Orthopedic Foot and Ankle Society score improved to 96.3 (range, 85-100). CONCLUSION Groove impaction offers a simple, quickly done procedure with low morbidity, relatively quick return to sports, and successful elimination of peroneal tendon instability.
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Affiliation(s)
- Markus Walther
- Department for Foot and Ankle Surgery, Orthopaedic Hospital Munich-Harlaching, Munich, Germany.
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A 3-Portal Endoscopic Groove Deepening Technique for Recurrent Peroneal Tendon Dislocation. TECHNIQUES IN FOOT AND ANKLE SURGERY 2008. [DOI: 10.1097/btf.0b013e318183a22a] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Klein SE, Varner KE, Marymont JV. Lateral talar process fracture and peroneal tendon dislocation: a previously unrecognized injury complex. Foot Ankle Int 2008; 29:1020-4. [PMID: 18851819 DOI: 10.3113/fai.2008.1020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral talar process fractures and peroneal tendon dislocations are frequently unrecognized at the time of injury. Lateral process fractures were initially classified by Hawkins as three types. Type II injuries are comminuted fractures involving both the talofibular and talocalcaneal articular surfaces. The purpose of this retrospective chart review was to describe an injury complex of Type II lateral talar process fracture with peroneal tendon dislocation. MATERIALS AND METHODS Between January of 1995 and December 2006, 13 patients were seen for a lateral talar process fracture. Patients' charts were reviewed for fracture classification, mechanism of injury, radiographic studies, treatment, secondary procedures, length of followup and return to previous activity level. Concurrent peroneal tendon dislocations were identified in a subset of these patients. RESULTS Thirteen patients were identified with lateral talar process fractures all of which were classified as a Hawkins Type II. Six patients (46%) had a simultaneous peroneal tendon dislocation. All patients underwent operative excision of the comminuted lateral process. Patients with the injury complex were more likely to undergo additional operative procedures, and were more likely to develop subtalar arthritis. At final followup, 71% of patients with isolated lateral process fractures and 33% of injury complex patients had returned to their previous level of activity CONCLUSION An injury complex of Hawkins Type II lateral talar process fractures and peroneal tendon dislocation exists. Patients with comminuted lateral talar process fractures, especially those resulting from high-energy injuries, should be carefully evaluated for the possibility of concurrent peroneal tendon dislocation.
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Affiliation(s)
- Sandra E Klein
- Washington University School of Medicine, 14532 South Outer Forty Road, St. Louis, MO 63017, USA.
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Abstract
Ankle inversions are common in the general population and in athletes. Multiple concurrent injuries are a common result of an ankle-inversion injury. Syndesmosis injury, lateral ankle ligament tears, peroneal retinaculum or tendon injury, osteochondral lesion, or fracture may occur. Chronic pain or instability may result from one or more of these injuries. MR imaging provides superior soft tissue resolution, high sensitivity for occult fractures, and the ability to image the articular cartilage and ankle ligaments directly. This article discusses the MR imaging evaluation of acute and chronic ankle inversion injuries.
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Affiliation(s)
- Franz Kopp
- San Diego Orthopaedic Associates, 4060 4th Avenue, 7th Floor, San Diego, CA 92103-2181, USA.
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Abstract
BACKGROUND Dislocation or subluxation of the peroneal tendons out of the peroneal groove under a torn or avulsed superior peroneal retinaculum has been well described. We identified a new subgroup of patients with intrasheath subluxation of these tendons within the peroneal groove and with an otherwise intact retinaculum. METHODS The cases of fifty-seven patients with painful snapping of the peroneal tendons posterior to the fibula were reviewed. Of these, forty-three had tendons that could be reproducibly subluxated out of the groove with a dorsiflexion-eversion maneuver of the ankle. Fourteen patients who could not subluxate the tendons out of the groove underwent a dynamic ultrasound examination of the tendons. While the same dorsiflexion and eversion maneuver was being performed, the tendons were seen to switch their relative positions (the peroneus longus came to lie deep to the peroneus brevis tendon) with a reproducible painful click. All fourteen patients underwent a peroneal groove-deepening procedure with retinacular reefing. Intraoperatively, thirteen patients were found to have a convex peroneal groove and all fourteen had an intact peroneal retinaculum. All patients subsequently underwent a follow-up dynamic ultrasound examination and an American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score evaluation at a minimum of twenty-four months after surgery. RESULTS All fourteen patients were female, with an average age of thirty-five years. Two subtypes of intrasheath subluxation were found. Type A (ten patients) involved intact tendons with relative switching of their anatomic alignment. Type B (four patients) involved a longitudinal split within the peroneus brevis tendon through which the longus tendon subluxated. Intraoperative confirmation of the ultrasound findings was 100%. At an average follow-up interval of thirty-three months, the average AOFAS score had improved from 61 points preoperatively to 93 points, and the average score on the 10-cm visual analog pain scale had improved from 6.8 to 1.2. Follow-up ultrasound evaluation revealed healed tendons without persistent subluxation in thirteen patients. Nine patients rated the result as excellent, four rated it as good, and one rated it as fair. CONCLUSIONS Patients with retrofibular pain and clicking of the peroneal tendons may not have demonstrable subluxation on physical examination and may have an intact superior peroneal retinaculum. They may have an intrasheath subluxation of the peroneal tendons, which can be confirmed with use of a dynamic ultrasound. Surgical repair of tendon tears combined with a peroneal groove-deepening procedure with retinacular reefing is a reproducibly effective procedure for this condition.
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Affiliation(s)
- Steven M Raikin
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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45
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Abstract
Peroneal tendon dislocation is an infrequent sports injury and can be difficult to diagnose. Posterior fibula tenderness and pain with eversion are useful signs to discriminate this from an ankle sprain. In the acute setting, a direct repair provides good results but may need to be augmented with additional soft tissue or bony restraints. For chronic injuries there are several methods of reconstruction, all with acceptable outcomes, although bone block procedures have the highest rate of secondary procedures.
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Abstract
The focus of this article is the diagnosis and treatment of peroneal tendon tears. The article first describes mechanisms of injuries resulting in peroneal brevis and longus tears. Associated pathologies, such as ankle instability, hindfoot varus, hypertrophied peroneal tubercle, are discussed. Following sections on diagnosis and conservative treatment, the article describes operative treatment for isolated peroneus brevis tear, isolated peroneus longus tear, and tears of both the peroneus longus and brevis. The authors also discuss hamstring allograft reconstruction, the silicone rod technique, flexor digitorum longus transfer to the peroneus brevis, and treatment of associated pathology.
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Affiliation(s)
- Natalie Squires
- InMotion Clinic, 1615 Delaware Street, Longview, WA 98632, USA
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47
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Ogawa BK, Thordarson DB, Zalavras C. Peroneal tendon subluxation repair with an indirect fibular groove deepening technique. Foot Ankle Int 2007; 28:1194-7. [PMID: 18021591 DOI: 10.3113/fai.2007.1194] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneal tendon subluxation or dislocation is a relatively uncommon entity with multiple operative treatment methods described. This is a report of an indirect fibular groove deepening technique. METHODS Fifteen consecutive patients had repair of peroneal tendon subluxation or dislocation with an indirect fibular groove deepening technique. The mean duration of symptoms before surgery was 32 (range 1 to 80) weeks. Mean followup was 13 (range 3 to 26) months. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was calculated and compared for patients with and without Worker's Compensation claims and in patients with and without concomitant operative procedures. RESULTS The average postoperative AOFAS score was 87.1. Patients with Worker's Compensation claims had an average AOFAS score of 80.6 compared to 90.4 in patients without Worker's Compensation claims (p = 0.07). Patients who had an isolated repair of peroneal subluxation had a substantially higher AOFAS hindfoot score (95.3) than patients who had other procedures such as a peroneal tendon repair (81.6; p = 0.004). No patient had residual tendency for subluxation or dislocation postoperatively. CONCLUSIONS An indirect groove deepening technique is an effective way of treating peroneal tendon dislocation with good results. Patients with Worker's Compensation claims or other associated pathology have poorer outcomes.
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Affiliation(s)
- Brent K Ogawa
- Department of Orthopaedic Surgery, Keck School of Medicine, University of South California, 1200 N. State Street, General Hospital Room 3900, Los Angeles, California 90033, USA
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48
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Affiliation(s)
- Brent K Ogawa
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Blitz NM, Nemes KK. Bilateral peroneus longus tendon rupture through a bipartite os peroneum. J Foot Ankle Surg 2007; 46:270-7. [PMID: 17586440 DOI: 10.1053/j.jfas.2007.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Indexed: 02/03/2023]
Abstract
Peroneus longus rupture with associated involvement of the os peroneum is an uncommon injury, and a small number of cases have been reported. Several mechanisms of injury have been suggested, but the most accepted theory is due to an inversion force placed on a cavovarus foot type. The sesamoid often becomes the focal point of the mechanical stresses and may fracture. Although the purpose of the sesamoid is to protect the tendon from rupture, the os peroneum may actually encourage fatigue (tear/rupture) under certain circumstances. Because this injury occurs at the cuboid notch, primary repair is complicated because of the inability to access the tendon as it courses deep within the midfoot. We present a bilateral case of peroneus longus rupture with involvement of the os peroneum in a patient with a cavovarus foot type. The injuries were sustained from an identical mechanism and occurred almost 1 year apart. In both situations, a peroneus longus to peroneus brevis tendon transfer was performed above the ankle joint in conjunction with partial excision of the fractured os peroneum. To the authors' knowledge, this is the only reported case of peroneus longus rupture associated with fracture of the os peroneum to occur bilaterally.
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Affiliation(s)
- Neal M Blitz
- Department of Orthopedics and Foot & Ankle Surgery, Kaiser Permanente Medical Center, 3925 Old Redwood Hwy, Santa Rosa, CA 95403, USA.
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Miyamoto W, Takao M, Komatu F, Uchio Y. Reconstruction of the superior peroneal retinaculum using an autologous gracilis tendon graft for chronic dislocation of the peroneal tendons accompanied by lateral instability of the ankle: technical note. Knee Surg Sports Traumatol Arthrosc 2007; 15:461-4. [PMID: 17187275 DOI: 10.1007/s00167-006-0258-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 11/16/2006] [Indexed: 01/12/2023]
Abstract
This is a technical note on reconstructive surgery for the combination of chronic dislocation of the peroneal tendons and lateral instability of the ankle. The traditional surgery for this condition consists of direct repairs of the lateral ligaments of the ankle and the superior peroneal retinaculum, if possible. However, repair surgery is difficult in cases with insufficient structural remnants. We describe here a technique of simultaneous reconstruction of the anterior talofibular ligament and superior peroneal retinaculum with an autologous gracilis tendon graft for the combination of chronic dislocation of the peroneal tendons and lateral instability of the ankle.
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Affiliation(s)
- Wataru Miyamoto
- Department of Orthopedic Surgery, Shimane University School of Medicine, 89-1, Enya, Izumo, Shimane, 693-8501, Japan.
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