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.

Biomechanical Cadaveric Evaluation of Partial Acute Peroneal Tendon Tears

2018 ◽  
Vol 39 (6) ◽  
pp. 741-745 ◽  
Author(s):  
Emilio Wagner ◽  
Pablo Wagner ◽  
Cristian Ortiz ◽  
Ruben Radkievich ◽  
Felipe Palma ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Peroneal Tendon ◽  
Cyclic Testing ◽  
Peroneal Tendons ◽  
Tendon Elongation ◽  
Tensile Forces ◽  
Load To Failure ◽  
Clear Guideline ◽  
The Mean ◽  
Tendon Tears

Background: No clear guideline or solid evidence exists for peroneal tendon tears to determine when to repair, resect, or perform a tenodesis on the damaged tendon. The objective of this study was to analyze the mechanical behavior of cadaveric peroneal tendons artificially damaged and tested in a cyclic and failure mode. The hypothesis was that no failure would be observed in the cyclic phase. Methods: Eight cadaveric long leg specimens were tested on a specially designed frame. A longitudinal full thickness tendon defect was created, 3 cm in length, behind the tip of the fibula, compromising 66% of the visible width of the peroneal tendons. Cyclic testing was initially performed between 50 and 200 N, followed by a load-to-failure test. Tendon elongation and load to rupture were measured. Results: No tendon failed or lengthened during cyclic testing. The mean load to failure for peroneus brevis was 416 N (95% confidence interval, 351–481 N) and for the peroneus longus was 723 N (95% confidence interval, 578–868 N). All failures were at the level of the defect created. Conclusion: In a cadaveric model of peroneal tendon tears, 33% of remaining peroneal tendon could resist high tensile forces, above the physiologic threshold. Clinical Relevance: Some peroneal tendon tears can be treated conservatively without risking spontaneous ruptures. When surgically treating a symptomatic peroneal tendon tear, increased efforts may be undertaken to repair tears previously considered irreparable.

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.

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.

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.

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 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.

scholarly journals Evaluation of anatomical structures after calcaneal Evans- or Hintermann osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Christian Plaass ◽  
Sarah Ettinger ◽  
Leif Claassen ◽  
Christina Stukenborg-Colsman ◽  
Daiwei Yao ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Articular Surface ◽  
Pes Planovalgus ◽  
Foot And Ankle ◽  
Anatomical Structures ◽  
Peroneus Longus Tendon ◽  
Peroneus Longus ◽  
Articular Surfaces ◽  
The Mean ◽  
Peroneus Brevis

Category: Hindfoot Introduction/Purpose: Both Evans- and Hintermann-osteotomies are commonly used for the treatment of flexible pes planovalgus deformity. The aim of this study was to examine, which anatomical structures are affected by the performed osteotomy. Methods: Two experienced foot and ankle surgeons performed an Evans- or Hintermann-osteotomy on each of 7 cadaver feet (Science Care, Arizona, USA). There were no defects on the preparations. All cadaver feet were prepared in the same way following predetermined preparation guidelines. All individual anatomical structures were prepared and, in particular, peroneal tendons, nervus suralis as well as articular surfaces evaluated. Results: The mean age of the donors was 80.8 years. Eight left and six right feet were prepared. After Hintermann osteotomy there was no damage of the peroneus longus tendon, after evans-osteotomy in one case (14.3%). The peroneus brevis tendon was once totally damaged after Hintermann osteotomy and once partially damaged after evans osteotomy. In one cadaver the suralis nerve was partially damaged after hintermann osteotomy, in no case after evans osteotomy. After Hintermann osteotomy the calcaneal anterior and medial articular surface were 100% and 85.7% intact, whereas after Evans osteotomy only 42.9% and 71.4% were not damaged. The posterior articular surface was affected in no cadaver. Conclusion: After both osteotomies anatomical structures can be damaged. Besides biomechanical advantages, with the Hintermann osteotomy the calcaneal anterior and medial articular surface can be protected in a higher percentage than with the Evans osteotomy. Further studies should be performed, if these findings correlate with the clinical outcome.

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

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

Sign in / Sign up

Export Citation Format

Share Document