Groove Deepening Research Articles

The efficiency of total endoscopic surgery with preferential incision of the tendon sheath and traditional open surgery for the treatment of peroneal tendondislocation

Objective: To compare the outcomes between the patients of peroneal tendon dislocation treated by either total endoscopic surgery with preferential incision of the tendon sheath or traditional open surgery. Methods: This is a retrospective cohort study. The clinical data of 45 patients with peroneal tendon dislocation were operated on Department of Sports Medicine and Joint Surgery, Nanjing First Hospital from July 2016 to June 2020. There were 26 males and 19 females,aged (31.2±9.3) years (range: 17 to 45 years). Among them,23 patients underwent open peroneal tendon groove deepening followed by tendon sheath repair(traditional open group), and the other 22 patients underwent similar operations but all-endoscopically with preferential incision of peroneal tendon sheath(total endoscopic group). The perioperative data of patients were collected, and pain visual analogue score (VAS) was used to evaluate the pain changes before and after surgery and during the follow-up period, and the American Orthopaedic Foot and Ankle Society anklehindfoot scale (AOFAS-AH), range of motion (ROM), the MOS item short form health survey (SF)-36, and the homemade questionnaire of patient satisfaction were used to evaluate the patients' outcomes after the operation, and CT scan was carried out to observe the deepening of the fibular groove and MRI to observe the status of the peroneal tendon and sheath during the follow-up. Independent sample t test, Wilcoxon rank sum test and repeated measure ANOVA were used for comparison of quantitative data between groups. Chi-square test,Mann-whitney U or Fisher exact test was used for comparison of classified data, respectively;and paired sample t test was used for comparison of quantitative data before and after surgery in groups. Results: There was no statistically significant difference between the two groups of patients in terms of gender, age, disease duration, side of injury, and injury typing (all P>0.05). There was no significant difference between the two groups in terms of operation time((47.9±5.4)minutes vs. (47.2±6.3)minutes;t=0.402, P=0.690), but the incision length ((2.17±0.35)cm vs. 5.97±0.42)cm;t=32.892,P<0.01)and hospitalization time ((4.0±1.7)days vs. (7.6±3.6)days;t=4.249,P<0.01) were significantly shorter in the total endoscopic group than those in the traditional open group. All patients were followed up for more than 12 months, and the follow-up time was (19.2±3.9) months (range: 12 to 24 months). The total endoscopic group showed a significant increase in VAS, AOFAS scores, SF-36 scores and patient satisfaction rate at 3 months postoperatively and the last follow-up (all P<0.05). Three months after surgery, the ROM in the total endoscope group was higher than that in the traditional group ((62.14±1.46) ° vs. (53.13±1.52) °;t=20.315, P<0.01), and there was no significant difference between the two groups at the last follow-up ((63.18±1.10) ° vs. (63.48±2.43) °;t=0.531, P=0.599). Conclusion: Total endoscopic surgery with preferential incision of the tendon sheath has the advantages of minimally invasivenessas compared with traditional open surgery with faster recovery and better outcome.

Retromalleolar Groove Deepening in Recurrent Peroneal Tendon dislocation: Short- and Medium-Term Functional Outcomes

Recurrent peroneal tendon dislocation is a rare and often underrecognized condition. It may result from acute injuries, more commonly seen in athletes, or from untreated ankle sprains leading to chronic ankle instability. The aim of this study is to retrospectively evaluate short- and medium-term functional outcomes of the surgical technique involving deepening of the retromalleolar groove for the management of recurrent peroneal tendon dislocation. Nine patients, one of whom had bilateral dislocation, were enrolled in this study. The study group consisted of six males and three females, with a mean age of 31.2 years. CT scans were used to measure the depth of the neo-grooves, while the EFAS score (European Foot and Ankle Society Score) and AOFAS score (American Orthopedic Foot and Ankle Score) were used to assess functional results. The medium follow-up period was 4.8 years. CT scan data revealed a mean increase of 4.69 mm in the depth of the neo-retromalleolar groove. AOFAS scores improved from a mean preoperative value of 74.4 to 86.9 after surgery, and EFAS scores increased from a mean preoperative score of 19.7 to 31. Statistical analysis of clinical scores yielded significant results with a p-value &lt; 0.005. All patients returned to their previous sports activities within an average time of 7.7 months, reporting no pain or limitations. There were no recurrences observed. The retromalleolar groove deepening technique demonstrated excellent results in the treatment of recurrent peroneal tendon dislocation, evidenced by significant improvements in clinical scores, functional recovery, successful return to sports, and high patient satisfaction.

Snapping ankles: peroneal tendon subluxation and dislocation.

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.

Approach for Neglected Calcaneal Fracture-Dislocation and Associated Complications

Calcaneal fractures lead to significant debility that can be increased due to delayed or improper surgical repair and are commonly complicated by nonunion. This report explores a unique case of neglected calcaneal fracture with malalignment complicated by subluxing peroneal tendons, arthritis of the hindfoot, and tear of the peroneal retinaculum. The operative intervention consisted of open Achilles tendon lengthening, bone block distraction arthrodesis of the subtalar joint with talonavicular and calcaneocuboid fusion, along with repair of subluxing peroneal tendons with fibular groove deepening. Postoperative imaging at 25 weeks revealed intact hardware, stable alignment, and complete osseous arthrodesis of involved joints, which was also redemonstrated at 1-year postoperative. Reports of reconstructive options for neglected calcaneal fractures that restore mobility, such as this case, are important due to the significant patient burden these injuries impose and the paucity of viably restorative options currently available. Level of Evidence: Level-IV.

Return to Sport after Surgical Treatment for Dislocation of the Peroneal Tendon: A Systematic Review of the Current Literature

Purpose: This study aims to analyze the return to normal activities and sports after surgical management of peroneal tendon dislocation through different surgical techniques. Methods: This review included studies (retrospective case series, prospective cohort study) that analyzed different aspects: return to sport (RTS), American Orthopedic Foot and Ankle Society Score (AOFAS), Visual Analogue Scale (VAS), satisfaction, and redislocation episodes after surgical treatment. We performed a systematic review, analyzing 1699 articles. We researched our selected studies through PubMed, Scopus, and Cochrane. The last search was performed in December 2022. We used the MINORS score to perform a quality assessment of pooled data. In total, 20 studies were included. Results: The postoperative AOFAS score, VAS scale, and high satisfaction percentages all improve with surgical therapy. At long-term follow-up, the redislocation following surgical treatment is minimal. Compared to patients who only receive superior peroneal retinaculum (SPR) repair and other surgical procedures, patients with groove deepening and SPR repair have greater rates of returning to sports (bony and rerouting procedures). Conclusions: Peroneal tendon dislocation surgery offers good outcomes, a quick return to sport, and high patient satisfaction. Those who received both groove deepening and SPR repair as opposed to other surgical procedures have greater rates of returning to sports.

Mechanism of ultrahigh ductility obtained by globularization of αGB for additive manufacturing Ti–6Al–4V

In the present work, two post-processes, the 800 °C and 950 °C for 4 h annealing below β transus, were designed to improve the performance of selective laser melted (SLM) Ti–6Al–4V (Ti64) alloy. The results show that 800 °C annealing raises the ductility to 18%, while 950 °C annealing raises the ductility high up to 26%. Although the residual stress relief and martensite decomposition fully accomplished in both annealed samples, there is still a noticeable difference in ductility. The difference is due to that 950 °C annealing induce noticeable globularization which further alters the fracture mode. Further study indicates that with globularization of αGB phase (α phase along prior β grain boundary), the transgranular fracture replaces the detrimental intergranular fracture. Particularly, the high angle grain boundary (HAGB) between equiaxed αGB phase effectively inhibits the initiation and propagation of crack, when comparing to the low angle grain boundary (LAGB) in α lamella. The reason for globularization in 950 °C annealing could be concluded as the boundary splitting model. The β phase grow along the LAGB in α lamella and form thermal grooving. With the groove deepening, the lamella was separated into equiaxed α phase. In this process, high temperature annealing promotes sufficient bulk diffusion, which is a necessary condition for globularization of lamellar α phase in SLM Ti64 alloy.

Return to Play and Clinical Outcomes in the Surgical Treatment of Peroneal Tendon Dislocation and Subluxation

Category:Ankle; SportsIntroduction/Purpose:To provide an overview of the available evidence on peroneal tendon dislocation and subluxation as well as the outcomes after surgical intervention.Methods:A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Criteria for inclusion were clinical studies reporting outcomes after surgical treatment for peroneal tendon dislocation and subluxation within the last 10 yearsResults:Fourteen articles evaluating a total of 321 patients were included in this review consisting of 240 males and 81 females. The weighted mean age of patients was 28.7 years (range 18-47). The weighted mean follow-up was 38.1 months (range 18 - 58). The weighted mean time to surgery was 5.32 months (range 3 - 9.5). Surgical treatments were categorized into 4 groups which comprised 13 of the 14 studies. Eleven studies recorded the AOFAS score with a weighted mean preoperative score of 65.97 and a weighted mean postoperative score of 92.9. Overall, 90% (145/162) of patients reported their satisfaction as either 'excellent' or 'good'. Time to return to play (RTP) was faster for patients who underwent SPR repair alone compared to SPR repair with groove deepening (p=0.001)Conclusion:The current systematic review showed that overall clinical outcomes were positive in lieu of the different modalities of surgical intervention for peroneal tendon dislocation and subluxation. However, patients who received SPR repair with groove- deepening returned to sport faster than patients who received SPR repair alone.

Modified Recession Wedge Trochleoplasty

Background: Trochlear dysplasia represents one of the main anatomic risk factors for patellar instability, with risk of failure and unfavorable clinical outcomes in patients with unaddressed dysplasia undergoing patellar stabilization. Indications: Patients with trochlear dysplasia characterized by supratrochlear prominence (DeJour B or D) and recurrent patellar instability, especially following failed soft tissue or bony stabilization. This technique addresses an anterior trochlea without pathologic convexity, as convexity may require conversion to other techniques for groove deepening (eg, DeJour “thick flap” or Schottle “thin flap”). Technique Description: A 6-cm lateral parapatellar arthrotomy is created. A marking pen is used to identify the native center of the trochlea, as well as the location of the planned resection and bony hinge point laterally. An osteotome is used to remove a wedge of bone proximally, such that the posterior aspect of the osteotomy is in line with the anterior femoral cortex. A resection guide is then used to perforate the lateral cortex, with care to avoid damaging the cartilage, and carried laterally and distally to ensure the bony cuts are connected, creating the bony flap. To ensure that all bony bridges are eliminated, the arthroscope is placed into the osteotomy to visualize reduction of the trochlea with manual pressure. A knotless PEEK anchor loaded with 8 loaded sutures is then placed on the roof of the trochlear notch. Sutures are then secured using anchors placed at the center of the trochlea, at the superolateral corner and far lateral edge of the trochlea to reduce the osteotomy, with 2 to 3 sutures placed in each anchor depending on surgeon preference. Results: Trochleoplasty has been reported to decrease the rate of recurrent patellar dislocation while improving mean Kujala score and knee function. Benefits of trochleoplasty must be balanced against the high rate of potential complications, primarily pain and decreased knee range of motion, secondary to the technical challenges and steep learning curve inherent to effectively performing the procedure. Discussion/Conclusion: Patients with recurrent patellar instability with trochlear dysplasia and failed prior stabilization may experience improved stability and outcomes following trochleoplasty.

Treatment of Recurrent Peroneal Tendon Dislocation by Peroneal Retinaculum Reattachment Without Fibular Groove Deepening

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.

Treatment of Recurrent Peroneal Tendon Dislocation by Peroneal Retinaculum Reattachment without Fibular Groove Deepening

Category:Ankle; Sports; TraumaIntroduction/Purpose: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.Methods:Thirty six patients with recurrent peroneal tendon dislocation, who underwent retinaculum repair without a fibular groove deepening procedure performed by two 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. AOFAS, VAS, 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.Results: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.Conclusion: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.

Tendoscopic Groove Deepening for Subluxation or Stenosis of the Peroneal Tendons

Category:Ankle, Arthroscopy, SportsIntroduction/Purpose:Peroneal tendon disorders frequently result in refractory posterolateral ankle and hindfoot pain which disables patients from daily activity and sports. Diagnosis can be challenging in certain cases of peroneal tendon pathology, such as subluxation and stenosis. Additionally, traditional open surgery is associated with complications including surgical scarring and injury to the sural nerve. Therefore peroneal tendoscopy has gained popularity as an effective diagnostic and treatment procedure. Recently tendoscopic groove deepening technique has been reported for the treatment of chronic subluxation or stenosing tenosynovitis of peroneal tendons. In this case series, we present the effectiveness of tendoscopic groove deepening procedure for subluxation or stenosis of the peroneal tendons.Methods:A retrospective cohort study investigating patients treated with tendoscopic groove deepening the fibular groove and concentrated bone marrow (CBMA) injection for the treatment of peroneal subluxation or stenosing peroneal tenosynovitis.Retrospective chart review was performed, and clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12) preoperatively and at final follow-up.Results:Twenty patients diagnosed with subluxation and/or stenosis were included. The mean age was 35.1±9.2 years and the mean follow-up time was 32.5±12.4 months. Mean symptoms, pain, daily activities, sports activities and quality of life scores in FAOS significantly improved from 56.8, 74.1, 72.3, 36.2 and 22.7 preoperatively to 86.5, 83.2, 92.3, 70.2 and 63.8 postoperatively, respectively at final follow-up (p<0.001). The mean SF-12 significantly improved from 48.7 to 75.8 postoperatively (p<0.001). No superior peroneal retinaculaum repair was perfumed in all subluxation cases. No complications were reported.Conclusion:The current study demonstrates that endoscopic groove deepening of the fibular groove was a reproducible and minimally invasive technique that provided a good clinical outcome for subluxation of the peroneal tendons and stenosing peroneal tenosynovitis.

Peroneal tendon subluxation: A case report

Background: Dislocation of the peroneal tendons is uncommon and is frequently misdiagnosed as an ankle sprain usually in young and active patients. The most common mechanism is a dorsiflexory force on the ankle associated with a rapid and strong contraction of the peroneal tendons and with eversion of the hindfoot, rapid contraction can also lead to injury to the superior peroneal retinaculum.Case Report: We reported a case of traumatic dislocation of the peroneal tendons. The patient was a 32-year-old who complained of right ankle pain and a feeling of dislocation after suffered an accident while playing football.Discussion: There have been many options reported for surgical repair of peroneal subluxation or dislocation. These include direct repair of peroneal retinaculum, reconstruction of peroneal retinaculum, bone block (lateral malleolus, sliding graft), and groove deepening and rerouting procedures.Reconstruction of the peroneal tendon can be accomplished using the peroneus brevis, plantaris, and/or Achilles tendons. Complications associated with these techniques include graft fracture, tendonitis, pain, and re-subluxation.Conclusions: Acute peroneal tendon dislocation is a challenging entity because it may mimic and frequently be misdiagnosed as an ankle sprain. Conservative treatment may be considered for acute dislocation but may be associated with high failure rate. There have been many options reported for surgical repair of peroneal subluxation or dislocation include direct repair of peroneal retinaculum, reconstruction of peroneal retinaculum, bone block (lateral malleolus, sliding graft), and groove deepening and rerouting procedures. Keywords: Peroneal Tendon, Subluxation, Dislocation, Ankle Injury.

Treatment of Chronic Subluxation of the Peroneal Tendons Using a Modified Posteromedial Peroneal Tendon Groove Deepening Technique

The present study investigated the clinical efficacy of a modified approach for the treatment of chronic subluxation of the peroneal tendons using posteromedial peroneal tendon groove deepening. We retrospectively analyzed the data from 21 patients who had undergone posteromedial peroneal tendon groove deepening combined with repair of the tendon sheath for the treatment of chronic subluxation of the peroneal tendons from March 2006 to October 2012. The lateral edge of the peroneal tendon groove was left untouched. A posterior osteocartilaginous flap was detached from the posterior fibula from medially to laterally. The retromalleolar groove was deepened through impaction of the posterior fibula. A visual analog scale and the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale were used. All patients achieved healing after the first surgery. No postoperative complications developed. Sixteen patients were followed up for 24 to 69 months. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score improved from 55.0 to 93.6 points after surgery. The mean visual analog scale score decreased from 5.3 to 1.2 points. Five patients had moderate hindfoot rigidity and achieved improvements after rehabilitation training. None of the patients had specific requirements for shoes and ground flatness. All patients had a normal gait. No case of recurrent subluxation developed. These results indicate that posteromedial peroneal tendon groove deepening combined with repair of the tendon sheath can achieve satisfactory efficacy.

A Biomechanical Comparison of Extensor Carpi Ulnaris Subsheath Reconstruction Techniques

Several surgical stabilization techniques have been described to address pathological subluxation of the extensor carpi ulnaris (ECU) tendon, with no comparative data available. This study compares ECU stability after subsheath reconstruction, with and without ulnar groove deepening, to stability with an intact subsheath in a cadaveric model. Position of the ECU tendon relative to the ulnar groove was measured in 5 human cadaveric specimens with the subsheath intact, sectioned, and after 3 reconstruction scenarios: reconstructed, reconstructed with ulnar groove deepened, and ulnar groove deepened with subsheath sectioned. Position of the tendon relative to the radial side of the ulnar groove was recorded with digital calipers in 9 combinations of wrist/forearm positions (wrist flexion, extension, and neutral; forearm pronation, supination, and neutral). Dislocation events, defined as the tendon being completely ulnar to the groove, were recorded. Extensor carpi ulnaris tendon displacement was not significantly different between intact subsheath, subsheath reconstruction, and reconstruction with groove deepening (1.5 mm vs 0.5 mm vs -0.3). Extensor carpi ulnaris tendon displacement after groove deepening with the subsheath sectioned was not significantly different from displacement with a fully sectioned subsheath. Sectioning of the subsheath induced dislocation events of the ECU tendon in multiple positions. Subsheath reconstruction with and without groove deepening allowed no dislocation events. In this cadaveric model, groove deepening did not improve stability of the ECU tendon compared with the reconstructed subsheath, and reconstruction alone was equally effective at eliminating dislocation events. Stabilization techniques that focus on restoration of the important ulnar attachment of the ECU subsheath are favored over routine deepening of the ulnar groove in attempts to stabilize the ECU tendon.

Return to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic review.

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.MethodsA 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.ResultsSurgical 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).ConclusionsSurgical 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 evidenceLevel IV, systematic review of level IV studies.

Morphology of the Extensor Carpi Ulnaris Groove and Tendon

Injury to the extensor carpi ulnaris (ECU) fascial supports on the distal ulna can result in ulnar-sided wrist pain, particularly when the tendon subluxates medially out of the fibroosseous groove with forearm rotation. To better understand the potential risk factors for injury and the indications for modifying the ECU groove, we have evaluated and quantified the morphology of the ECU groove and tendon. Axial plane magnetic resonance imaging of the wrist obtained for triangular fibrocartilage complex and intercarpal pathology in 60 patients were reviewed. Mean and standard error of the mean were calculated and unpaired Student t tests performed to compare groove width and depth, radius of curvature of the groove, carrying angle, and tendon-to-groove ratio. There were 23 females (38%), and the mean patient age was 40 years (range, 17-71 y). The average ECU groove depth and standard error of the mean was 1.4 mm ± 0.1 mm. The radius of curvature for the ulnar ECU groove was found to be 7.0 mm ± 0.4 mm with a carrying angle of 143° ± 2°. In neutral forearm rotation, the average ratio of the width of the ECU tendon to groove was 0.7 ± 0.02. The data approximated a normal distribution. There were no statistically significant differences in these measurements between the triangular fibrocartilage complex and the intercarpal pathology subgroups. Variability in the relationship of the ECU groove and tendon may combine to represent risk factors for tendinosis or tendon subluxation. There may be a more normal distribution of ECU groove morphology than previously recognized. ECU injuries may require clinical imaging of the tendon and subsheath, in addition to potential surgical reconstruction and ulnar groove deepening. This report establishes the normative morphology and depth of the ECU groove and provides a comparative baseline when considering treatment modalities.

Comparison of Outcome After Retinaculum Repair With and Without Fibular Groove Deepening for Recurrent Dislocation of the Peroneal Tendons

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. 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. 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). 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 II, prospective, nonrandomized, comparative study.

Investigation on deformation behavior of sheet metals in viscous pressure bulging based on ESPI

In order to analyze the effect of viscous medium on the deformation behavior of sheet metals in viscous pressure bulging (VPB), the entire deformation process including instability and fracture was investigated real-timely by the aid of electronic speckle pattern interferometry (ESPI). Images of speckle patterns were captured continuously to obtain fringe patterns representing the full field strain rate. Values of strain rates were calculated based on the fringe patterns. The evolution of the weak region from the initial defect to the groove until crack was also observed through the fringe patterns. The onset of diffuse and localized necking were determined qualitatively and quantitatively. Experimental results show that the deformation of sheet metals in VPB passed through five states, namely, uniform deformation, strain localization, diffuse necking, localized necking and fracture. A defect emerged in strain localization. The growth of the defect caused the diffuse necking and generated a groove. The groove expanded mainly in length direction until the localized necking occurred. Finally the specimen fractured as a result of groove deepening. The tangential adhesive stress provided by viscous medium in VPB restricted the locally larger strain of the specimen. The diffuse necking was postponed greatly. Theoretical prediction of the limit strains of sheet metals in VPB would be made based on the experimental results in further work.

Recurrent dislocation of the peroneal tendons.

Peroneal tendon dislocations occur in sports, particularly in skiing and soccer. This paper presents the outcome of 15 patients with post-traumatic recurrent peroneal tendon dislocations, operated on with a soft-tissue reconstruction of the superior peroneal retinaculum, i.e. reattachment and reinforcement, in combination with a retrofibular groove deepening. Mean follow-up was 3.5 (2-7) years after surgery. There were no redislocations and no neurovascular injuries. The functional results were satisfactory in 13/15 (87%) patients, with full range of ankle motion and no pain. The two patients with unsatisfactory functional results had restricted ankle motion and pain on exertion. This simple reconstruction seems to be a good alternative to other more complex procedures and can be recommended in patients with recurrent peroneal tendon dislocations. Conservative treatment is not an option in patients with recurrent peroneal tendon dislocations, due to persistent symptoms of instability and pain.

Sliding fibular graft repair for chronic dislocation of the peroneal tendons.

Chronic recurrent subluxation of the peroneal tendons can be a disabling condition in the young athlete. Conservative techniques of management, including taping, pads, or special shoes, are usually ineffective. Many authors have reported favorable results with surgical reconstruction. These repairs fall into four categories: periosteal reattachment, groove deepening, tenoplasty procedures, and bone block procedures. We are reporting the results of treatment of 12 patients with a sliding fibular graft procedure that has not previously been reported in the literature. Results were excellent in 11 of the 12 procedures. One patient with bilateral repairs reported recurrence of symptoms on one side and required reexploration.