Peroneal Tendoscopy

Abstract

Objectives:Peroneal tendon pathology should be within the differential diagnoses of patients who are admitted to the hospital with posterolateral ankle pain. Peroneal tendoscopy is a minimally invasive choice for the diagnosis and the treatment of peroneal tendon pathologies. Aim of this study is to discuss the role of tendoscopy within the diagnosis and the treatment of peroneal tendon pathologies.Methods:From 2006 to 2012, 18 patients with retrofibular pain are included in this study. This study had been planned prospectively. For the patients who had been pre-diagnosed as ‘’ peroneal tendinopathy’’ with physical examination, X-ray and MRI findings, ‘’peroneal tendoscopy’’had been performed diagnostically. After diagnostic peroneal tendoscopy, patients were definitively treated either with tendoscopy or with open surgery.Results:We have included 18 patients with retrofibular pain, 13 were female and 5 were male. The mean age was 46.8 (29-71). Preoperatively taken MRI scans showed talar osteochondral lesions (TOL) in 8 patients, peroneal tenosynovitis in 8 patients (3 of them were with TOL), suspected peroneal tendon rupture in 3 patients (2 of them were with TOL, accessory peroneal tendon in 1 patient). MRI scans of 5 patients were normal regarding peroneal pathology, these patients were operated according to physical examinations and the findings. 13 of 18 patients had accompanying anterior and posterior ankle pathologies. The most common pathology which had been detected in 8 patients with retrofibular pain was talar ostechondral lesion (TOL). The other 5 patients had no concomitant pathology. During peroneal tendoscopy, accessory peroneal tendon in 6 patients and distal insertion of peroneus brevis tendon in 3 patients had been detected and excised minimally invasively. In 4 patients, peroneal tendon rupture had been detected and excision/repair/tenodesis had been performed, in 3 patients tenosynovectomy had been performed for peroneal tenosynovitis, duplication had been performed in 1 patient, tubulisation had been performed in 1 patient and vincula excision had been performed in 1 patient.Conclusion:Peroneal tendoscopy is a useful procedure to diagnose and to treat the pathology of peroneal tendons. According to our theory, patients could have a sensation of fullness within their ankle joints with the presence of accessory muscle and distal insertion of peroneus brevis tendon within the superior peroneal retinaculum and may put their ankle in slight inversion position. This positional change within the ankle may disturb the ankle biomechanics and may be one of the causes of osteochondral lesions of the talus.