Measuring Visualized Tendon Length in Peroneal Tendoscopy

2018 ◽  
Vol 39 (8) ◽  
pp. 990-993 ◽  
Author(s):  
Michael Hull ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
R. Frank Henn ◽  
Rebecca A. Cerrato
Keyword(s):  
Kirschner Wires ◽  
Anatomic Landmarks ◽  
Muscle Belly ◽  
Peroneal Tendons ◽  
Portal Site ◽  
Peroneus Longus ◽  
First Metatarsal ◽  
Tendon Length ◽  
Peroneus Brevis ◽  
Portal Placement

Background: Despite multiple studies outlining peroneal tendoscopy, no study exists to evaluate how effective tendoscopy is at visualizing the peroneal tendons without missing a lesion. We sought to measure the length of the peroneal tendons that could be visualized using tendoscopy. Methods: Ten fresh cadaveric specimens were evaluated using standard peroneal tendoscopy techniques. Peroneus longus and brevis tendons were pierced percutaneously with Kirschner wires at the edge of what could be seen through the camera. The tendon sheaths were then dissected and the distances from anatomic landmarks were directly measured. During zone 3 peroneus longus tendoscopy, a more distal portal site was created for the final 5 specimens. Results: The peroneus brevis could be visualized through the entirety of zone 1 and up to an average of 19.5 mm (95% confidence interval, 16.5-22.5) from its insertion onto the base of the fifth metatarsal in zone 2. Peroneus longus could be visualized through the entirety of zones 1 and 2 and up to an average of 9.7 mm from its insertion onto the base of the first metatarsal in zone 3. This distance was decreased significantly with a more distal portal. The muscle belly of peroneus brevis terminated an average of 1.8 mm (–3.7 to 7.3) above the tip of the lateral malleolus. Conclusions: Despite limitations, these results suggest that the vast majority of the length of the peroneal tendons can be seen during routine peroneal tendoscopy. A more distal skin portal site may improve visualization of zone 3 of peroneus longus. Clinical Relevance: This study confirms the ability of peroneal tendoscopy to see the entire tendon length with appropriate portal placement.

scholarly journals Measuring Visualized Tendon Length in Peroneal Tendoscopy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Michael Hull ◽  
John T. Campbell ◽  
Rebecca Cerrato ◽  
Clifford Jeng ◽  
R. Frank Henn
Keyword(s):  
Cadaver Study ◽  
Skin Incision ◽  
Direct Visualization ◽  
Musculotendinous Junction ◽  
Peroneal Tendons ◽  
Portal Site ◽  
Peroneus Longus ◽  
Ankle Surgery ◽  
Peroneus Brevis ◽  
Distal Aspect

Category: Arthroscopy, Sports Introduction/Purpose: Tendoscopy is a relatively new method of evaluating for tendon lesions in foot and ankle surgery. Despite multiple studies describing peroneal tendoscopy use, no study exists to determine the efficacy of tendoscopy at visualizing the entire length of the peroneal tendons. The purpose of this cadaver study was to measure the length of the peroneal tendons that could be visualized using tendoscopy Methods: Ten (10) fresh cadaveric specimens, complete above- or through-knee specimens, were evaluated. Peroneal Tendoscopy was performed with routine portal placement including proximally 2 cm above the lateral malleolar tip and mid- tendon proximal to the peroneal tubercle. For the initial 5 specimens, the peroneus longus sheath was entered distal to the tendon bifurcation and proximal to the lateral cuboid under direct visualization for zone 3 tendoscopy. For the subsequent 5 specimens, a more distal point closer to the base of the 5th metatarsal was used as a landmark for skin incision and the sheath was entered at the distal aspect of the cuboid. The edges of visualized longus and brevis tendons were marked with kirschner wires placed through the tendon percutaneously under direct visualization. The tendon sheaths were then dissected and the distances from anatomic landmarks were directly measured. Results: Proximally (zone 1), both the peroneus tendons were followed circumferentially to the musculotendinous junction of the longus in all specimens. Peroneus brevis was visualized in zone 2 to an average of 19.5 mm (95% CI 16.5-22.5) from its insertion onto the base of the 5th metatarsal. Using a peroneal tubercle start point, zone 3 of peroneus longus was visualized up to an average of 17 mm (11-23) from its insertion onto the base of the 2nd metatarsal. Using a more distal start point, longus was seen up to 1.6 mm (0.3-2.9) from its insertion. The muscle belly of peroneus brevis ended an average of 1.9 mm (-3.7-7.3) above the tip of the lateral malleolus. Conclusion: The results suggest that the vast majority of the peroneal tendons can be visualized during peroneal tendoscopy. It was also noted that a more distal skin portal site may improve visualization of zone 3 of peroneus longus.

T2* Mapping of Peroneal Tendons Using Clinically Relevant Subregions in an Asymptomatic Population

2017 ◽  
Vol 38 (6) ◽  
pp. 677-683 ◽  
Author(s):  
Katharine J. Wilson ◽  
Rachel K. Surowiec ◽  
Nicholas S. Johnson ◽  
Carly A. Lockard ◽  
Thomas O. Clanton ◽  
...  
Keyword(s):  
T2 Mapping ◽  
Lateral Malleolus ◽  
Peroneal Tendon ◽  
Peroneal Tendons ◽  
Peroneus Longus ◽  
Mapping Sequence ◽  
Asymptomatic Volunteers ◽  
Peroneus Brevis ◽  
Magnetic Resonance Imaging Mri ◽  
Tendon Pathology

Background: Peroneal tendon evaluation is particularly demanding using current magnetic resonance imaging (MRI) techniques because of their curving path around the lateral malleolus. Quantifiable, objective data on the health of the peroneal tendons could be useful for improving diagnosis of tendon pathology and tracking post-treatment responses. The purpose of this study was to establish a method and normative T2-star (T2*) values for the peroneal tendons in a screened asymptomatic cohort using clinically reproducible subregions, providing a baseline for comparison with peroneal tendon pathology. Methods: Unilateral ankle scans were acquired for 26 asymptomatic volunteers with a 3-Tesla MRI system using a T2* mapping sequence in the axial and sagittal planes. The peroneus brevis and peroneus longus tendons were manually segmented and subregions were isolated in the proximity of the lateral malleolus. Summary statistics for T2* values were calculated. Results: The peroneus brevis tendon exhibited a mean T2* value of 12 ms and the peroneus longus tendon was 11 ms. Subregions distal to the lateral malleolus had significantly higher T2* values ( P < .05) than the subregions proximal in both tendons, in both the axial and sagittal planes. Conclusion: Peroneal tendon regions distal to the inferior tip of the lateral malleolus had significantly higher T2* values than those regions proximal, which could be related to anatomical differences along the tendon. Clinical Relevance: This study provides a quantitative method and normative baseline T2* mapping values for comparison with symptomatic clinically compromised peroneal tendon patients.

scholarly journals The Role of MRI in the Assessment of Chronic Lateral Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Parke Hudson ◽  
Cesar de Cesar Netto ◽  
Ashish Shah ◽  
Ibukunoluwa Araoye ◽  
Bahman Sahranavard ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Surgical Approaches ◽  
Peroneal Tendon ◽  
Lateral Ankle ◽  
Muscle Belly ◽  
Peroneal Tendons ◽  
Chronic Lateral Ankle Instability ◽  
Not Otherwise Specified ◽  
Lateral Ankle Instability ◽  
Peroneus Brevis

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Chronic lateral ankle instability is a common problem in foot and ankle surgery, especially in patients with neutral or varus alignment of the hindfoot. Peroneal tendinopathy is a common associated condition with reported incidence as high as 77%. Not all surgical approaches allow for assessment of the peroneal tendons intraoperatively, and so physical exam and imaging, by either ultrasound or MRI, often plays an important role in pre-operative planning. We evaluated the usefulness of MRI reports in identifying peroneal tendon pathology in patients with lateral ankle instability. Specifically, we aimed to identify the most commonly missed lesions, as well as the sensitivity of an MRI report at detecting any peroneal pathology, as we reason this finding to have the great effect on preoperative planning. Methods: We performed a retrospective chart review of all patients who had undergone surgery for lateral ankle instability at our institution in the past 7 years (January 1, 2009 to December 31, 2015). We used intraoperative peroneal pathology as our gold standard for diagnosis, and identified cases via the operative report. We defined peroneal pathology as peroneal brevis/longus rupture, split lesion, tenosynovitis, or tendinopathy not otherwise specified. Additionally, we assessed for low insertion of the peroneus brevis muscle belly. Then we examined all cases of intraoperative peroneal pathology that had a preoperative MRI report. We correlated MRI reports to intraoperative peroneal findings aiming to assess the accuracy of MRI reports in diagnosing peroneal pathology in patients undergoing surgical treatment for chronic lateral ankle instability. Results: We identified 76 patients with intraoperative peroneal pathology and preoperative MRI reports. Forty-six had some form of peroneal pathology noted on their MRI report (60.5% sensitivity, 39.5% false negatives). MRI report had a 53.3% (16/30) sensitivity for detecting peroneus brevis split lesions, and a 46.2% (30/65) sensitivity for peroneal tenosynovitis or tendinopathy not otherwise specified. Additionally, 41 cases of low insertion of the peroneus brevis muscle belly were found intraoperatively, but MRI report failed to identify any of these specifically. Of the 30 patients who had intraoperative peroneal pathology without such findings on their MRI report, 93.3% (28/30) had peroneal tenosynovitis or tendinopathy not otherwise specified, while 26.7% (8/30) had a peroneus brevis split lesion and 6.7% (2/30) had a peroneus longus split lesion. Conclusion: Our findings suggest that MRI reports may not be accurate in describing the presence of peroneal tendons pathology in patients with chronic lateral ankle instability. With a false-negative rate of nearly 40%, it is likely that MR imaging underestimates peroneal pathology in these patients. This is clinically significant as certain limited surgical approaches such as the “smile” incision, do not allow intraoperative assessment of the peroneal tendons. Our study findings encourage surgeons to review MR images preoperatively and to use a surgical approach that allows peroneal tendon assessment when repairing the lateral ankle ligaments.

Microvascular Anatomy of the Peroneal Tendons

Foot & Ankle ◽  
1992 ◽  
Vol 13 (8) ◽  
pp. 469-472 ◽  
Author(s):  
Mark Sobel ◽  
Mark J. Geppert ◽  
Jo A. Hannafin ◽  
Walther H. O. Bohne ◽  
Steven P. Arnoczky
Keyword(s):  
Compressive Load ◽  
Vascular Supply ◽  
Peroneal Artery ◽  
Peroneus Longus Tendon ◽  
Peroneal Tendons ◽  
Longitudinal Splitting ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
India Ink ◽  
Peroneus Brevis

The etiology of longitudinal splitting of the peroneus brevis tendon is unclear. It has been hypothesized that compressive load applied to the tendon as it passes through the fibular groove may compromise the vascularity of the tendon with resultant inhibition of the repair response and degeneration of tendon structure. To investigate this possibility, a study of the microvascularity of the peroneal tendons was undertaken. Twelve fresh, frozen cadaveric limbs were injected with India ink. The vascularity of the peroneal tendons was examined in situ and the tendons were harvested and cleared using a modified Spalteholz technique. The vascularity of the cleared tendons was evaluated utilizing a dissecting microscope. The vascular supply of the peroneal tendons arises from two posterolateral vincula, one for the peroneus longus tendon and one for the peroneus brevis tendon. These vincula are supplied by branches of the posterior peroneal artery. A zone of hypovascularity within the peroneus brevis or peroneus longus tendon correlating with the site of peroneus brevis splits was not found. There was no relationship between increasing age of specimens and alteration in vascular supply.

scholarly journals Peroneal Tendon Tears

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Emilio Wagner ◽  
Pablo Wagner ◽  
Diego Zanolli de Solminihac ◽  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Distal Tibia ◽  
Peroneal Tendon ◽  
Peroneal Tendons ◽  
Peroneus Longus ◽  
Load To Failure ◽  
The Mean ◽  
Tendon Tears ◽  
Peroneus Brevis ◽  
Cyclic Phase

Category: Ankle, Basic Sciences/Biologics, Sports Introduction/Purpose: Peroneus brevis tendon tears are frequently diagnosed when ankle instability is present. No clear guideline exists as to when to repair or resect peroneal tendon tears, as most of the available literature uses Meyer’s work published in 1924 where a risk of spontaneous rupture would exist when less than 50% of the tendon remains undamaged. Our objective was to analyze the mechanical behavior of cadaveric peroneal tendons subjected to an artificially made damage, compromising 66% of its visible width and tested in a cyclic and failure phase. Our hypothesis was that no failure would be observed in the cyclic phase. Methods: 8 cadaveric foot- ankle – distal tibia specimens were included in this study. A longitudinal full thickness tendon defect was created, 3 cms in length, centered behind the tip of the fibula, compromising 66% of the visible width of the peroneal tendons as measured by a caliper. The peroneal retinaculum was kept intact. All specimens were mounted onto a special frame specifically designed for the study. All tendons were tested in a cyclic fashion using 100 repetitions between 50 N and 200 N. If no visual change or tendon failure was observed after the initial testing, a load to failure test was performed until tendon rupture or fixation failure was observed. Tendon stiffness and load to failure were registered. Statistical analysis was performed using the SPSS software. Results: No tendon failed during the cyclic testing. No defect lengthening was observed after the cyclic phase. On the failure phase, the mean load resisted by the peroneus brevis was 416 N, with a 95% confidence interval between 351 N -481 N. The mean load resisted by the peroneus longus was 723 N, with a 95% confidence interval between 578 N – 868 N. All failures were at the level of the defect created. The coefficient of variation was low for both tendons. Conclusion: A 33% of remaining peroneal tendon was able to resist very high tensile forces; therefore, it can be suggested that a 66% defect can be repaired and does not necessarily need a tenodesis as it has been historically recommended. The high resistance offered by the peroneus longus tendon offers the theoretical potential to use part of it as a free graft to repair peroneus brevis tears. The 50% rule, which determines when a peroneal tendon tear needs a tenodesis or repair, should be revisited.

Lipoma Arborescens of the Peroneus Longus and Peroneus Brevis Tendon Sheath

2009 ◽  
Vol 99 (2) ◽  
pp. 153-156 ◽  
Author(s):  
Yunus Dogramaci ◽  
Aydiner Kalaci ◽  
Teoman Toni Sevinç ◽  
Esin Atik ◽  
Erdinc Esen ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Tendon Sheath ◽  
Joint Effusion ◽  
Lipoma Arborescens ◽  
Peroneal Tendons ◽  
Peroneus Longus ◽  
Suprapatellar Pouch ◽  
Peroneus Brevis

Lipoma arborescens is an uncommon pseudotumoral synovial lesion usually located in the suprapatellar pouch of the knee. Lipoma arborescens involving the synovial sheaths of the tendons is exceedingly rare. This diagnosis should be considered, particularly in patients with chronic joint effusion. We report a case with lipoma arborescens affecting the synovial sheaths of the peroneal tendons without involvement of the adjacent ankle joint. To our knowledge, this is the second reported case of lipoma arborescens involving tenosynovial sheaths of tendons arround the ankle joint without ankle joint involvment. (J Am Podiatr Med Assoc 99(2): 153–156, 2009)

scholarly journals Relationship Between Peroneal Tendons and Anterior Talofibular Ligament

2021 ◽  
pp. 18
Author(s):  
Keyword(s):  
Double Bundle ◽  
Single Bundle ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Peroneal Tendons ◽  
Peroneus Longus ◽  
Three Bundles ◽  
Fresh Frozen ◽  
The Mean ◽  
Peroneus Brevis

Background: Anterior talofibular ligament (ATFL) injuries are the most common in ankle torsional injuries. ATFL and peroneal tendons are both important stabilizers of lateral ankle joint. We aimed to evaluate peroneal tendons and ATFL. Methods: Fifteen nonpaired leg of fresh frozen cadavers were assessed in this study. After harvesting, ATFL diameters were measured at three points by calipers, these are fibular side, intermediate side and talar side. The mean of these three measurements were assessed and tissue a 15 lb load was applied to the peroneal tendons for 10 minutes, and the transverse diameters were measured by folding the thickest part of the tendon in a double-strand. Results: 5 single bundle, 8 double-bundle and 2 three bundles of ATFL were obtained after dissection. . There was no correlation between ATFL diameter, peroneus longus, peroneus brevis and total tendon diameters of peroneus longus and peroneus brevis in women (p> 0.05). A strong correlation was found between ATFL diameter, peroneus longus (r: 0.95), peroneus brevis (r: 0.81) and total tendon diameters of peroneus longus and peroneus brevis (r: 0.92) in men. Conclusion: Relationship between the diameter of the ATFL and peroneal tendons diameters were evaluated and a correlation was observed in males, while no correlation was observed in females.

Chronic Peroneal Tendon Subluxation Produced by an Anomalous Peroneus Brevis: Case Report and Literature Review

Foot & Ankle ◽  
1989 ◽  
Vol 10 (1) ◽  
pp. 45-47 ◽  
Author(s):  
Warren A. Hammerschlag ◽  
J. Leonard Goldner
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Congenital Anomalies ◽  
Present Report ◽  
Peroneal Tendon ◽  
Anatomical Studies ◽  
Peroneal Tendons ◽  
Symptomatic Case ◽  
Peroneus Brevis ◽  
Time Of Operation

Although congenital anomalies of the peroneal muscles have been well documented from anatomical studies, only a single clinically symptomatic case has been previously reported. In the present report, a previously unreported variation of the peroneus brevis, a bifid peroneus brevis, is described. This variation contributed to chronic subluxation of the peroneal tendons. Diagnosis was made at the time of operation, and resection of the duplicated tendon and reinforcement of the peroneal retinaculum relieved the symptoms of the patient.

Kinesio taping techniques for ankle stabilisation in patients with stroke: a single-blinded randomised controlled study

2021 ◽  
Vol 28 (2) ◽  
pp. 1-12
Author(s):  
Ramazan Kurul ◽  
Tamer Cankaya ◽  
Necmiye Un Yildirim
Keyword(s):  
Barthel Index ◽  
Intervention Group ◽  
Controlled Study ◽  
Timed Up And Go ◽  
Peroneus Longus ◽  
Kinesio Taping ◽  
Functional Reach ◽  
Significant Difference ◽  
Functional Reach Test ◽  
Peroneus Brevis

Background/AimsAnkle proprioception and neuromuscular feedback from this region provides the sensory input needed for balance. The aim of this study was to investigate the effects of repeated correction taping applied on the ankle and peroneus longus and peroneus brevis muscles on balance and gait in patients with stroke.MethodsA total of 61 patients with stroke with a mean age of 62.25 ± 7.04 years were included in this study. The patients were randomly divided into two groups. The control group (n=30) received 1 hour of rehabilitation, which took place during weekdays over the course of 2 weeks. The intervention group (n=31) received 1 hour of daily rehabilitation as well as having kinesio tape applied to their ankle. Both groups were assessed with the Balance Evaluating Systems Test, Timed Up and Go Test, Functional Reach Test, Tetrax Balance System and Barthel Index. Clinical assessments were performed at baseline, immediately after the first application, 1 week and 2 weeks later, following the first taping.ResultsThere was a significant improvement in the Balance Evaluating Systems and Functional Reach Tests scores between the first and last measurements in favour of the intervention group (P<0.05). There were no significant changes between baseline and immediately after assessment for all measurements (P>0.05). There was no significant difference in Tetrax scores, Timed Up and Go Test and Barthel Index scores (P>0.05).ConclusionsIn this study, it was found that dynamic balance was improved by taping the peroneus longus and peroneus brevis muscles, but the static balance did not change. One week of kinesio taping would be beneficial; however, prolonged use would not provide further improvement.

scholarly journals An Untypical Case of Gouty Infiltration of Both Peroneal Tendons and a Longitudinal Lesion of the Peroneus Brevis Tendon Mimicking Synovial Sarcoma

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Konstantinos Anagnostakos ◽  
Andreas Thiery ◽  
Christof Meyer ◽  
Octavian Tapos
Keyword(s):  
Synovial Sarcoma ◽  
Histopathological Examination ◽  
Soft Tissue Tumors ◽  
Resonance Imaging ◽  
Open Biopsy ◽  
Tissue Samples ◽  
Peroneal Tendons ◽  
Orthopedic Surgeons ◽  
History Of ◽  
Peroneus Brevis

We present a case of a 70-year-old male patient with an untypical gout infiltration of the peroneal tendons mimicking synovial sarcoma. The patient had a negative history of gout at initial presentation in our department. Magnetic resonance imaging of the region revealed a finding highly suspicious for synovial sarcoma of the peroneal tendons. Open biopsy was performed. Histopathological examination of the tissue samples demonstrated the presence of gout with no signs of malignancy. The gout infiltration was excised in a subsequent surgery. Orthopedic surgeons should be aware of the potential manifestation of gout in tendons and bear this in mind in the differential diagnosis of soft tissue tumors.

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