Peroneal Subluxation

NewsBot · Jun 23, 2021

Treatment of recurrent peroneal tendon dislocation by peroneal retinaculum reattachment without fibular groove deepening
Seung-Hwan Park et al
June 18, 2021

Highlights
•Recurrent dislocation of the peroneal tendon is commonly treated by fibular groove deepening.
•Traumatic peroneal tendon dislocation did not occur before the injury, so it can appear as though there is no structural defect in the peroneal groove itself.
•For the treatment of recurrent dislocation of the peroneal tendon, only reattachment of the superior retinaculum is sufficient.
•Post-operative rehabilitation, that early weight bearing and gradual ankle plantarflexion with restricted dorsiflexion by brace is important.
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Background
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. (p=0.02, 0.01, 0.02)
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.
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NewsBot · Jul 18, 2021

Nontraumatic Bilateral Recurrent Peroneal Tendon Dislocation with Pes Planovalgus: A Case Report
Tadashi Kimura, Makoto Kubota, Hidekazu Hattori, Mitsuru Saito
JBJS Case Connect. 2021 Jul 8;11(3)

Case: Peroneal tendon dislocation is a relatively infrequent problem. Most cases are traumatic, and nontraumatic cases are rare. In this case, a 21-year-old man had nontraumatic bilateral recurrent peroneal tendon dislocation on standing and pes planovalgus. We performed medial displacement osteotomy of the calcaneus for the pes planovalgus and reattachment of the retinaculum and groove deepening for the peroneal tendon dislocations.

Conclusion: The dislocations were attributed to the force of the tendon riding up the lateral malleolus on standing because of pes planovalgus. A good outcome was achieved by surgical intervention for both the pes planovalgus and peroneal tendon dislocations.
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NewsBot · Aug 2, 2021

Relapses of traumatic peroneal tendons subluxation already treated surgically: a new surgical approach
Alessandro Tomarchio et al
Med Glas (Zenica). 2021 Aug 1;18(2).

Aim To illustrate the surgical treatment of relapses of traumatic peroneal tendons subluxation. Methods We came across a young woman, who sustained a sprain in her dominant ankle after a trauma; we noticed subluxation of the peroneal tendons during eversion and extension of the foot. She referred to a previous accident some years before with peroneal tendon subluxation treated by superior peroneal retinaculum (SPR) sutures with a synthetic braided absorbable material. We prescribed conventional radiography, magnetic resonance imaging (MRI) and performed surgery: we removed scar tissue, reattached the retinaculum using suture anchors strengthening it with an acellular dermal matrix allograft patch. Results Periodic clinical follow-ups until 24 months were performed evaluating the stability of the ankle, checking the range of movement, and the Visual Analogic Scale (VAS) and American Orthopedic Foot and Ankle Society Score (AOFAS) was administered. At the first check the subluxation was resolved and the ankle was stable. The VAS scale had the value of 0 at the 3-month follow-up maintained until the final check. Conclusion Relapsing traumatic peroneal tendons subluxation is rare, as well as the possibility of a re-intervention years later. This technique seems to guarantee an excellent result even in the long term, allowing resolution of pain and joint stability. In fact, the use of acellular dermal patch is an already commonly described technique for the augmentation in rotator cuff and hip capsular repair; no reports are available in literature in relation to the use of graft for the repair of the superior peroneal retinaculum.
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NewsBot · Mar 11, 2022

Surgical treatment options for chronic instability of the peroneal tendons: a systematic review and proportional meta-analysis
Joline Lootsma et al
Arch Orthop Trauma Surg. 2022 Mar 9

Introduction: Several surgical techniques for chronic instability of the peroneal tendons have been reported. Yet, the most optimal technique has not been clarified. This study aims to perform a systematic review and meta-analysis of all existing evidence and compare all published surgical techniques in both the athletic as the nonathletic population.

Materials and methods: A systematic review and a proportional meta-analysis, with a random-effects model, were carried out according to the PRISMA guidelines, using the keywords "chronic luxation" OR "instability" AND "peroneal tendon" AND "treatment" OR "treatment protocol". Four surgical techniques were compared in patients with chronic peroneal instability, comprising superior peroneal retinaculum (SPR) repair or replacement, groove deepening procedures (primarily with additional SPR operations), rerouting procedures, and bony procedures (respectively group S, G, R and B). Outcomes of interest include the pre- and postoperative American orthopedic foot and ankle society hindfoot score, return to sports, postoperative redislocation and complications. Pooled estimates of the last two outcomes were obtained.

Results: For the systematic review, 31 studies were eligible. Of these, 25 papers met the criteria for inclusion in the meta-analysis. All techniques demonstrated a clinical improvement postoperatively. Group B, however, demonstrated overall more unsatisfactory results, and higher complication rates were observed for both group R and group B. The latter was established by the proportional meta-analysis as well [95% confidence interval group S: (0.01-0.10); group G: (0.02-0.10); group R: (0.13-0.57); group B: (0.24-0.40)]. Concerning surgical efficacy (= no postoperative redislocation), no significant difference was statistically observed. Finally, considerable differences in study quality were identified.

Conclusion: Surgical treatment results in excellent clinical and functional outcomes in patients with chronic peroneal instability. More inferior results were demonstrated for rerouting and bony procedures. However, no high-quality studies are available and future randomized controlled trials are necessary to advocate for the most advantageous approach.
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NewsBot · Mar 12, 2022

Skeletal MRI Features Associated with Peroneal Tendon Split Tears – A Comparative
Retrospective Cohort
Michael Huuskonen
Source

Background: Peroneal split tears are an underrated cause of ankle pain. While MRI (magnetic
resonance imaging) evaluation is useful in diagnosis, the condition is among the most
challenging to identify due to complex anatomy and artifacts. Several anatomical variants,
soft tissue lesions and skeletal pathologies have been suspected to be associated with the
condition. There is a lack of contemporary and comprehensive radiological research studying
the relationship between peroneal split tears and other lesions seen on MRI.
Objectives: Investigate whether skeletal anatomical variants and pathologies of the ankle are
associated with peroneal tendon split tears.
Methods: This retrospective cohort assessed existing MR images of the ankle in two groups:
one with peroneus split tears (N=80) and one without (control group, N=115). Predetermined
skeletal anatomical variants and pathologies were noted. The proportion of findings in each
group were compared with Fishers exact test and analyzed with Pearson correlation.
Results: Moderate joint effusion, concave malleolar groove, bone marrow edema in the
posterior fibula and in the lateral talus were significantly (p<0.05, confidence interval not
including 0) more common in the split tear group than in the control group. No joint effusion
and history of trauma were significantly less common. Distinct correlations in the split tear
group were primarily found between bone marrow edema in the medial talus and no joint
effusion.
Conclusion: Certain MRI features (i.e., moderate joint effusion, concave malleolar groove,
bone marrow edema in the posterior fibula and in the lateral talus) were associated with
peroneal split tears and these could potentially inform future research, guidelines and facilitate
MRI evaluation.
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NewsBot · Nov 21, 2022

Ultrasound Imaging and Prevalence of Intrasheath Peroneal Tendon Subluxation in Asymptomatic Volunteers
Shefali Kanal, Christopher E. Gross, MD, […], Caroline P. Hoch, and Leah Davis,
Source

Introduction/Purpose:
Intrasheath peroneal tendon subluxation is typically an incidental finding in athletes with sports-related injuries and is characterized by a temporary reversal in the anteroposterior positions of the peroneus longus (pL) and peroneus brevis (pB) tendons within their common tendon sheath. It is currently unclear whether intrasheath subluxation represents normal physiologic or pathologic tendon motion. This study aims to determine the normal variation in motion of supramalleolar pB and pL tendons in multiple ankle positions and to determine the overall prevalence of intrasheath tendon subluxation in asymptomatic volunteers.
Methods:
Static sonographic images of the peroneal tendons in 22 asymptomatic volunteers were collected in the neutral position, in eight fixed ankle positions (active and passive pronation, dorsiflexion, supination, and plantarflexion), and during dynamic ankle circumduction. The center of each tendon in relation to the lateral fibular cortex and in relation to each other was measured in each position and used to calculate absolute and percentage displacement. Two-way ANOVA was used to determine the significance of passive versus active motion and two-tailed paired sample t-test was used to compare the mean displacement of pL and pB in active and passive positions.
Results:
Intrasheath subluxation was not visualized in any static position but was visualized in 33% of patients during active ankle circumduction, regardless of direction or laterality. Percent displacement was greatest in active ankle plantarflexion (55%) for pB and in active pronation (34%) for pL. A statistically significant difference in the tendon positions in relation to each other was found in the anteroposterior direction (p=0.026), but there were no statistically significant differences between active and passive motions or with ankle positioning. A non-painful ankle 'snap' was palpated by the sonographer in all cases of intrasheath subluxation.
Conclusion:
Intrasheath subluxation is a fairly common occurrence seen in one third of our volunteers. Our results suggest that a snapping ankle in otherwise asymptomatic patients is highly suggestive of intrasheath peroneal tendon subluxation and can be well-documented with dynamic ultrasound. Establishing the normal ranges of motion of supramalleolar peroneal tendons may assist in the evaluation of patients with lateral ankle pain.
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NewsBot · Feb 20, 2023

Peroneal Tendon Dislocation: A Report of Two
Cases
Mohammed Maroc et al
Source

Ankle injuries are a very common cause of patient visits to the primary care units and emergency
departments. Although the most frequent ones are lateral ligament sprains, peroneal tendon subluxations
have the same inversion mechanism and are described as one of the main causes of lateral ankle pain and
instability. They are often missed during the acute phases as they are misdiagnosed as ankle sprains since
both injuries share similar mechanisms and often occur in athletes and patients with high sports activity.
We present two different cases of peroneal tendon dislocation that illustrate how this pathological condition
may be present under different circumstances. We aim, through these cases, to provide clinical awareness
and help improve earlier diagnosis of this condition; we also demonstrate the effectiveness of surgical
reattachment of the upper retinaculum that two of our patients underwent.
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NewsBot · Mar 8, 2023

Modified posterior fibular groove deepening procedure with repair of the superior peroneal retinaculum for peroneal tendon subluxation
Peng Zhang et al
Int Orthop. 2023 Mar 7

Purpose: To evaluate the clinical results of modified peroneal sulcus deepening combined with superior peroneal retinaculum repair in peroneal tendon subluxation treatment.

Methods: From 2016 to 2020, 18 patients with peroneal tendon subluxation were diagnosed and treated; all patients underwent modified peroneal sulcus deepening combined with superior peroneal retinaculum repair. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS-AH) score, and subjective patient satisfaction were evaluated before surgery and during follow-up.

Results: The operative time was 66.44 ± 5.22 min. All patients' surgical incisions showed grade A healing, and there were no complications. All patients were followed up for 24-48 months; no patients were lost to follow-up. At the last follow-up, the VAS and AOFAS-AH scores were significantly improved compared with those pre-operatively (P < 0.05). There was no significant difference in the activity of the 18 patients between pre- and post-operatively, and all patients recovered their normal gait before injury.

Conclusion: Modified fibular groove deepening combined with superior peroneal retinaculum repair for treating peroneal tendon subluxation may be a simple operation with minimal trauma, rapid recovery, and good clinical efficacy.
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NewsBot · Mar 8, 2023

Anatomic Features of Patients With Recurrent Peroneal Tendon Dislocation
Akinobu Nishimura et al
Source

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.
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NewsBot · Oct 5, 2023

Snapping ankles: peroneal tendon subluxation and dislocation
Tom Hosack, Oliver Perkins, Sabri Bleibleh, Rahul Singh
British Journal of Hospital Medicine:29 Sep 2023

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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Peroneal Subluxation

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Sub-clinical peroneal neuropathy (SCPN)

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Peroneal Subluxation

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NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Adolescent Peroneal Subluxations

Has anyone here been diagnosed with peroneal brevis tears?

Peroneal muscle inhibition

Association of Cavovarus Foot Alignment With Peroneal Tendon Tears

Intraneural ganglion cysts of the peroneal nerve

Sub-clinical peroneal neuropathy (SCPN)

Peroneal artery entrapment syndrome (PRAES): a rare cause of ischaemic toes.

Share This Page

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