Current Concepts Review: Peroneal Tendon Subluxation and                Dislocation

Pathological abnormality of the peroneal tendons is an under-appreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from lateral ankle ligament injuries.Enclosed within the lateral compartment of the leg, the peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilisers.Pathology of the tendons falls into three broad categories: tendinitis and tenosynovitis, tendon subluxation and dislocation, and tendon splits and tears. These can be associated with ankle instability, hindfoot deformity and anomalous anatomy such as a low lying peroneus brevis or peroneus quartus.A thorough clinical examination should include an assessment of foot type (cavus or planovalgus), palpation of the peronei in the retromalleolar groove on resisted ankle dorsiflexion and eversion as well as testing of lateral ankle ligaments.Imaging including radiographs, ultrasound and MRI will help determine the diagnosis. Treatment recommendations for these disorders are primarily based on case series and expert opinion.The aim of this review is to summarise the current understanding of the anatomy and diagnostic evaluation of the peroneal tendons, and to present both conservative and operative management options of peroneal tendon lesions.Cite this article: EFORT Open Rev 2017;2:281-292. DOI: 10.1302/2058-5241.2.160047

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“…High complication rates including bone displacement, malunion, metal ware irritation, and tendon attrition have been reported. 44 …”

Section: Pathological Conditionsmentioning

confidence: 99%

“…45 This has been associated with high complication rates including sural nerve neuropathy and ankle instability, and has failed to gain popularity. 44 …”

Section: Pathological Conditionsmentioning

confidence: 99%

Peroneal tendon disorders

et al. 2017

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“…The anterior border is formed by the fibular groove and the fibrous ridge. The posterior wall is created by the deep investing fascia of the leg and the calcaneofibular ligament 4. The calcaneofibular and posterior talofibular ligaments represent the medial frame.…”

Section: Anatomy and Functionmentioning

confidence: 99%

“…The clinician must keep a high index of suspicion for peroneal tendon injuries, as the described mechanism of injury may be similar to that of a lateral ankle sprain, leading to potential misdiagnosis 4. We offer an algorithm (fig.…”

Section: Clinical Presentationmentioning

confidence: 99%

Peroneal tendon subluxation: the other lateral ankle injury

2009

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Ankle injuries are a frequent cause of patient visits to the emergency department and orthopaedic and primary care offices. Although lateral ligament sprains are the most common pathologic conditions, peroneal tendon subluxations occur with a similar inversion mechanism. Multiple grades of subluxation have been described with a recent addition of intrasheath subluxation. Magnetic resonance imaging is the best imaging modality to view the peroneal tendons at the retrofibular groove. Currently, point-of-care ultrasound is gaining clinical ground, especially for the dynamic viewing capability to capture an episodic subluxation. Although conservative treatment may be attempted for an acute injury, it has a low rate of success for the prevention of recurrent subluxation. Surgical procedures of various techniques have resulted in excellent recovery rates and faster return to play. The aim of this paper was to give a complete review of the current literature on peroneal tendon subluxation and to propose a clinical algorithm to help guide diagnosis and treatment. The goal of this study was to heighten clinical awareness to improve earlier detection and treatment of this sometimes elusive diagnosis.

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“…3,4 Therefore, surgical management can reasonably be considered as an appropriate initial treatment alternative, especially in high-demand individuals. 9 Over the past century, more than 20 surgical reconstruction techniques have been described for relocating the peroneal tendons and restoring the integrity of the superior peroneal tunnel. A recent systematic review found a greater rate of return to sports in patients treated with both repair of the superior peroneal retinaculum (SPR) and deepening of the retromalleolar groove as compared with SPR repair alone.…”

mentioning

confidence: 99%

Retromalleolar Groove Deepening in Recurrent Peroneal Tendon Dislocation: Technique Tip

Dijk

Vopat

Guss

et al. 2017

Orthopaedic Journal of Sports Medicine

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Peroneal tendon dislocations are most prevalent in the active and athletic population, so accurate diagnosis and management are essential for optimal return of function. Although many nonoperative and surgical management options have been described, the optimal treatment method continues to be debated. In this technique article, a modified retromalleolar groove–deepening technique is described for addressing all anatomic variations of the posterior distal fibula and retromalleolar groove without unduly disturbing the important anatomic facets meant for retention in this region. This technique is indicated for chronic dislocated peroneal tendons, recurrent dislocating peroneal tendons, and dislocation of the tendons after acute injury with a shallow fibular peroneal groove. Although it remains unclear what effect a cortically abraded fibular gliding surface or forceful cortical impaction on the fibrocartilage gliding surface might have on peroneal tendon integrity and function long term, it would seem preferable to avoid such techniques if reliable alternatives are available.

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Current Concepts Review: Peroneal Tendon Subluxation and Dislocation

Cited by 61 publications

References 38 publications

Peroneal tendon disorders

Peroneal tendon disorders

Peroneal tendon subluxation: the other lateral ankle injury

Retromalleolar Groove Deepening in Recurrent Peroneal Tendon Dislocation: Technique Tip

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