Successful reconstruction of distal peroneus longus tendon dislocation associated with a split lesion – a case report

Background Peroneal tendon injuries are one of the differential diagnoses in lateral ankle and rearfoot pain. While partial tears are not uncommon, peroneal tendon dislocation at the peroneal tubercle is very rare. Until now, only three papers have been published, presenting five cases of peroneus longus tendon dislocation over the peroneal tubercle. This report adds a previously undescribed case of a peroneus longus tendon split tear that was partially dislocated and entrapped over the peroneal tubercle. The respective operative approach and the outcome are described. Case presentation A 25-year-old international top-level speed skater developed a painful mass over the lateral calcaneal wall. There was no specific inducing injury in his medical history. In contrast to previous reports, according to the patient’s history, a snapping phenomenon was not present. Conservative treatment was not effective. By inspection and palpation an enlarged peroneal tubercle was assumed. During operative exploration, we found an incomplete longitudinal split tear of the peroneus longus tendon, which was partially dislocated and entrapped over the peroneal tubercle. This mimicked an enlarged peroneal tubercle. A portion of the split tendon was resected. A deepening procedure of the flat groove of the peroneus longus tendon below the peroneal tubercle and a transosseous reconstruction of the avulsed inferior peroneal retinaculum were performed. After six months, the patient had completely reintegrated into his elite sport and has been free of symptoms since then. Conclusions From the presented case it can be speculated that the inferior peroneal retinaculum was overused, worn out, detached, or ruptured due to overpronation and friction the lateral edge of the low-cut speed skating shoe. Then the peroneus longus tendon experienced substantial friction with the peroneal tubercle with possible dislocation during ankle motion. This frictional contact may have finally led to further degeneration and a longitudinal tear of the tendon. Obviously, dislocations can develop insidiously resulting in lesions of the peroneus longus tendon at the peroneal tubercle, ultimately leading to a tendon entrapment. This mimics an enlarged tubercle. The pathology is very rare and can be successfully addressed surgically.

Tryphactothrips rutherfordi (Bagnall) (Thysanoptera, Panchaetothripinae): first description of the male

The subfamily Panchaetothripinae (family Thripidae) is represented by 140 species under 40 genera (Thrips Wiki 2019). In India, 36 species under 16 genera are recorded (Tyagi & Kumar 2016, Tyagi et al. 2017, Rachana and Varatharajan, 2018, Johnson et al. 2019). The members of this subfamily are leaf-feeders and usually dark brown in colour with strongly reticulate sculpture on body, terminal antennal segments needle-shaped, tarsi 1- or 2-segmented, fore wing upper vein fused with costa. The genus Tryphactothrips was established by Bagnall (1919), and this genus remains monobasic with only Dinurothrips rutherfordi Bagnall from Sri Lanka as the type species. The genus Tryphactothrips can be distinguished from related genera by the presence of sculptured round areolae on abdominal segments. It is closely related to Anisopilothrips Stannard & Mitri but can be identified by paired sigmoidal setae on abdominal tergites (absent in Anisopilothrips), mesonotum without complete median longitudinal split (complete median longitudinal in Anisopilothrips). Recently, a series of both sexes of Tryphactothrips rutherfordi with banded fore wings was collected on fern from Kerala state of India. Females were identified using published keys (Wilson 1975), and the male is here described for the first time. DNA was isolated from the studied specimens and partial fragment of mtCOI gene was amplified and sequenced (Tyagi et al. 2017). Four sequences were submitted in the GenBank (Accession No. MN627201 to MN627204). Photographs and illustrations were taken through a Leica Trinocular Microscope (Leica DM-1000) using Leica software application suite (LAS EZ 2.1.0). The studied specimens were deposited in the National Zoological Collections (NZC), Zoological Survey of India, Kolkata, India.

Extensor Carpi Ulnaris Tendon Anatomy May Mimic Tears

Background: Asymptomatic, incidental extensor carpi ulnaris (ECU) tendon abnormalities are frequently noted on imaging studies of the wrist. The aim of this investigation was to determine if variations in gross tendon anatomy existed that could possibly account for these findings on MRI and ultrasound (US) imaging. Methods: The upper extremities of eleven (6 male and 5 female) formalin preserved cadavers were dissected and examined under loupe magnification with attention to the dorsal-ulnar wrist and hand and the ECU tendon. The tendons were inspected for anatomic variations, degenerative changes, and any other pathologies. The presence of intra-tendinous splits arising within the ECU tendon was noted and measured. The distances of the splits from the distal tendon insertion and the edge of the extensor retinaculum were recorded. Statistical correlations between age and the tendon splits were considered using R-squared to assess a linear regression. Results: 17 ECU tendons were dissected and examined, and 5 ECU tendons were excluded due to poor preservation of that upper extremity; all five were right sided upper extremities. Eleven of the 17 specimens demonstrated at least one split in the distal tendon: Seven had 1 split, 1 had 2 splits, and 3 had 3 splits. The mean length of the tendon split was 3.52 cm. The mean distance of the distal edge of the split to the tendon insertion site was 2.4 cm. A linear regression was calculated and showed no correlation between age and number of tendon splits. Conclusions: 64% of specimens showed a longitudinal split in the distal ECU tendon. The location of these frequent splits corresponds to imaging abnormalities on MRI and US in prior studies.

Peroneus Quartus Muscle Autograft

This case report highlights a novel approach to strengthening the repair of a split peroneus brevis tendon tear with a peroneus quartus muscle autograft. We describe a 51-year-old woman with a longitudinal split tear of the peroneus brevis tendon confirmed by magnetic resonance imaging. Intraoperatively, a peroneus quartus muscle was appreciated, resected, and used as an autograft in the repair of the peroneus brevis tendon. Use of a peroneus quartus muscle as an autograft in peroneal tendon repair has not been documented in the literature, to our knowledge.