Tendinopathies des muscles fibulaires, traitement par synovectomie débridement. Intérêt du ténoscanner

Abstract

The tendinopathies of the side peroneal tendon are a relatively frequent pathology but still little is known about them. It is necessary to think of this in the case of any painful symptomatology, with or without instability, at the external face of the ankle. In our series, there is no reference to sex. On the other hand, they are more common among subjects of about fifty years of age and one also notes a clear prevalence with overweight subjects. With regard to our patients, it seems that the symptoms appear mainly at the time of antecedents of surgery on the level of the ankle or the foot (18 cases). Contrary to other studies and although the traumatic aetiology is recognised as prevalent in this pathology, only 15 out of 39 of our subjects presented a traumatic aetiology found at the interrogation and 6 others practised a sport regularly. The tenoscanner allows a direct visualisation of the tendons and neighbouring structures and the opacification highlights the longitudinal cracks. We had 30 tenosynovitis, 24 tendinous cracks and 3 osteotendineous conflicts. Certain cracks could not be detected because of the difficulties of diffusion of the product of contrast but no positive forgery was noted. Indeed, any anomaly visualised during the examination was confirmed by the per-operational diagnosis. In the event of chronic pathology, after failure of preserving a good follow-up treatment and confirmation of pathology by the tenotomodensitometry, a surgical gesture had to be carried out, especially if it highlighted a intra-tendinous crack, since no preserving treatment can improve symptomatology. It was carried out with a combination of synovectomy and meant immobilisation for one month. All the patients then noted a clear improvement of their symptoms since the total score gives 9 very good, 18 good, 12 passable and no bad results. The patients treated by combination present a very positive index of subjective satisfaction with 33 satisfactory cases. With a variable passing between 1 and 4 years, 15 took up a normal activity once again and no longer presented any of the clinical signs they had during the consultations. Due to a defect of healing and the appearance of synovial cysts concerning 3 subjects, a surgical recovery had to be carried out at the level of the scar. Three patients have still not been able to return to their former occupation and 3 need to wait before resuming an intensive sporting activity (although the mobility of ankle is, for the latter, very satisfactory). Our study confirms the need for making a surgical intervention by synovectomy in the event of chronic symptomatology of the peroneal tendon, in the case of any anomaly detected with the tenoscanner (in particular a crack) and in the event of failure of the followup treatment.Tendinopathies des muscles fibulaires, traitement par synovectomie débridement. Intérêt du ténoscanner. À propos de 39 observations Résumé : Les tendinopathies des fibulaires latéraux sont une pathologie relativement fréquente mais encore peu connue. Il faut y so...