Retromalleolar Groove Research Articles

Recurrent peroneal tendon dislocation-the current concept of management.

The peroneus muscles, consisting of the peroneus longus (PL) and peroneus brevis (PB) tendons, are vulnerable to injury at anatomically specific sites or within tendon sheaths. Peroneal tendon dislocation (PTD) is often misdiagnosed as a lateral ankle sprain as it occurs at a lower frequency than a lateral ankle sprain. Anatomical variations in the retromalleolar groove, soft tissue overstuffing, and presence of accessory peroneal muscles contribute to the etiology of PTD. PTD has been classified into four types based on injury patterns involving the superior peroneal retinaculum (SPR) and fibrocartilaginous ridge. Diagnosis involves recognizing tender points and using imaging including magnetic resonance imaging (MRI) and ultrasonography. Conservative treatments, including below-knee plaster casts, have varying success rates, and some patients progress to recurrent PTD (RPTD), prompting consideration of surgical interventions. Diagnosis is easy in patients with RPTD who can reproduce the dislocation by themselves; however, in many cases, this is not possible. In such cases, ultrasonography after intrasheath injection is effective in confirming the presence of a pseudo-pouch. RPTD can be diagnosed if a pseudo-pouch is identified during ultrasonography. Surgical approaches such as osteotomy, soft tissue procedures, and groove deepening techniques are used to stabilize the peroneal tendons. Soft tissue procedures, especially SPR reattachment, have emerged as a preferred option, demonstrating outcomes comparable to those of osteotomy, with fewer complications. Intrasheath subluxation, a unique PTD subtype, is diagnosed using ultrasonography. In this type of subluxation, no damage to the SPR is observed, and the positions of the PL and PB tendons are interchanged. Surgical intervention may involve excision of the synovium and SPR repair. In cases of PTD complicated by a longitudinal rupture of the PB tendon, suturing of the torn area or tubularization of the remaining tendon for partial resection of the degenerated tendon can be performed. The purpose of this article is to describe the methods for diagnoses and management of PTD.

Retromalleolar groove morphology of the tibialis posterior tendon (TPT) in patients without TPT pathology evaluated by axial computed tomography scans

BackgroundThis study aimed to evaluate the shape of the retromalleolar groove of the tibialis posterior tendon (TPT) using computed tomography (CT). MethodsCT images of patients with foot or ankle pathologies were retrospectively reviewed. The morphology of the retromalleolar groove of the TPT was assessed at two different levels: the ankle joint and 10 mm above the ankle joint. The groove shape was classified into three types; concave, flat, or irregular. In cases with concave grooves, the width and depth of the grooves were measured. ResultsOf the 116 ankles from 116 subjects included in this study, 80.2 % showed a shallow concave shape (mean depth, 1.6 mm) at the two scan levels. The shape and width of the groove differed significantly by gender, although there was no significant difference in the groove depth. ConclusionApproximately 80% showed a shallow concave groove of the TPT. The groove characteristics differed by gender, although there was no significant difference in the groove depth. Level of evidenceCross-sectional cohort study; Level of evidence, Ⅳ

Differences in Retromalleolar Fibular Groove Morphology According to Level of Axial Computed Tomography Scans.

Studies have evaluated types of retromalleolar groove using axial magnetic resonance imaging at the level of 10 mm above the tip of the lateral malleolus. However, no evidence is available to support that this level is appropriate for evaluating retromalleolar groove morphology. To assess the influence of the level of axial computed tomography (CT) scans on the assessment of retromalleolar groove morphology. Cross-sectional study; Level of evidence, 3. The study population included 122 patients (mean age, 27.9 ± 11.8 years; 69 males, 53 female) who underwent CT scans to evaluate foot or ankle pathologies between 2020 and 2023. The shape of the retromalleolar groove (concave, flat, convex, or irregular) at 3 levels of axial CT scans (8, 10, and 12 mm above the tip of the lateral malleolus) was assessed independently by 2 orthopaedic surgeons. The length from the tip of the lateral malleolus to the proximal tip of the fossa of the lateral malleolus was also measured on coronal CT scans. The type of retromalleolar groove was significantly different according to the level of CT scans (8 vs 10 mm, P = .0001; 10 vs 12 mm, P = .0001; 8 vs 12 mm, P = .001). The type of retromalleolar groove was the same at all 3 levels in 31.1% of patients (38/122). The length from the tip of the lateral malleolus to the proximal tip of the fossa of the lateral malleolus was <10 mm in 17.2% of patients (21/122). The shape of the retromalleolar fibular groove was affected by the level at which the CT scan was obtained. Approximately 70% of the patients showed different types of retromalleolar grooves among the 3 CT scan levels.

Peroneal tendon injuries

The peroneal tendons work to both evert the foot and stabilize the hindfoot on plantarflexion and push off. The tendons are frequently injured as part of sprains and soft tissue injuries to the ankle joint, but diagnosis and treatment are often delayed. Athletes participating in activities with repetitive ankle motion, particularly those involving cutting and twisting movements, as well as those with certain anatomical features, are prone to peroneal tendon injury. Often synovitis and low-grade tendinopathy of the peroneal tendons can be managed with physiotherapy and bracing. Large longitudinal tears, rupture, and subluxation or dislocation of the tendons from the retromalleolar groove are more likely to be treated operatively, although pre-surgical rehabilitation will still be useful in chronic cases. Other surgical procedures can be combined as part of an effective treatment plan such as ankle arthroscopy, ligament stabilization and realignment procedures such as a lateralizing calcaneal osteotomy and Barouk–Rippstein–Toullec first metatarsal elevation osteotomy for non-neurogenic cavus. Persistent weakness in the peroneal tendons post injury may contribute to worsening hindfoot varus deformity: in turn, this leads to further stress on peroneus brevis which can lead to its rupture and consequently further deformity if untreated.

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.

Anatomical Features of Patients with Recurrent Dislocation of the Peroneal Tendons

Category: Hindfoot; Sports Introduction/Purpose: The occurrence of peroneal tendon dislocation (PTD) may be influenced by anatomical variations in the peroneal muscles and ankle lateral malleolus. One such factor is peroneal groove crowding, which can result from increased muscle and tendons bulk within the peroneal tendon sheath. Another potential factor is the shape of the retromalleolar groove, which determines the inherent stability of the tendons in the groove. This study aims to examine the anatomical variations of the retromalleolar groove and peroneal muscles in patients with and without recurrent PTD (RPTD) using magnetic resonance imaging (MRI) and computed tomography (CT). Methods: This study included 30 patients (30 ankles) with recurrent PTD who underwent both MRI and CT before surgery (PD group) and 30 age- and sex-matched patients (control (CN) group) who underwent MRI and CT. The imaging was reviewed at the level of the tibial plafond (TP level) and the center slice between the TP and the fibula tip (CS level). CT images were used to assess the appearance of a malleolar groove (convex, concave, or flat) and the posterior tilting angle of the fibula. MRI images were used to assess the appearance of accessory peroneal muscles, height of the peroneus brevis muscle belly, and volume of the peroneal muscle and tendons. Low-lying muscle belly (LLMB) of the PB was defined as when the musculotendinous junction extended beyond the tip. The Mann-Whitney U test was used to compare continuous variables, and Fisher’s exact test was used to compare nominal variables. Results: There were no differences in the appearance of the malleolar groove, posterior tilting angle of the fibula, or accessory peroneal muscles at the TP and CS levels between the PD and CN groups. However, the peroneal muscle ratio was significantly higher in the PD group than in the CN group at both levels (both p&lt; 0.001). The peroneal tendons ratio was not significantly different between the groups at both levels. The height of the peroneus brevis muscle belly was significantly lower in the PD group than in the CN group (p=0.001). LLMB of the PB was identified in 19 patients (63.3%) in the PD group and in eight patients (26.7%) in the CN group (p=0.009). Conclusion: The findings of this study suggest that LLMB of the PB and the peroneal muscle ratio are significantly related to RPTD, whereas retromalleolar bony morphology is not. Therefore, maintaining proper volume in the peroneal tunnel is more important than the groove shape. Reduction of the muscle belly of the peroneus brevis during RPTD surgery may help prevent peroneal tendon dislocation.

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.

Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures.

We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning. In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated. In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (P = .03), dislocated peroneal tendons (P < .001), calcaneal fracture-dislocation (P < .001), SPR avulsion fracture (P < .001), and Sanders type IV of calcaneal fracture (P = .02). There was no statistically significant relationship between PTI and the mechanism of injury (P = .98), side of fracture (P = .30), uni- or bilateral calcaneal fractures (P = .27), a fracture at the tip of lateral malleolus (P = .69), shape of the retromalleolar groove (P = .78), or excessive displacement of the lateral calcaneal wall (P = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%). Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures. Level III, retrospective case control study.

Tibial Retro-Malleolar Groove Morphology in Patients With Posterior Tibialis Tendon Dysfunction

The posterior tibial tendon is a gliding tendon which courses around the medial malleolus and fails in posterior tibialis tendon dysfunction (PTTD) leading to a flat foot deformity. Distal tibial bone spurs have been identified as a secondary sign of PTTD although they have not been quantified in detail. The aim of this study was to assess the association of tendon dysfunction with the bony morphology of the tibial retro-malleolar groove. We performed a retrospective review of the clinical presentation, plain radiographs, and 103 magnetic resonance imaging (MRI) scans in 82 consecutive patients with PTTD compared with a non-PTTD group. We carried out a quantitative and qualitative assessment of the presence of plain radiographic bone spurs, stage of PTTD and MRI imaging of the morphology of the tibial bony malleolar groove. Plain radiographic bone spurs, as a secondary sign of PTTD, were present in 21.3% of ankle radiographs. MRI bone spurs were identified in 26/41 (63.4%) for all high-grade partial and complete tears and 7/41 (17.1%) for isolated complete tears compared with only 3.9% of the non-PTTD group. There was a significant association between the presence of bone spurs on MRI imaging and high-grade partial and complete tibialis posterior tears (p < .001; odds ratio of 4.98). Eleven of 103 (10.7%) of spurs were large and in 4/103 (3.9%) were substantial enough to create a tunnel-like hypertrophic groove not previously reported. There is variation in the bony structure of the malleolar groove in PTTD not observed in the non-PTTD group. Further investigation over time may elucidate whether the groove morphology may lead to mechanical attrition of the tibialis posterior tendon and contribute to failure of healing and progressive tendon degeneration.

Anatomic Features of Patients With Recurrent Peroneal Tendon Dislocation

Background: There are several anatomic variations of the peroneal muscles and lateral malleolus of the ankle that may play an important role in the onset of peroneal tendon dislocation. Purpose: To investigate the anatomic variations of the retromalleolar groove and peroneal muscles in patients with and without recurrent peroneal tendon dislocation using magnetic resonance imaging (MRI) and computed tomography (CT). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 30 patients (30 ankles) with recurrent peroneal tendon dislocation who underwent both MRI and CT before surgery (PD group) and 30 age- and sex-matched patients (control [CN] group) who underwent MRI and CT were included in this study. The imaging was reviewed at the level of the tibial plafond (TP level) and at the center slice between the TP and the fibular tip (CS level). The appearance of a malleolar groove (convex, concave, or flat) and the posterior tilting angle of the fibula were assessed on CT images. The appearance of accessory peroneal muscles, height of the peroneus brevis muscle belly, and volume of the peroneal muscle and tendons were assessed on MRI scans. Results: There were no differences in the appearance of the malleolar groove, posterior tilting angle of the fibula, or accessory peroneal muscles at the TP and CS levels between the PD and CN groups. The peroneal muscle ratio was significantly higher in the PD group than in the CN group at the TP and CS levels (both P < .001). The height of the peroneus brevis muscle belly was significantly lower in the PD group than in the CN group (P = .001). Conclusion: A low-lying muscle belly of the peroneus brevis and a larger muscle volume in the retromalleolar space were significantly associated with peroneal tendon dislocation. Retromalleolar bony morphology was not associated with peroneal tendon dislocation.

Translated article] Relationship between low lying peroneus brevis muscle belly and peroneal tendons dislocation

IntroductionPeroneal tendon pathologies are an important cause of pain in the lateral aspect of the ankle. It has been proposed in the literature that low lying peroneus brevis muscle belly occupies more space in the retromalleolar groove and could cause laxity of the superior retinaculum which would promote tendon dislocation, tenosynovitis or ruptures. The objective of the study is to characterise the population with low lying peroneus brevis muscle belly and determine the association between the low lying peroneus brevis muscle belly found on magnetic resonance imaging and clinical peroneal tendon dislocation. MethodsA case–control study was developed with a sample of 103 patients. The cases were patients with low lying peroneus brevis muscle belly and peroneal dislocation and the controls were patients with normal implantation of the peroneus brevis muscle and peroneal tendon dislocation. ResultsThe prevalence of clinical peroneal dislocation in patients with low implantation of the peroneal brevis muscle belly was 7.64%, and the prevalence of clinical peroneal dislocation in patients with normal implantation of the peroneus brevis muscle belly was 8.88%. The OR was 0.85 (CI 0.09–7.44, p=0.88). DiscussionOur findings indicate that there is no statistically significant relationship between low lying peroneus brevis muscle belly and clinical dislocation of the peroneal tendons.

Posterior tibial tendon dislocation after a medial ankle sprain: a case report

Medial ankle sprains have a very low incidence (5% of ankle ligament injuries), and most of the time, the first structure involved is the deltoid ligament complex. However, other structures, such as the spring ligament, posterior tibial tendon, and flexor retinaculum, can also get damaged. A 32-year-old man who had an ankle sprain while performing sports activities showed magnetic resonance imaging findings compatible with a detachment of the flexor retinaculum and medial dislocation of the posterior tibial tendon. Surgical intervention was suggested to this patient; deepening of the medial retromalleolar groove and reattaching of the retinaculum were performed. It is very important to consider this rare injury after a medial ankle sprain and to think out of the box, not always assuming a deltoid ligament lesion. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Clinical Outcomes Following Suturing of Sheath of Peroneal Tendons to the Calcaneal Plate as an Innovative Technique for Reduction of Peroneal Tendon Instability Accompanying Calcaneal Fracture.

The aim of the study was to evaluate the clinical and functional outcomes following suturing of sheath of peroneal tendons to the calcaneal plate as an innovative technique for reduction of peroneal tendon instability (PTI) accompanying calcaneal fracture surgically treated via extensile lateral approach (ELA). In a retrospective comparative study, among 245 operatively treated calcaneal fractures through ELA, we had 33 cases with PTI who underwent relocation of the peroneal tendons with ethibond suture in a figure-of-8 shape, passed through 2 parts of sheath of peroneal tendons and stitched to the calcaneal plate. Of the 33 cases, 12 were evaluated in the experimental group. Twelve surgically treated calcaneal fractures without PTI were matched as the control group. The outcome of the patients was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI) percentage, Visual Analog Scale (VAS) pain, changes in Tegner activity level, maximal peroneal muscles strength testing, modified Star Excursion Balance Test (mSEBT), and triple hop for distance (THD) test. For the last 3 tests, the difference between operated and normal feet was calculated for each patient and this difference was compared between the 2 groups. There was no statistically significant difference between the 2 groups for AOFAS Ankle-Hindfoot Scale (P = .09), FFI percentage (P = .12), VAS pain (P = .73), changes in Tegner activity level (P = .87), maximal peroneal muscles strength testing (P = .45), mSEBT (P > .05), and THD (P = .87) tests. We had a case with point tenderness on retromalleolar groove and 4 cases with paresthesia in the territory of the sural nerve in the experimental group in contrary to one case of sural nerve paresthesia in the control group (P = .31). Relocation of peroneal tendons in PTI accompanying calcaneal fractures by fixing sheath of peroneal tendons to the calcaneal plate could be an acceptable procedure with good outcomes but may have increased chance of sural nerve injury. Therapeutic, Level III: Retrospective.

Idiopathic hallux saltans an unusual presentation of flexor hallucis longus tendinopathy: a case report

Hallux saltans is a rare condition characterized by an entrapment of the flexor hallucis longus. Its tendon passes through the retromalleolar groove below the flexor retinaculum, directing the plantar aspect of the foot through a fibro-osseous tunnel below the sustentaculum tali. This study presents a young active patient without any of the conditions or etiological agents previously described in the literature that could explain the cause of this rare condition. After failing conservative treatments, an arthroscopic release of the tendon and the fibrous tunnel was performed, achieving direct visualization and minimal soft tissue injury. At six month follow-up, the patient resumed sports and daily living activities without symptoms. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Relación entre implantación baja del vientre muscular del peroneo corto y luxación de los tendones peroneos

IntroductionPeroneal tendon pathologies are an important cause of pain in the lateral aspect of the ankle. It has been proposed in the literature that low lying peroneus brevis muscle belly occupies more space in the retromalleolar groove and could cause laxity of the superior retinaculum which would promote tendon dislocation, tenosynovitis or ruptures. The objective of the study is to characterize the population with low lying peroneus brevis muscle belly and determine the association between the low lying peroneus brevis muscle belly found on magnetic resonance imaging and clinical peroneal tendon dislocation. MethodsA case-control study was developed with a sample of 103 patients. The cases were patients with low lying peroneus brevis muscle belly and peroneal dislocation and the controls were patients with normal implantation of the peroneus brevis muscle and peroneal tendon dislocation. ResultsThe prevalence of clinical peroneal dislocation in patients with low implantation of the peroneal brevis muscle belly was 7.64%, and the prevalence of clinical peroneal dislocation in patients with normal implantation of the peroneus brevis muscle belly was 8.88%. The OR was 0.85 (CI 0.09–7.44, P=0.88). DiscussionOur findings indicate that there is no statistically significant relationship between low lying peroneus brevis muscle belly and clinical dislocation of the peroneal tendons.

Closed isolated anterolateral calcaneal dislocation: a case report

BackgroundComplete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury.Case presentationA 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint.ConclusionPatients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.

Anatomical Factors Which Influence the Formation of Peroneal Tendon Tears: A Retrospective Comparative Study

This study aims to investigate the anatomical factors that are effective in the formation of peroneal tendon tears comparing with the control group. The patients with ankle magnetic resonance imaging (MRI) due to pain on the lateral side of the ankle were retrospectively analyzed using the clinical archive between July 2015 and January 2020. Peroneal tendon tears, peroneal tubercle type and size, presence of peroneal quartus, presence and type of retromalleolar groove, retromalleolar groove area, lateral malleolus type, presence of os peroneum, peroneus brevis-lateral malleolus distance (PBLMD), and accompanying pathologies in coronal, axial, and sagittal planes MRI were evaluated. PBLMD was measured as 27.1 ± 12.3 mm in Group 1. With PBLMD, it was measured as 39.6 ± 11.68 mm in Group 2. There was a significant relationship between low-lying peroneus brevis muscle and peroneal tear (p < .001). Peroneal tendon tear was more common in patients with peroneal quartus muscle (p < .001). There was a relationship between the retromalleolar groove type and the presence of peroneal tear (p = .004). More peroneal tears were observed in the concave retromalleolar groove type. The presence of concave type retromalleolar groove, peroneus quartus, and low-lying peroneus brevis muscle was found to be associated with peroneal tendon tears.

Peroneal tendon pathologies : From the diagnosis to treatment

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.

Can We Release All Calcaneal Attachments of the Superior Peroneal Retinaculum During Extensile Lateral Approach to the Calcaneus?

During extensile lateral approach to the calcaneus, in order to see all fractured fragments and subtalar joint, all soft tissues including insertion site of superior peroneal retinaculum (SPR) on the calcaneus should be released. The aim of this study was to evaluate the probability of peroneal tendon dislocation by releasing all soft tissues attached to the calcaneus. In 10 fresh cadavers, after standard extensile lateral approach to the calcaneus in right side, all soft tissues attached to the lateral wall of the calcaneus were excised. In the left side of each cadaver, all soft tissues inserted to the superior border of calcaneal tuberosity in addition to the lateral wall of the calcaneus were cut out. Probable anterior dislocation of peroneal tendons in the retromalleolar groove was assessed by placing a clamp into the peroneal tendon sheath from distal to proximal and advancing it to the retromalleolar groove. Also by careful dissection, any instability of peroneal tendons was visualized. Not any anterior dislocation of peroneal tendons to the lateral malleolus tip was seen in any stage of the procedure. Insertions of the SPR to the fascia of the deep posterior compartment of the leg and the Achilles tendon sheath are the main soft tissue stabilizer of the peroneal tendons in the retromalleolar groove. So resection of the insertion site of the SPR to the calcaneus might not result in the peroneal tendon instabilities.

Ultrasound Evaluation of the Peroneal Tendons in an Asymptomatic Elite Military Population: A Prospective Cohort Study.

The purpose of this study was to identify the location of the peroneal tendons in relationship to the fibular groove in an asymptomatic population of elite U.S. Military Service members. The peroneal tendons of 41 active duty U.S. Army Rangers were examined. Subjects were placed in a lateral recumbent position with the ankle in a resting neutral position to visualize the tendon in a retromalleolar short-axis view. Maximum active ankle eversion followed by gravity inversion was facilitated while the ultrasound probe was maintained in its original position. Distance from the fibrous lateral ridge of the retromalleolar groove to the anterior aspect of the peroneal brevis was measured in the short axis in neutral, eversion, and inversion. The mean sagittal distance and standard deviation was 0.48±0.9mm. No subjects demonstrated greater than 1mm difference between positions, and no dislocations were identified. Side-to-side difference and dominant vs nondominant differences were not statistically significant. The study demonstrates that the distance between the peroneal brevis and the lateral fibular ridge is consistent throughout extremes of motion. These results further the understanding of peroneal tendon function under dynamic examination. Our findings also establish side-to-side consistency prompting a bilateral examination to help identify abnormal pathology.