Tendoscopic Treatment of Peroneal Intrasheath Subluxation: A New Subgroup With Superior Peroneal Retinaculum Injury

Guelfi, Matteo; Vega, Jordi; Malagelada, Francesc; Baduell, Albert; Dalmau-Pastor, Miki

doi:10.1177/1071100718764674

Cited by 19 publications

(42 citation statements)

References 48 publications

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“…The fibular groove may be deepened directly using a chisel, mallet, motorized shaver, or burr. 1 , 7 , 28 , 29 The Zoellner and Clancy technique entails formation of an osteoperiosteal flap along the posterolateral distal fibula and lateral malleolus, whose medial side remains attached to the fibula and acts as a hinge. The flap is swung posteriorly along this hinge and fixated, directly deepening the groove.…”

Section: Discussionmentioning

confidence: 99%

Open Peroneal Tendon Stabilization With Fibular Groove Deepening

Hwang¹,

Sol²,

Jenkins³

et al. 2022

Arthroscopy Techniques

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Section: Discussionmentioning

confidence: 99%

Open Peroneal Tendon Stabilization With Fibular Groove Deepening

Hwang¹,

Sol²,

Jenkins³

et al. 2022

Arthroscopy Techniques

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“…SPR connections are essential components of a functional complex at the lateral malleolus level (12,27) . Statistically significant differences in the occurrence of connections revealed on MRI between the ATFL and PTS were noticed before between groups of single and double fascicular ATFL and CFL (11) .…”

Section: Discussionmentioning

confidence: 99%

Anatomical variations and interconnections of the superior peroneal retinaculum to adjacent lateral ankle structures: a preliminary imaging anatomy study

et al. 2021

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Aim: This imaging anatomy study aimed at detecting anatomical variations and potential interconnections of the superior peroneal retinaculum to other lateral stabilizing structures. Materials and methods: We retrospectively reviewed the imaging archives of 63 patients (38 females, 25 males, mean age 32.7, range 18–58 years) with available ankle US, MR and CT images to detect whether US and MR can detect the presence of interconnections between the superior peroneal retinaculum and the anterior talofibular ligament, inferior extensor retinaculum and peroneal tendon sheath. We evaluated the presence of common anatomical variations including low peroneus brevis muscle belly, peroneal tubercle, os peroneum, and retromalleolar fibular groove shape in relation to the presence of superior peroneal retinaculum connections. Results: The connections of the superior peroneal retinaculum can be revealed on magnetic resonance imaging (MRI) and ultrasound (US). The connection to the anterior talofibular ligament was located (a) inferior to the lateral malleolus, (b) at the level of the lateral malleolus and (c) on both levels, respectively (a) 49.2% on MRI and 39.7% on US, p <0.05, (b) 44.4% and 58.7%, p <0.05, 36.5% and (c) 27%, p <0.05. Superior peroneal retinaculum–inferior extensor retinaculum (MRI 47.6%, US 28.6% p <0.001) and superior peroneal retinaculum–peroneal tendon sheath (MRI 22.2%, US 25.4% p >0.05) connections were also found both on MR and US. Conclusion: Ankle US and MR revealed interconnections between the superior peroneal retinaculum and the anterior talofibular ligament, inferior extensor retinaculum, and superior peroneal retinaculum. Our results are a starting point for further studies on the connections of the superior peroneal retinaculum and the applicability of ultrasound and MRI in assessing their occurrence. Knowledge of the anatomical connections of the superior peroneal retinaculum may help radiologists with the assessment of lateral ankle injuries, and surgeons with treatment planning.

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“…This condition is characterized by retrofibular pain and painful clicking of the tendons without disruption of the superior peroneal retinaculum. 13,18,28,34,43 Raikin et al 34 showed 14 cases with PL tendon subluxation around or through the PB tendon without interruption of the superior peroneal retinaculum. The open groove-deepening procedure has successfully managed all cases.…”

Section: Discussionmentioning

confidence: 99%

“…All of them showed signs of tenosynovitis while 2 had a new peroneal tendon tear, 3 had noted LLMB, and 2 had PQ muscle present. 46 Analysis by Guelfi et al 18 of 12 patients with intrasheath subluxations showed that 4 patients had partial PB tendon tear, 4 had LLMB, and 3 had PQ muscle present. We observed LLMB in 7 of 8 cases with intrasheath subluxation of the peroneal tendons.…”

Section: Discussionmentioning

confidence: 99%

“…42 Anatomical variations, such as a low-lying peroneus brevis muscle belly (LLMB) and a peroneus quartus (PQ) muscle alone or in addition to a flat or convex retrofibular groove, may predispose to peroneal tendon damage and subluxation, as well as posterolateral ankle pain. 10,18,23 If the PB muscle extends distally past the SPR occupying the superior peroneal tunnel past the tip of the fibula, it is defined as an LLMB. 14,19,27,39,42 Highlander et al, 19 in a retrospective magnetic resonance imaging (MRI) study, showed the presence of LLMB in 87.5% (28/32) of patients presenting with clinical symptoms of a peroneal tendon disorder.…”

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confidence: 99%

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Importance of Space-Occupying Anatomical Variations in Peroneal Tendoscopy

2020

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Background: We hypothesized that peroneal tendons disorders are more commonly associated with anatomical variations, which could overcrowd the retrofibular groove. Methods: This single-center retrospective case study covered 84 consecutive cases that had undergone peroneal tendoscopy. Peroneal tendoscopy was performed on 82 patients, predominantly female (3:1) with a median age of 46 years. The preoperative evaluation and all the procedures were performed by a single surgeon using a standardized technique. Results: Two patients required revision surgery 8 and 52 months after the index procedure due to persistent posterolateral ankle pain. Peroneal tendoscopy was performed as a solitary procedure in 45.1% (37/82) of cases, while the remaining cases involved peroneal tendoscopy as a supplementary procedure. Low-lying peroneus brevis muscle belly (LLMB) was the most common finding in this series in 53.7% (44/82) of cases. In 41.5% (34/82) of cases, longitudinal tears of the peroneus brevis tendon were noted. Some patients presented with more than 1 concomitant peroneal tendon pathology. The LLMB was observed in 23.5% (8/34) of cases with a longitudinal tear of the peroneus brevis tendon. Conclusion: Peroneal tendon anatomical variations, especially LLMB, were associated with the presence of peroneus brevis tendon ruptures and intrasheath peroneal tendon subluxations as well as posttraumatic posterolateral ankle pain. Due to high rates of undiagnosed and misdiagnosed cases of LLMB preoperatively, we believe special care should be taken to recognize it during tendoscopy. Peroneal tendoscopy is a high-efficiency, low-complication method to treat some peroneal tendon conditions. Level of Evidence: Level IV, case series.

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Tendoscopic Treatment of Peroneal Intrasheath Subluxation: A New Subgroup With Superior Peroneal Retinaculum Injury

Abstract: Level IV, case series.

Cited by 19 publications

References 48 publications

Open Peroneal Tendon Stabilization With Fibular Groove Deepening

Open Peroneal Tendon Stabilization With Fibular Groove Deepening

Anatomical variations and interconnections of the superior peroneal retinaculum to adjacent lateral ankle structures: a preliminary imaging anatomy study

Importance of Space-Occupying Anatomical Variations in Peroneal Tendoscopy

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