Preoperative Gait Analysis of Peroneal Tendon Tears

2021 ◽  
pp. 107110072110368
Author(s):  
Noah Chinitz ◽  
Daniel D. Bohl ◽  
Manoj Reddy ◽  
Shay Tenenbaum ◽  
Scott Coleman ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Strong Association ◽  
Axial Rotation ◽  
Peroneal Tendon ◽  
Level Of Evidence ◽  
Ankle Motion ◽  
Tendon Tears ◽  
Peroneus Brevis ◽  
The Impact

Background: Little is known regarding the impact of peroneal tendon tears on function. This study quantifies gait changes associated with operatively-confirmed peroneal tendon tears. Methods: Sixty-five patients with unilateral peroneal tendon tears were prospectively evaluated using preoperative 3D multisegment gait analysis of both limbs. Data were analyzed according to pattern/severity of tears, as confirmed surgically: peroneus brevis tears, reparable (PBR); peroneus brevis tears, irreparable (PBI); peroneus longus tears, irreparable (PLI); and concomitant irreparable tears of both tendons (PBI+PLI). The following parameters were analyzed: ankle sagittal motion, coronal motion, axial rotation, foot progression angle, sagittal power, sagittal moment. Results: Twelve patients (18.5%) had the PBR pattern, 37 (56.9%) PBI, 10 (15.4%) PLI, and 6 (9.2%) PBI+PLI. Compared with the contralateral, nonpathologic extremities, limbs with peroneal tears had diminished ankle sagittal motion (mean 23.14 vs 24.30 degrees, P = .012), ankle/hindfoot axial rotation (6.26 vs 7.23 degrees, P = .001), sagittal moment (1.16 vs 1.29 Nm/kg, P < .001), and sagittal power (1.24 vs 1.47 W/kg, P < .001). The most severe tear patterns had the greatest derangements in multiple parameters of gait (PBI+PLI > PBI or PLI > PBR). For example, all groups except PBR had loss of ankle sagittal moment and/or power in the affected limb, and the greatest losses in moment and power were in the PBI+PLI group (1.22 vs 0.91 Nm/kg, P = .003 for moment; 0.73 vs 1.31 W/kg, P < .001 for power). The PBI+PLI group had a >10-degree varus shift in coronal motion on the affected side ( P = .002). Conclusion: This is the first study to demonstrate diminished biomechanical function in patients with peroneal tendon tears. In vivo 3-dimensional gait analysis found significant changes in hindfoot motion, ankle motion, and ankle power. Impairments were related to the pattern and severity of the tears, and demonstrated a strong association of peroneal tendon tears with diminished ankle plantarflexion strength. Level of Evidence: Level III, retrospective cohort study.

MRI Quantification of the Impact of Ankle Position on Syndesmosis Anatomy

2016 ◽  
Vol 38 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Marie-Lyne Nault ◽  
Melissa Marien ◽  
Jonah Hébert-Davies ◽  
G. Yves Laflamme ◽  
Vincent Pelsser ◽  
...  
Keyword(s):  
Measurement System ◽  
External Rotation ◽  
Neutral Position ◽  
Level Of Evidence ◽  
Ankle Motion ◽  
Radiologic Study ◽  
Ankle Trauma ◽  
Magnetic Resonance Imaging Mri ◽  
The Impact

Background: Despite the common occurrence of syndesmotic injuries in ankle trauma, the distal tibiofibular relationship remains poorly understood. The aim of this study was to evaluate the anatomical impact of ankle sagittal positioning on the tibiofibular relationship in intact ankles by using a validated magnetic resonance imaging (MRI)–based measurement system. Methods: In this radiologic study, 34 healthy volunteers underwent a series of ankle MRIs with the ankle stabilized in 3 positions: neutral position (NP), dorsiflexion (DF), and plantarflexion (PF). Using a previously validated measurement system, 6 fixed translational measurements and 2 fixed angles were recorded on each MRI and compared using paired t tests. Results: When comparing PF to DF, the anterior distance between the tibial incisura and the fibula varied from 2.5 mm to 3.9 mm ( P < .001), respectively. The middle distance between the tibial incisura and the fibula varied from 1.5 mm to 2.6 mm ( P < .001). Fibular angle varied from 8.7 degrees to 7.8 degrees of internal rotation ( P = .046), respectively. When comparing NP to DF, only the anterior distance was found to be significantly different, varying 0.4 mm ( P < .002). Conclusions: Ankle dorsiflexion leads to an increase in external rotation and lateral translation of the fibula. These changes could be measured on MRI using a validated measurement system. Ankle motion did have an impact on the distal tibiofibular relationship and should be considered in studies pertaining to syndesmosis imaging. Clinical Relevance: This is the first in vivo study demonstrating the impact of sagittal ankle position on the distal tibiofibular relationship in an uninjured ankle. Our findings also support the practice of placing the ankle in dorsiflexion when fixing a disrupted syndesmosis. Level of Evidence: Level III, comparative study.

Association of Cavovarus Foot Alignment With Peroneal Tendon Tears

2021 ◽  
pp. 107110072199034
Author(s):  
Akira Taniguchi ◽  
Shannon F. Alejandro ◽  
Justin M. Kane ◽  
Yahya Daoud ◽  
Yasuhito Tanaka ◽  
...  
Keyword(s):  
Coordinate System ◽  
Control Group ◽  
Peroneal Tendon ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Retrospective Comparison ◽  
Comparative Cohort Study ◽  
Tendon Tears ◽  
Peroneus Brevis

Background Although it is a widely accepted clinical principle that cavovarus deformity predisposes to peroneal tendon problems, there are limited data to support that assumption. This study tested the hypothesis that cavovarus is associated with peroneal tendon tears and evaluated which radiographic measures correlated with that association. Methods: A retrospective comparison of radiographic measures of cavovarus in 234 consecutive patients operatively treated for chronically symptomatic peroneal tendon tears was compared to a matched control group. Measures included calcaneal pitch, anteroposterior (AP) talometatarsal and talocalcaneal angles, and talonavicular coverage angle. A novel coordinate system analyzed midfoot and hindfoot components of cavovarus. Analysis of variance was used to compare cohorts, and a Tukey-Kramer test used to analyze 3 subgroups of brevis and longus tears, and concomitant tears. Results: The distribution of tears was 73% peroneus brevis, 8% longus, and 19% both tendons. Compared with controls, the study group, and subgroups, had multiple measures of increased cavovarus, including greater calcaneal pitch ( P = .0001), decreased AP talo–first metatarsal angle ( P = .0001), and increased talonavicular coverage angle ( P = .0001). Elevated medial longitudinal arch, and rotational changes in the radiographic profiles of the hindfoot were found with the coordinate system described by Yokokura. Conclusion: This study found a statistically significant association of increased cavovarus deformity with peroneal tendon tears, compared to controls. It documented the relative incidence of tears of peroneus brevis, peroneus longus, and concomitant tears in a large surgical series. It demonstrated which simple radiographic angles and complex coordinate measurements of cavovarus deformity were significantly associated with peroneal tendon tears. Level of Evidence: Level III, retrospective comparative cohort study.

scholarly journals Reconstruction of the Peroneus Brevis Tendon Tears with Semitendinosus Tendon Autograft

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Fernando Aires Duarte ◽  
Guilherme Honda Saito ◽  
Cesar de Cesar Netto ◽  
Augusto César Monteiro ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Treatment Options ◽  
Clinical Results ◽  
Semitendinosus Tendon ◽  
Peroneal Tendon ◽  
Salvage Procedure ◽  
Common Causes ◽  
Tendon Tears ◽  
Peroneus Brevis ◽  
Tendon Autograft

Peroneal tendon disorders are common causes of lateral and retromalleolar ankle pain. For irreparable tears of the tendon, a salvage procedure is indicated with segmental resection followed by reconstruction with tenodesis, tendon transfer, or bridging the defect using allograft or autograft. Although there is insufficient evidence to guide which of these treatment options provides the best outcomes, reconstruction with tendon allograft has provided satisfactory clinical results and is effective for pain relief and restoration of tendon function. However, there are concerns about the use of tendon allografts which include its cost and availability, disease transmission, delayed incorporation, and stretching of the graft. The aim of this study is to present the surgical technique for the reconstruction of the peroneus brevis tendon tears using semitendinosus tendon autograft as an alternative to the allograft and report the short-term results of three cases.

Importance of Space-Occupying Anatomical Variations in Peroneal Tendoscopy

2020 ◽  
pp. 107110072096632
Author(s):  
Ivan Bojanić ◽  
Igor Knežević ◽  
Damjan Dimnjaković
Keyword(s):  
High Efficiency ◽  
Preoperative Evaluation ◽  
Case Series ◽  
Anatomical Variations ◽  
Common Finding ◽  
Peroneal Tendon ◽  
Ankle Pain ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Peroneus Brevis

Background: We hypothesized that peroneal tendons disorders are more commonly associated with anatomical variations, which could overcrowd the retrofibular groove. Methods: This single-center retrospective case study covered 84 consecutive cases that had undergone peroneal tendoscopy. Peroneal tendoscopy was performed on 82 patients, predominantly female (3:1) with a median age of 46 years. The preoperative evaluation and all the procedures were performed by a single surgeon using a standardized technique. Results: Two patients required revision surgery 8 and 52 months after the index procedure due to persistent posterolateral ankle pain. Peroneal tendoscopy was performed as a solitary procedure in 45.1% (37/82) of cases, while the remaining cases involved peroneal tendoscopy as a supplementary procedure. Low-lying peroneus brevis muscle belly (LLMB) was the most common finding in this series in 53.7% (44/82) of cases. In 41.5% (34/82) of cases, longitudinal tears of the peroneus brevis tendon were noted. Some patients presented with more than 1 concomitant peroneal tendon pathology. The LLMB was observed in 23.5% (8/34) of cases with a longitudinal tear of the peroneus brevis tendon. Conclusion: Peroneal tendon anatomical variations, especially LLMB, were associated with the presence of peroneus brevis tendon ruptures and intrasheath peroneal tendon subluxations as well as posttraumatic posterolateral ankle pain. Due to high rates of undiagnosed and misdiagnosed cases of LLMB preoperatively, we believe special care should be taken to recognize it during tendoscopy. Peroneal tendoscopy is a high-efficiency, low-complication method to treat some peroneal tendon conditions. Level of Evidence: Level IV, case series.

Clinical and Functional Outcomes of Peroneus Longus to Brevis Tendon Transfer

2021 ◽  
pp. 107110072098259
Author(s):  
Marco D. Burkhard ◽  
Stephan H. Wirth ◽  
Octavian Andronic ◽  
Arnd F. Viehöfer ◽  
Florian B. Imhoff ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Contralateral Side ◽  
Isokinetic Strength ◽  
Peroneal Tendon ◽  
Peroneus Longus ◽  
Measurement Protocol ◽  
Tendon Tears ◽  
Peroneus Brevis ◽  
And Inversion

Background: Peroneal tendon lesions can cause debilitating pain, but operative treatment remains controversial. Some studies recommend peroneal tenodesis or transfer if more than half of the tendon is affected. However, clinical outcomes and inversion/eversion motion after peroneal transfer have not been investigated yet. Methods: Patients who underwent distal peroneus longus to brevis transfer for major peroneus brevis tendon tears with a minimum follow-up of 2 years were included. Clinical outcome parameters included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the German Foot Function Index (FFI-D), and Karlsson-Peterson score. Functional outcome was tested with a standardized active range-of-motion (ROM) and isokinetic strength measurement protocol, including concentric and eccentric eversion and inversion tests. Results: Of total 23 eligible patients, 14 (61%) were available for follow-up. Clinical outcome scores were good with AOFAS 86 ± 16 points, FFI-D pain 26% and FFI-D disability 26%, and Karlsson-Peterson score 78 ± 23 points. There was no difference in strength in comparison to the contralateral foot (all P > .05). Isokinetic strength was 16.3 ± 4.9 Nm (108% of contralateral side) and 18.8 ± 4.5 Nm (101%) at concentric 30 deg/s and eccentric 30 deg/s eversion tests, as well as 15.7 ± 5.2 Nm (102%) and 18.7 ± 3.3 Nm (103%) at concentric 30 deg/s and eccentric 30 deg/s inversion tests, respectively. There was no difference in ROM compared to the contralateral side (eversion/inversion 14.5-0-18.7 vs 14.1-0-16.1 degrees). Conclusion: Peroneus longus to brevis transfer is a viable option for treating severe peroneus brevis tendon tears and does not compromise measurable strength or ROM in inversion or eversion in comparison to the contralateral ankle joint. Level of Evidence: Level IV, prospective case series.

Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report

2013 ◽  
Vol 3 (1) ◽  
pp. 1-7
Author(s):  
William R Mook ◽  
James A Nunley
Keyword(s):  
Pain Score ◽  
Preliminary Report ◽  
Short Form ◽  
Peroneal Tendon ◽  
Radiographic Findings ◽  
Allograft Reconstruction ◽  
Functional Scores ◽  
Tendon Ruptures ◽  
Tendon Tears ◽  
Peroneus Brevis

ABSTRACT Background Peroneal tendon injuries represent a significant but underappreciated source of lateral ankle pain. Partial thickness tears of the peroneus brevis amenable to direct repair techniques are common. Irreparable tears are uncommon and require more complex surgical decision-making. Intercalary segment allograft reconstruction has been previously described as a treatment option; however, there are no reports of the outcomes of this technique in the literature. We present our results utilizing this technique. Materials and methods A retrospective chart review was conducted to identify all patients who underwent intercalary allograft reconstruction of the peroneus brevis. Mechanism of injury, concomitant operative procedures, pertinent radiographic findings, pre- and postoperative physical examination, intercalary graft length, medical history, visual analog scores (VAS) for pain, short form-12 (SF-12) physical health survey, lower extremity functional scores (LEFS), and complications were reviewed. Results Eight patients with eight peroneus brevis tendon ruptures requiring reconstruction were indentified. Mean follow-up was 15 months (range, 10-31). The average length of the intercalary segment reconstructed was 12 cm ± 3.9 (range, 8-20). The average postoperative VAS decreased to 1.0 ± 1.6 from 4.0 ± 2.2 (p = 0.01). No patient had a higher postoperative pain score than preoperative pain score. Average postoperative eversion strength improved from 3.5 ± 1.2 to 4.81 ± 0.37 (p = 0.03). The average SF-12 survey improved from 41.1 ± 12.3 to 50.2 ± 9.31 (p = 0.06). The average LEFS improved from 53.3 ± 17.0 to 95.25 ± 10.0 (p = 0.02). Four patients experienced sensory numbness in the sural nerve distribution, and two of these were transient. There were no postoperative wound healing complications, infections, tendon reruptures or reoperations. No allograft associated complications were encountered. All patients returned to their preoperative activity levels. Conclusion Allograft reconstruction of the peroneus brevis can improve strength, decrease pain, and yield satisfactory patientreported outcomes. Importantly, this can be successfully performed without incurring the deleterious effects associated with tendon transfer procedures. Our results suggest that allograft reconstruction may be a safe and reasonable alternative in the treatment of irreparable peroneal tendon ruptures. Level of evidence Therapeutic level IV. Mook WR, Nunley JA. Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report. The Duke Orthop J 2013;3(1):1-7. I

Association Between Hindfoot Alignment and First Metatarsal Rotation

2021 ◽  
pp. 107110072110335
Author(s):  
Neil Bakshi ◽  
Jesse Steadman ◽  
Matthew Philippi ◽  
Christopher Arena ◽  
Richard Leake ◽  
...  
Keyword(s):  
Strong Association ◽  
Improve Patient Care ◽  
Axial Rotation ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
First Metatarsal ◽  
Substantial Correlation ◽  
First Ray ◽  
Improve Patient ◽  
Patient Subgroups

Background: The association between forefoot and hindfoot position for planus and cavus feet is fundamental to the treatment of these deformities. However, no studies have evaluated the association between hindfoot alignment and first metatarsal (M1) axial rotation. Understanding this possible relationship may help to understand the deformity and improve patient care. The purpose of this study is to determine a correlation between hindfoot alignment and metatarsal rotation as assessed by weightbearing computed tomography (WBCT). Methods: Patients who underwent weightbearing plain radiography (WBPR) and WBCT between 2015 and 2018 were evaluated. Hindfoot alignment was measured with the calcaneal moment arm (CMA). M1 rotation was measured using the Kim and Saltzman angles. Patient subgroups were created according to the severity of valgus/varus hindfoot alignment. Statistical analyses were performed to evaluate for association between variables. Results: Among the 196 patient feet included in the study, the average CMA was 6.0 ± 16.2 mm. The average Kim and Saltzman angles were 7.7 ± 12.9 degrees and 2.8 ± 13.1 degrees, respectively. The average Meary angle was 182.0 ± 11.9 degrees. A moderately strong association was found between the CMA and the Saltzman ( r = 0.641, P < .01) and Kim angles ( r = 0.615, P < .01). Hindfoot valgus was associated with M1 pronation and hindfoot varus with M1 supination. Additionally, inverse relationships between the Meary angle and the Saltzman ( r = −0.600, P < .01) and Kim angles ( r = −0.529, P < .01) were identified. Conclusion: In this well-defined cohort, we found substantial correlation between hindfoot alignment and M1 rotation. Hindfoot valgus was associated with M1 pronation, and hindfoot varus was associated with M1 supination. Surgeons correcting cavovarus/planovalgus deformities should be aware of this association and evaluate the need for first-ray derotation. Level of Evidence: Level III, retrospective cohort study.

Peroneus Brevis Tendon Tears: Pathophysiology, Surgical Reconstruction, and Clinical Results

1998 ◽  
Vol 19 (5) ◽  
pp. 271-279 ◽  
Author(s):  
John O. Krause ◽  
James W. Brodsky
Keyword(s):  
Cross Sectional Area ◽  
Surgical Reconstruction ◽  
Peroneal Tendon ◽  
Sectional Area ◽  
Maximum Function ◽  
Cross Sectional ◽  
Clinical Series ◽  
Tendon Tears ◽  
Peroneus Brevis ◽  
The Cross

Chronic peroneus brevis tendon tears are frequently overlooked or misdiagnosed. They are a more common problem than previously noted. Twenty patients were reviewed in the largest clinical series of its kind. The most reliable diagnostic sign was persistent swelling along the peroneal tendon sheath. The pathophysiologic mechanism is subclinical, or overt, subluxation of the tendon over the posterolateral edge of the fibula. This produces multiple longitudinal splits. Treatment is primarily surgical and must address both the split tendon and the subluxation that caused it. A new classification that guides surgical treatment is proposed. Debridement and repair are recommended for grade 1 tendons, which have damage to less than 50% of the cross-sectional area. Excision of the damaged segment and tenodesis to the peroneus longus are recommended for grade 2 tendons, which have destruction of greater than 50% of the cross-sectional area. Both methods must be augmented by stabilization of the etiologic subluxation. The average postoperative AOFAS score was 85. Return to maximum function is prolonged, but good-to-excellent results were found in the majority of patients.

scholarly journals RESULTS OF ORTHOSES USED ON AMBULATORY PATIENTS WITH BILATERAL CEREBRAL PALSY

2020 ◽  
Vol 28 (3) ◽  
pp. 137-141
Author(s):  
ALESSANDRO GIURIZATTO MELANDA ◽  
ANA CAROLINA PAULETO ◽  
DIELISE DEBONA IUCKSCH ◽  
RODRIGO FAUCZ MUNHOZ DA CUNHA ◽  
SUHAILA MAHMOUD SMAILI
Keyword(s):  
Cerebral Palsy ◽  
Gait Analysis ◽  
Gait Velocity ◽  
Temporal Data ◽  
Level Of Evidence ◽  
The Right ◽  
The Impact ◽  
Control Study ◽  
Gait Index

ABSTRACT Objective: To investigate the impact of ankle-foot orthoses (AFO) on subjects diagnosed with bilateral cerebral palsy (CP) using the gait index and temporal data parameters. Methods: Twenty-four subjects, 14 male and 10 female, with a mean age of 11 (5-17 years old), underwent a comprehensive gait analysis under both barefoot (BF) and braced walking conditions. All children had been wearing the orthoses for at least 2 months before the gait analysis. Results: The overall values for the left and right Gait Profile Scores (GPS) did not show statistically significant variations when comparing the same individuals with and without orthoses. Gait velocity increased by 19.5% (p < 0.001), while the cadence decreased by 4% with use of orthosis, although it was not statistically significant (p > 0.05). The stride and the step lengths on both the right and left sides, however, resulted in statistically significant increases, when wearing AFO. Conclusion: AFO, prescribed for assistance by professionals without using gait data, did not significantly affect the gait index (GPS), but improved temporal data. The determination of quantitative clinical parameters for the prescription of orthotics in patients with bilateral CP, as well as orthotics that meet the specific requirements are points to be addressed in the future to obtain more significant effects. Level of evidence III, Case control study.

Impact analysis of missense variants on heat shock protein offarmed carp rohu, Labeo rohita (Hamilton, 1822)

2016 ◽  
Author(s):  
Prajna Pradhan ◽  
Kiran Dashrath Rasal ◽  
Dibyashree Swain ◽  
Pranati Swain ◽  
Jitendra Kumar Sundaray ◽  
...  
Keyword(s):  
Heat Shock ◽  
Impact Analysis ◽  
Labeo Rohita ◽  
Strong Association ◽  
Interaction Mechanism ◽  
Missense Mutations ◽  
Missense Variants ◽  
Shock Proteins ◽  
The Impact

The progress in the computational field is advantageous for investigating the impact of missense variants/mutation on the protein structure-function. The impact analyses of variants on the genes/proteins using in vivo laboratory methods are laborious and time consuming. Thus, the present study was performed for investigating the impact of missense mutations on the Heat-shock proteins (HSP70) of farmed carp, rohu, Labeo rohita. We have used several sequence-based computational tools/algorithms such as SIFT, PANTHER, PROVEAN and I-Mutant2.0. We have depicted that all mutations (p.G6V, p.A56I, and p.A159T) in the HSP70 were deleterious. The 3D model of HSP70 of rohu was generated using Modeller9.14 and subsequently validated using SAVEs server. The Ramachandran plot shown that shifting of residues in the mutant structure towards the disallowed region due to mutation as compared to native counterpart. The ERAT score and PROSA score, also given clues of deteriorating quality of mutant protein HSP70. Moreover, STRING9.1 shown that HSP70 protein interacting with several proteins and strong association was observed with two proteins, hsp90 and dnajb (Hsp40 homolog). The RMSD was obtained 0.04Å between native and mutant structure. The present study will helpful for understanding the impact of missense mutations on the HSP70 of rohu using in vivo methods. This study enriched for further exploring disturbances of protein-protein interaction mechanism as well as associated molecular pathways.

Sign in / Sign up

Export Citation Format

Share Document