Peroneus Quartus Muscle Autograft

Abstract

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.

Peroneus brevis tendon injuries: Report of two cases and review of literature

“…The torn fragment of the PB tendon was excised and the ankle was mobilized early Pts were satisfied, although they still had some exertion pain in their ankle/good outcome Minoyama et al [42] 2 M 17 & 22 Ankle sprain MRI Debridement/the torn tendon was sutured with 4-0 nylon Returned to his full activity 3 m post-op Nishikawa et al [34] 2 M, 1 F Mean age 46 Ankle sprain MRI Semitendinosus tendon autograft was sutured to the proximal stump of the native PB tendon using a Pulvertaft suture with a 1-0 Vicryl. Bone tunnel in 5th metatarsal in 1 case Pts 3 m post-op were pain free Ochoa et al [43] F 16 Chronic pain-hypertrophied tubercle MRI and CT-scan Resection of the hypertrophied tubercle and peroneal tendon repair Returned to her daily activities 6 m post-op Tiwary et al [44] F 40 Old trauma MRI Suture-tubularization of tendon with non-absorbable 4-0 nylon sutures Returned to her daily activities with no pain 4 m post-op Carlis et al [45] F 51 MRI The peroneus quartus tendon was resected as distal as possible and was sutured to the peroneus brevis tendon using 2-0 FiberWire Returned to her returned to her daily routine 3 m post-op Chauhan et al [28] F 64 Old trauma-running-ankle sprain injury 20y MRI Surgical treatment was suggested but the patient denied. Conservative treatment: physical therapy, heel pads and ankle support with a lace-up ankle brace, NSAIDS Diaz et al [46] M 56 2w of progressive pain and swelling of his left ankle.…”

Bilaterally Variant Accessory Fibularis Muscle: Its Phylogenetic, Molecular and Clinical Perspective

“…Later Hecker studied the muscle in detail and reported the existence of accessory muscle in 13% of the cadaveric specimens [7]. According to the existing scientific library text, prevalence of AFM ranges from 2.9 to 21.8% [3][4][5]7,8]. However, a cadaveric study on 70 Indian specimens estimated much lower prevalence in Indian population (4.3%) [3].…”

“…The reported prevalence of bilateral occurrence of accessory fibularis muscle is 0.36% [6]. Cheung reported the prevalence of AFM higher in male which is often bilateral and unilateral in females [4]. Researchers have categorized AFM on the basis of origin and insertion as peroneus quartus [2,6,[8][9][10], peroneus accessorius [10], peroneus digiti minimi (quinti brevis) [2,8,10], peroneocalcaneus externum, peroneocuboideus, peroneocalcaneocuboideus [7], etc.…”

“…Furthermore literature also includes clinical reports encompassing serendipitous detection of accessory muscle in the lateral compartment of leg in patients complaining lateral retromalleolar ankle pain and swelling [15,16]. It was observed that topography of AFM renders nearby structures like FB to undergo attrition due to pressure atrophy under peroneal retinaculum or FL and FB to subluxate [17] or may itself get ruptured due to undue trauma [4,15]. Hence cases with chronic lateral ankle pain must be checked for the presence of AFM [2,6].…”

“…This extra slip has been reported to have beneficial as well as detrimental effects. It may be an additional source of graft harvest for tendon transfer surgeries and autograft [2][3][4]. Bilgili et al mirrored the drawbacks of having a variant muscle in lateral compartment of leg by reporting statistically significant correlation between existence of accessory muscle and longitudinal degeneration of FB which may result in ankle pain [2].…”