Reversal of Peroneal Tenodesis With Allograft Reconstruction of the Peroneus Brevis and Longus

2014 ◽  
Vol 7 (4) ◽  
pp. 327-331 ◽  
Author(s):  
Manuel J. Pellegrini ◽  
Samuel B. Adams ◽  
Selene G. Parekh
Keyword(s):  
Clinical Situation ◽  
Peroneal Tendon ◽  
Therapeutic Level ◽  
Unique Case ◽  
Peroneal Tendons ◽  
Allograft Reconstruction ◽  
Knowledge Reconstruction ◽  
Feasible Alternative ◽  
Peroneus Brevis

Chronic peroneal tendinopathy and tears represent a challenging clinical situation. Traditionally, tenodesis of the torn tendon to the remaining healthy tendon has been advocated if more than half of the tendon is compromised. Allograft reconstructions have been reserved for patients with functional muscles and both peroneal tendons extensively compromised. We report a unique case of a peroneal tenodesis takedown and reconstruction of both peroneal tendons using semitendinosus allograft. A description of the surgical technique and tips are provided. Peroneal tendon function is crucial to maintain a balanced hindfoot. To the best of our knowledge, reconstruction of both peroneal tendons after a tenodesis has not been previously reported. Allograft reconstruction of the peroneal tendons arises as a feasible alternative in patients with residual pain and weakness after a failed tenodesis surgery Levels of Evidence: Therapeutic Level IV, case study

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.

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.

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

scholarly journals Endoscopic Treatment of Intrasheath Peroneal Tendon Subluxation

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Frederick Michels ◽  
Stéphane Jambou ◽  
Stéphane Guillo ◽  
Jan Van Der Bauwhede
Keyword(s):  
Lateral Approach ◽  
Endoscopic Approach ◽  
Peroneal Tendon ◽  
Peroneal Tendons ◽  
The Third ◽  
Recommended Treatment ◽  
Distal Muscle ◽  
Early Return ◽  
Wound Healing Problems ◽  
Peroneus Brevis

Intrasheath subluxation of the peroneal tendons within the peroneal groove is an uncommon problem. Open exploration combined with a peroneal groove-deepening procedure and retinacular reefing is the recommended treatment. This extensive lateral approach needs incision of the intact superior peroneal retinaculum and repair afterwards. We treated three patients with a painful intrasheath subluxation using an endoscopic approach. During this tendoscopy both tendons were inspected. The distal muscle fibers of the peroneus brevis tendon were resected in two patients. A partial tear was debrided in the third patient. All patients had a good result. No wound-healing problems or other complications occurred. Early return to work and sports was possible. An endoscopic approach was successful in treatment of an intrasheath subluxation of the peroneal tendons.

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.

Load to Failure and Stiffness of Interference Screw vs Pulvertaft Weave for Distal Fixation in Peroneal Allograft Reconstruction

2020 ◽  
pp. 107110072095209
Author(s):  
Mostafa M. Abousayed ◽  
Michelle M. Coleman ◽  
Pooyan Abbasi ◽  
Bryan A. Bean ◽  
John M. Thompson ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Interference Screw ◽  
Fixation Method ◽  
Myotendinous Junction ◽  
Initial Stiffness ◽  
Peroneal Tendons ◽  
Allograft Reconstruction ◽  
Load To Failure ◽  
Peroneus Brevis ◽  
Distal Fixation

Background: Allograft reconstruction of the peroneal tendons is an option for treatment of major tears of 1 or both peroneal tendons. No consensus on a superior distal fixation method has been reported. The purpose of the study was to compare load to failure and stiffness of a Pulvertaft weave (PTW) through a residual tendon stump to direct-to-bone interference screw (IS) fixation. Methods: Fifteen pairs of long leg cadaver specimens were used. All grafts were secured proximally to the peroneus brevis myotendinous junction via a PTW technique. Distally, the tendons were either sutured to the peroneus brevis stump via PTW or secured to the base of the fifth metatarsal via IS. Stiffness (slope of force/displacement) was measured for the intact tendon and after reconstruction, and finally each specimen was loaded to failure. Results: Mean load to failure was significantly higher in the PTW group compared with the IS group (373.6 ± 265.5 N vs 150.1 ± 93.1 N; P = .01). The PTW and IS groups had significantly lower stiffness compared with the intact specimens ( P < .001). There was no statistical significance in stiffness between the 2 techniques ( P = .96). Conclusion: The PTW technique yielded higher load to failure in comparison to IS. There was no difference in overall construct stiffness between both techniques. Both constructs demonstrated 19% decrease in stiffness compared to the intact state. Clinical Relevance: The PTW and IS constructs were biomechanically similar, and these results suggest that both should be moderately overtensioned to compensate for an inherent decreased initial stiffness.

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.

Frontal Lobe Epilepsy Presenting as a Psychotic Disorder With Delusions and Hallucinations: A Case Study

CNS Spectrums ◽  
1999 ◽  
Vol 4 (9) ◽  
pp. 64-66,82 ◽  
Author(s):  
Bonnie J. Ramsey
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Frontal Lobe ◽  
Psychotic Disorder ◽  
Temporal Lobe ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
Frontal Lobe Epilepsy ◽  
Unique Case ◽  
Frontal Lobe Seizures

AbstractAlthough psychotic symptoms are a recognized manifestation of epilepsy, these are more often associated with seizures of the temporal lobe type. While 10% of children with temporal lobe epilepsy develop a psychotic disorder by adulthood, the literature does not report any cases of psychotic disorders associated with frontal lobe seizures in children. This article presents a unique case of a girl whose frontal lobe seizures were associated with delusional psychotic symptoms. Once her seizure disorder was identified through electroencephalography (EEG) and appropriate anticonvulsant therapy was initiated, her associated psychotic symptoms resolved.

Irrigation in the Medieval Islamic Fayyum: Local Control in a Large-Scale Hydraulic System

2012 ◽  
Vol 55 (1) ◽  
pp. 1-31 ◽  
Author(s):  
Yossef Rapoport ◽  
Ido Shahar
Keyword(s):  
Water Supply ◽  
Local Control ◽  
Water Allocation ◽  
Hydraulic System ◽  
Large Scale ◽  
Close Reading ◽  
Unique Case ◽  
Islamic Period ◽  
Distinctive Aspect

Abstract Because of the unique set of sources available, the Fayyum in Middle Egypt offers a unique case study of large-scale irrigation from antiquity to the Islamic period. A close reading of a cadastral survey of the province from 641/1243-4 shows that the distinctive aspect of the Islamic period was the local control of water supply and management. Drawing on the engineering experience of the villagers, water allocation and management in the gravity-fed canals of the Fayyum were in the hands of iqṭāʿ holders and tribal groups along the main canals, a pattern similar to that which pertained in mediaeval al-Andalus.

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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