|
1
|
Duarte Silva F, Akram R, Taneja AK, Andrew D, He A, Gupta A, Rajamohan N, Liu G, VanPelt M, Xi Y, Chhabra A. Assessment of peroneal tendon lesions using 2-dimensional and 3-dimensional isotropic magnetic resonance imaging with surgical correlation. J Foot Ankle Surg 2025; 64:285-290. [PMID: 39672295 DOI: 10.1053/j.jfas.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/24/2024] [Accepted: 12/08/2024] [Indexed: 12/15/2024]
Abstract
Accurate diagnoses of peroneal pathologies remains a challenge due to limitations of conventional 2D (dimensional) imaging, which can impact long-term patient outcomes. This study evaluates MRI accuracy and inter-reader reliability of peroneal compartment pathology for 2D and 3D MRI. A consecutive series of patients who underwent peroneal compartment surgery with preoperative 1.5- or 3.0-Tesla ankle MRIs from 2009 to 2024 included 32 scans (22 with 2D, 10 with 2D+3D) from 31 patients (ages 17-74 years, all genders). Three musculoskeletal readers blinded to surgical findings independently analyzed MRI scans for common peroneal tenosynovitis, peroneus brevis and peroneus longus tenosynovitis, tendinopathy, and tears. Inter-reader reliability and diagnostic performance measures were calculated. Using majority vote, overall accuracy, sensitivity, and specificity for peroneal tendons using 2D MRI were 80%, 81%, and 79%, respectively. Using 3D MRI sequences, whether in isolation or combination with 2D MRI, accuracy, sensitivity, and specificity increased to 85%, 88%, and 83%, respectively. The inter-reader reliability for peroneus brevis lesions was 0.45-0.75 for 2D, 0.25-0.35 for 3D, and 0.31-0.54 for combined 2D+3D, while for peroneus longus lesions, it was 0.45-0.90 for 2D, 0.20-0.71 for 3D, and 0.64-0.81 for combined 2D+3D scans. The inter-reader reliability for tenosynovitis ranged from 0.62-0.64 for 2D, 0.25-0.37 for 3D, and 0.57-0.66 for combined 2D+3D scans. The addition of 3D MRI to 2D high-resolution ankle MRI protocol or 3D MRI alone increases accuracy of peroneal compartment lesion detection with minor decrease in inter-reader reliability for peroneal brevis tendon assessment. Larger studies may help validate our findings.
Collapse
Affiliation(s)
- Flavio Duarte Silva
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA.
| | - Rubeel Akram
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA
| | - Atul Kumar Taneja
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA
| | - Dhilip Andrew
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA
| | - Angela He
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA
| | - Anuj Gupta
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA
| | - Naveen Rajamohan
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA
| | - George Liu
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA
| | - Michael VanPelt
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA; Associate Professor Foot & Ankle Surgery Section, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Yin Xi
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA
| |
Collapse
|
|
2
|
Gorbachova T, Saad SS, Pruna R, Melenevsky YV. Patterns of ankle injury in soccer: MRI clues to traumatic mechanism. Skeletal Radiol 2025; 54:683-693. [PMID: 38157033 DOI: 10.1007/s00256-023-04547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/10/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
Understanding the traumatic mechanisms of ankle injuries in soccer is crucial for an accurate and complete MRI diagnosis. Many ankle injuries share universal mechanisms seen in other athletic activities, but certain patterns are found to be more specific and relatively unique to soccer. Ankle impingement syndromes encountered in soccer encompass a spectrum of disorders that include anterior and posterior impingement categories, with anterior impingement representing pathology relatively specific to soccer. Lateral ligamentous sprains are one of the most common injuries; however, there is a higher rate of injuries to the medial structures in soccer as compared to other sports. Ankle fractures are uncommon in soccer while bone contusions and chondral and osteochondral injuries frequently accompany ligamentous sprains. Tendon abnormalities in soccer most commonly result from overuse injuries and typically affect peroneal tendons, posterior and anterior tibialis tendons, and Achilles tendon. Acute Achilles tendon ruptures occur in both recreational players and elite soccer athletes. Tibialis anterior friction syndrome may mimic tibial stress fractures. Long-term sequelae of acute traumatic and chronic overuse ankle injuries in professional soccer players manifest as ankle osteoarthritis that is more prevalent compared to not only the general population, but also to former elite athletes from other sports. This article examines the most common and specific injuries in soccer in order of their frequency.
Collapse
Affiliation(s)
- Tetyana Gorbachova
- Department of Radiology, Jefferson Einstein, 5501 Old York Road, Levy building, Philadelphia, PA, 19141, USA.
| | - Sherif S Saad
- Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ, USA
| | - Ricard Pruna
- FC Barcelona Medical Department, Barcelona, Spain
| | - Yulia V Melenevsky
- Department of Radiology, University of Alabama at Birmingham, UAB Medical Center, Birmingham, AL, USA
| |
Collapse
|
|
3
|
Munshi S, Nair R, Nair R, Soni A, Reghuram V, Munuswamy S, Baqai N, Kanesan H. Diagnostic and Therapeutic Role of Peroneal Tenography in Chronic Peroneal Disorders: A Service Evaluation. Cureus 2025; 17:e81742. [PMID: 40330353 PMCID: PMC12051077 DOI: 10.7759/cureus.81742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2025] [Indexed: 05/08/2025] Open
Abstract
Purpose The aims were to investigate if there was a diagnostic difference between peroneal tenography and MRI to guide the management of peroneal tendon disorders with the secondary aim to investigate the therapeutic effect of peroneal tenography. Methods A retrospective study was carried out over a 75-month period, including all patients over 18 years who presented with ankle injuries to identify patients with peroneal tendon disorders. Symptomatic patients were investigated using MRI and peroneal tenography. This was also compared with intraoperative findings of peroneal tendons. Fischer's exact test was used to determine the diagnostic difference between peroneal tenography as compared to MRI. The therapeutic effect of peroneal tenography was also calculated. Results The cohort consisted of 27 patients (20 females and 7 males), with the median age being 50 years and the mean BMI being 31.9. The follow-up period after the final management plan was 12 months before discharge from care. Findings from peroneal tenography were more likely to match intraoperative findings than MRI when compared with intraoperative findings (p=0.033). Fifteen out of the 27 patients who underwent peroneal tenography reported adequate pain relief following the procedure. Conclusion Peroneal tenography is more sensitive and specific in determining peroneal tendon disorders as compared to MRI and plays a role as a therapeutic intervention in ankle pain management for these patients.
Collapse
Affiliation(s)
- Sandeep Munshi
- Trauma and Orthopaedics, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Barrow in Furness, GBR
| | - Ranjith Nair
- Trauma and Orthopaedics, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Barrow in Furness, GBR
| | - Rajiv Nair
- Trauma and Orthopaedics, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Barrow in Furness, GBR
| | - Aditya Soni
- Trauma and Orthopaedics, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Barrow in Furness, GBR
| | - Vaisakh Reghuram
- Trauma and Orthopaedics, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Barrow in Furness, GBR
| | - Sivasankaran Munuswamy
- Trauma and Orthopaedics, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Barrow in Furness, GBR
| | - Nadeem Baqai
- Trauma and Orthopaedics, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Barrow in Furness, GBR
| | - Hariprasath Kanesan
- Trauma and Orthopaedics, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
| |
Collapse
|
|
4
|
Lui TH, Choi YH. Endoscopic Retrofibular Groove Deepening for Management of Type A Intrasheath Peroneal Tendon Subluxation. Arthrosc Tech 2024; 13:103148. [PMID: 39780890 PMCID: PMC11704903 DOI: 10.1016/j.eats.2024.103148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/30/2024] [Indexed: 01/11/2025] Open
Abstract
In intrasheath peroneal tendon subluxation, the peroneal tendons subluxate on each other within the retrofibular peroneal tendon sheath. Two subtypes can be distinguished: type A, in which the tendons are normal, and type B, in which the peroneus brevis tendon has an associated longitudinal split and the peroneus longus tendon subluxates through this tendon split. The purpose of this technical note is to describe the details of endoscopic retrofibular groove deepening for management of type A intrasheath peroneal tendon subluxation. This can prevent extensive scar formation, tendon adhesions, and sural nerve entrapment, as well as the problem of prolonged postoperative immobilization.
Collapse
Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, China
| | - Yu Hei Choi
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Sha Tin, China
| |
Collapse
|
|
5
|
Bokwa-Dąbrowska K, Mocanu D, Alexiev A, Helander KN, Szaro P. Peroneus brevis split rupture is underreported on magnetic resonance imaging of the ankle in patients with chronic lateral ankle pain. Eur J Radiol Open 2024; 13:100591. [PMID: 39131949 PMCID: PMC11314861 DOI: 10.1016/j.ejro.2024.100591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Peroneus brevis split rupture poses a diagnostic challenge, often requiring magnetic resonance imaging (MRI), yet splits are missed in initial radiological reports. However, the frequency of reported peroneus brevis split rupture in clinical MRI examinations is unknown. Aim This study aimed to investigate underreporting frequency of peroneus brevis split rupture in patients with lateral ankle pain. Methods We re-evaluated 143 consecutive MRI examinations of the ankle joint, conducted in 2021 in our region, for patients experiencing ankle pain persisting for more than 8 months. Two musculoskeletal radiologists, with 12 and 8 years of experience respectively, assessed the presence of peroneus brevis split rupture. Patients with recent ankle trauma, fractures, postoperative changes, or MRI artifacts were excluded. The radiologists evaluated each MRI for incomplete or complete peroneus brevis split rupture. The consensus between the raters was used as the reference standard. Additionally, raters reviewed the original clinical radiological reports to determine if the presence of peroneus brevis split rupture was noted. Agreement between raters' assessments, consensus, and initial reports was evaluated using Gwet's AC1 coefficients. Results Initial radiological reports indicated 23 cases (52.3 %) of peroneus brevis split rupture, meaning 21 cases (47.7 %) were underreported. The Gwet's AC1 coefficients showed that the agreement between raters and initial reports was 0.401 (standard error 0.070), 95 % CI (0.261, 0.541), p<.001, while the agreement between raters in the study was 0.716 (standard error 0.082), 95 % CI (0.551, 0.881), p<.001. Conclusion Peroneus brevis split rupture is underreported on MRI scans of patients with lateral ankle pain.
Collapse
Affiliation(s)
- Katarzyna Bokwa-Dąbrowska
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Mocanu
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alex Alexiev
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Nilsson Helander
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
|
6
|
Taljanovic MS, Omar IM, Melville DM, Shultz CL, Klauser AS, Weaver JS. Imaging mimickers of MSK infection. Skeletal Radiol 2024; 53:2227-2246. [PMID: 39150526 DOI: 10.1007/s00256-024-04763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/17/2024]
Abstract
Along with clinical and laboratory findings, imaging has a significant role in the initial evaluation and treatment follow-up of a wide variety of infectious and non-infectious musculoskeletal (MSK) conditions. The imaging findings of many non-infectious MSK processes, such as inflammatory, metabolic, and degenerative arthropathies, complications of diabetes mellitus, osseous and soft tissue injuries, osteonecrosis, tumors, and tumor-like lesions may be nonspecific and often overlap with those found in MSK infections. In this article, the authors discuss the imaging findings of both frequent and rare mimickers of MSK infections, including potential distinguishing characteristics.
Collapse
Affiliation(s)
- M S Taljanovic
- Departments of Medical Imaging and Orthopaedic Surgery, The University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA.
- Department of Radiology, University of New Mexico, MSC 10 5530, Albuquerque, NM, 87131, USA.
| | - I M Omar
- Department of Radiology, Northwestern Memorial Hospital, 676 N. Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - D M Melville
- Department of Radiology, Mayo Clinic Arizona, 5777 E. Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - C L Shultz
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131, USA
| | - A S Klauser
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - J S Weaver
- Department of Radiology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| |
Collapse
|
|
7
|
Pirri C, Pirri N, Macchi V, Porzionato A, De Caro R, Stecco C. Ultrasound Imaging of Ankle Retinacula: A Comprehensive Review. Tomography 2024; 10:1277-1293. [PMID: 39195730 PMCID: PMC11359401 DOI: 10.3390/tomography10080095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/28/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
The retinacula of the ankle are specialized anatomical structures characterized by localized thickenings of the crural fascia that envelop the deep components of the lower leg, ankle and foot. The ankle retinacula include the extensor retinacula, the peroneal retinacula and flexor retinaculum. Despite their potential to explain persistent and unexplained pain following an injury, these structures are often overlooked or incorrectly diagnosed. Hence, this comprehensive review was performed aiming to investigate the use and the methodology of US imaging to assess ankle retinacula. The search was performed on PubMed and Web of Science databases from inception to May 2024. The MeSH keywords used were as follows: "Ankle Retinacula", "Foot Retinacula", "Superior extensor retinaculum", "Inferior extensor retinaculum", "peroneal retinaculum", "superior peroneal retinaculum", "inferior peroneal retinaculum", "flexor retinaculum", "Ultrasound Imaging", "Ultrasound", "Ultrasonography" and "Ultrasound examination". In total, 257 records underwent screening, resulting in 22 studies meeting the criteria for inclusion after the process of revision. Data heterogeneity prevents synthesis and consistent conclusions. The results showed that advanced US imaging holds promise as a crucial tool to perform an US examination of ankle retinacula, offering static and dynamic insights into ankle retinacula pathology. Understanding normal anatomy and US imaging is essential for accurately identifying injuries. Future research should focus on clinical trials to validate parameters and ensure their reliability in clinical practice.
Collapse
Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Nina Pirri
- Department of Medicine—DIMED, School of Radiology, Radiology Institute, University of Padova, 35122 Padova, Italy;
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| |
Collapse
|
|
8
|
Pirri C, Stecco C, Güvener O, Mezian K, Ricci V, Jačisko J, Fojtik P, Kara M, Chang KV, Dughbaj M, Özçakar L. EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Ankle/Foot. Am J Phys Med Rehabil 2024; 103:e29-e34. [PMID: 37903600 DOI: 10.1097/phm.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
ABSTRACT In this dynamic scanning protocol, ultrasound examination of the ankle is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine.
Collapse
Affiliation(s)
- Carmelo Pirri
- From the Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CP, CS); Department of Physical and Rehabilitation Medicine, Mersin University Medical School, Mersin, Turkey (OG); Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine, Prague, Czech Republic (KM); Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic (JJ); Institute of Anatomy, Charles University, First Faculty of Medicine, Prague, Czech Republic, Department of Orthopedics, The Central Military Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic (PF); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, L Ö); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taiwan (K.-VC); National Taiwan University College of Medicine, Taipei, Taiwan (K.-VC); Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait (MD)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
9
|
Melville DM, Taljanovic MS, Gimber LH, Miller M, Ahmad A, Sepich D, Latt LD. Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation. J Clin Med 2024; 13:740. [PMID: 38337434 PMCID: PMC10856550 DOI: 10.3390/jcm13030740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Suspected peroneal tendinopathy, tears, and subluxation are often confirmed preoperatively using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). No study has directly compared the accuracy of these tests for the diagnosis of peroneal tendon pathology. The purpose of this study is to directly compare MRI and US to intraoperative findings in patients who underwent surgery for suspected peroneal pathology to determine the imaging diagnostic accuracy. Operative records and diagnostic images for 21 consecutive patients who had both MRI and US prior to surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. The results of this review are compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality. For the diagnosis of peroneal tendon tears, US was found to have a sensitivity of 88% and specificity of 100%, compared to 100% sensitivity and specificity for MRI. In the diagnosis of peroneal tendinopathy, both US and MRI had a sensitivity and specificity of 100%. In diagnosing peroneal subluxation, US was 100% sensitive compared to 66% for MRI, and both were 100% specific. In conclusion, US was found to be more effective in diagnosing peroneal subluxation and MRI was slightly more accurate in the diagnosis of peroneal tendon tears.
Collapse
Affiliation(s)
- David M. Melville
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85259, USA;
| | - Mihra S. Taljanovic
- Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA;
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Lana H. Gimber
- Kaiser Permanente Moanalua Medical Center, Honolulu, HI 96819, USA;
| | - Matthew Miller
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA;
| | - Aamir Ahmad
- Department of Orthopaedic Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA;
| | | | - L. Daniel Latt
- Kaiser Permanente Moanalua Medical Center, Honolulu, HI 96819, USA;
| |
Collapse
|
|
10
|
Castilho RS, Magalhães JMB, Veríssimo BPM, Perisano C, Greco T, Zambelli R. Minimally Invasive Peroneal Tenodesis Assisted by Peroneal Tendoscopy: Technique and Preliminary Results. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:104. [PMID: 38256365 PMCID: PMC10819866 DOI: 10.3390/medicina60010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/19/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Introduction: Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability. Clicking, swelling, pain, and tenderness in the peroneal tendons track are frequent symptoms, but they can be confused with other causes of lateral ankle pain. The management of peroneal disorders can be conservative or surgical. When the conservative treatment fails, surgery is indicated, and open or tendoscopic synovectomy, tubularization, tenodesis or tendon transfers can be performed. The authors present a surgical technique of tendoscopy associated to minimally invasive tenodesis for the treatment of peroneal tendon tears, as well as the preliminary results of patients submitted to this procedure. Methods: Four patients with chronic lateral ankle pain who were diagnosed with peroneal brevis pathology were treated between 2020 and 2022 with tendoscopic-assisted minimally invasive synovectomy and tenodesis. Using a 2.7 mm 30° arthroscope and a 3.0 mm shaver blade, the entire length of the peroneus brevis tendon and most parts of the peroneus longus tendon can be assessed within Sammarco's zones 1 and 2. After the inspection and synovectomy, a minimally invasive tenodesis is performed. Results: All patients were evaluated at least six months after surgery. All of them reported improvement in daily activities and in the Foot Function Index (FFI) questionnaire (pre-surgery mean FFI = 23.86%; post-surgery mean FFI = 6.15%), with no soft tissue complications or sural nerve complaints. Conclusion: The tendoscopy of the peroneal tendons allows the surgeon to assess their integrity, confirm the extent of the lesion, perform synovectomy, prepare the tendon for tenodesis, and perform it in a safe and minimally invasive way, reducing the risks inherent to the open procedure.
Collapse
Affiliation(s)
- Rodrigo Simões Castilho
- Department of Orthopaedics and Traumatology, Mater Dei Hospital, Belo Horizonte 30170-041, Brazil (B.P.M.V.); (R.Z.)
| | - João Murilo Brandão Magalhães
- Department of Orthopaedics and Traumatology, Mater Dei Hospital, Belo Horizonte 30170-041, Brazil (B.P.M.V.); (R.Z.)
| | - Bruno Peliz Machado Veríssimo
- Department of Orthopaedics and Traumatology, Mater Dei Hospital, Belo Horizonte 30170-041, Brazil (B.P.M.V.); (R.Z.)
| | - Carlo Perisano
- Orthopaedics and Traumatology, Dipartimento di Scienze Dell’invecchiamento, Ortopediche e Reumatologiche Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (T.G.)
| | - Tommaso Greco
- Orthopaedics and Traumatology, Dipartimento di Scienze Dell’invecchiamento, Ortopediche e Reumatologiche Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (T.G.)
| | - Roberto Zambelli
- Department of Orthopaedics and Traumatology, Mater Dei Hospital, Belo Horizonte 30170-041, Brazil (B.P.M.V.); (R.Z.)
- Surgical Department of Faculty of Medical Sciences of Minas Gerais, Belo Horizonte 30170-041, Brazil
| |
Collapse
|
|
11
|
Lee B, Parellada AJ, Gorbachova T. Retracted os peroneum with partial integrity of the peroneus longus tendon. Skeletal Radiol 2024; 53:179-185. [PMID: 37486361 DOI: 10.1007/s00256-023-04407-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/15/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
Painful os peroneum syndrome encompasses a spectrum of disorders associated with lateral foot and ankle pain. In the setting of an os peroneum fracture or diastasis of a partitioned os peroneum, marked displacement of the proximal fragment on radiographs is often used as an imaging surrogate for detection of a complete peroneus longus tendon tear. We present a case of a displaced proximal fragment of the os peroneum above the level of the ankle joint on radiographs and MRI associated with incomplete tear of the peroneus longus tendon. We hypothesize that such an injury pattern results from an anatomic prerequisite where the os peroneum occupies a portion of the cross-sectional diameter of the tendon. We suggest that the retracted proximal moiety of the sesamoid bone is the result of elastic recoil of delaminated fibers of the peroneus longus directly inserting on the os, whereas eccentric bundles of the tendon draping over the os remain in continuity. Although treatment implications are debatable, the case questions the assumption of a complete peroneus longus tear based on a retracted os peroneum on radiography and highlights the role of MRI in providing a full description.
Collapse
Affiliation(s)
- Brian Lee
- Department of Radiology, Einstein Healthcare Network, Part of Jefferson Health, Sidney Kimmel Medical College at Thomas Jefferson University, 5501 Old York Rd, Philadelphia, PA, 19141, USA.
| | - Antoni J Parellada
- Department of Radiology, Einstein Healthcare Network, Part of Jefferson Health, Sidney Kimmel Medical College at Thomas Jefferson University, 5501 Old York Rd, Philadelphia, PA, 19141, USA
| | - Tetyana Gorbachova
- Department of Radiology, Einstein Healthcare Network, Part of Jefferson Health, Sidney Kimmel Medical College at Thomas Jefferson University, 5501 Old York Rd, Philadelphia, PA, 19141, USA
| |
Collapse
|
|
12
|
Cerezal A, Ocampo R, Llopis E, Cerezal L. Ankle Instability Update. Semin Musculoskelet Radiol 2023; 27:231-244. [PMID: 37230124 DOI: 10.1055/s-0043-1767767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.
Collapse
Affiliation(s)
- Alvaro Cerezal
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Ronald Ocampo
- Department of Radiology, Hospital de Trauma del Instituto Nacional de Seguros, San Jose, Costa Rica
| | - Eva Llopis
- Department of Radiology, Hospital IMSKE, Hospital de la Ribera, Valencia, Spain
| | - Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Santander, Spain
| |
Collapse
|
|
13
|
Huuskonen M, Borkmann S, Bengtsson A, Sobecki P, Józwiak R, Solidakis N, Szaro P. Radiological features accompanying peroneus brevis split rupture revealed on magnetic resonance imaging - a cohort study. J Foot Ankle Res 2023; 16:10. [PMID: 36864523 PMCID: PMC9979459 DOI: 10.1186/s13047-023-00604-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/01/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Peroneal split tears are an underrated cause of ankle pain. While magnetic resonance imaging (MRI) is useful for diagnosis, split tears are challenging to identify. The aim of the study was to investigate the association of peroneus brevis split rupture with abnormalities of the superior peroneal retinaculum (SPR), anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), joint effusion, morphology of the malleolar groove, presence of the bone marrow oedema and prominent peroneal tuberculum. METHODS Ankle MRI cases were assessed by independent observers retrospectively in two groups: one with peroneus brevis split tears (n = 80) and one without (control group, n = 115). Two observers evaluated the soft tissue lesions, and three graded the bone lesions. Fisher's exact test and Pearson correlation were used for analysis. The Bonferroni-Holm method (B-H) was used to adjust for multiple comparisons. RESULTS Only bone marrow edema in the posterior part of the lateral malleolus was significantly (p < 0.05) more common in the split tear group after applying B-H. SPR total rupture was seen only in the experimental group. No differences in incidence of ATFL and CFL lesions or other SPR lesions were noticed (p < 0.05). CONCLUSION Bone marrow edema in the posterior part of the lateral malleolus is associated with peroneus split tears on MRI.
Collapse
Affiliation(s)
- Michael Huuskonen
- grid.8761.80000 0000 9919 9582Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Borkmann
- grid.1649.a000000009445082XDepartment of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alexander Bengtsson
- grid.1649.a000000009445082XDepartment of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Piotr Sobecki
- grid.426232.30000 0001 2228 7645Applied Artificial Intelligence Laboratory, National Information Processing Institute, Warsaw, Poland
| | - Rafał Józwiak
- grid.426232.30000 0001 2228 7645Applied Artificial Intelligence Laboratory, National Information Processing Institute, Warsaw, Poland ,grid.1035.70000000099214842Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Nektarios Solidakis
- grid.8761.80000 0000 9919 9582Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paweł Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.
| |
Collapse
|
|
14
|
Abou Diwan R, Badr S, Boulil Y, Demondion X, Maynou C, Cotten A. Presurgical Perspective and Postsurgical Evaluation of Non-Achilles Tendons of the Ankle and Retinaculum. Semin Musculoskelet Radiol 2022; 26:670-683. [PMID: 36791736 DOI: 10.1055/s-0042-1760121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The vast majority of non-Achilles ankle tendinopathies are related to overuse. This article discusses the clinical aspect, imaging appearance, and management of tendinopathies of the lateral, medial, and the anterior compartments with a focus on presurgical perspective and postsurgical evaluation.
Collapse
|
|
15
|
Ayanoglu T, Arikan E, Kurtbogan M, Yilmaz OF, Kaya YE, Ozturan KE. Anatomical Factors Which Influence the Formation of Peroneal Tendon Tears: A Retrospective Comparative Study. J Foot Ankle Surg 2022; 61:1299-1302. [PMID: 35606277 DOI: 10.1053/j.jfas.2022.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 02/03/2023]
Abstract
This study aims to investigate the anatomical factors that are effective in the formation of peroneal tendon tears comparing with the control group. The patients with ankle magnetic resonance imaging (MRI) due to pain on the lateral side of the ankle were retrospectively analyzed using the clinical archive between July 2015 and January 2020. Peroneal tendon tears, peroneal tubercle type and size, presence of peroneal quartus, presence and type of retromalleolar groove, retromalleolar groove area, lateral malleolus type, presence of os peroneum, peroneus brevis-lateral malleolus distance (PBLMD), and accompanying pathologies in coronal, axial, and sagittal planes MRI were evaluated. PBLMD was measured as 27.1 ± 12.3 mm in Group 1. With PBLMD, it was measured as 39.6 ± 11.68 mm in Group 2. There was a significant relationship between low-lying peroneus brevis muscle and peroneal tear (p < .001). Peroneal tendon tear was more common in patients with peroneal quartus muscle (p < .001). There was a relationship between the retromalleolar groove type and the presence of peroneal tear (p = .004). More peroneal tears were observed in the concave retromalleolar groove type. The presence of concave type retromalleolar groove, peroneus quartus, and low-lying peroneus brevis muscle was found to be associated with peroneal tendon tears.
Collapse
Affiliation(s)
- Tacettin Ayanoglu
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
| | - Emre Arikan
- Department of Orthopaedics and Traumatology, Çanakkale State Hospital, Çanakkale, Turkey.
| | - Mahmut Kurtbogan
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
| | - Omer Faruk Yilmaz
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
| | - Yasin Emre Kaya
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
| | - Kutay Engin Ozturan
- Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey
| |
Collapse
|
|
16
|
Park J, Kim YH, Choi WJ, Cho HR, Hong UJ, Yi J, Choi YS, Lim YS, Kim YU. The value of the peroneus brevis tendon cross-sectional area in early diagnosing of peroneus brevis tendinitis: The peroneus brevis tendon cross-sectional area. Medicine (Baltimore) 2022; 101:e31276. [PMID: 36316917 PMCID: PMC10662861 DOI: 10.1097/md.0000000000031276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/20/2022] [Indexed: 01/05/2023] Open
Abstract
A thickened peroneus brevis tendon has been considered to be an important morphologic parameter of peroneus brevis tendinitis (PBT). Previous researchers have found that the peroneus brevis tendon thickness (PBTT) is correlated with inflammation of the peroneus brevis tendon. However, inflammatory hypertrophic change is different from simple thickness. Thus, we devised the peroneus brevis tendon cross-sectional area (PBTCSA) as a new diagnostic parameter to analyze the hypertrophy of the whole PBT. We assumed that the PBTCSA is a major morphologic parameter useful for early PBT diagnosis. Peroneus brevis tendon images were collected from 22 patients with PBT and from 22 normal subjects who underwent ankle-magnetic resonance imaging and revealed no evidence of PBT. The T1-weighted axial ankle-magnetic resonance imaging images were evaluated at the ankle level from all participants. The PBTT was measured as the thickest point at the transverse image of the peroneus brevis tendon. The PBTCSA was measured as the cross-sectional ligament whole area of the peroneus brevis tendon that was most hypertrophied in the axial A-MR images. The average PBTT was 2.22 ± 0.29 mm in the normal group and 2.85 ± 0.36 mm in the PBT group. The average PBTCSA was 6.98 ± 1.54 mm2 in the normal group and 13.11 ± 2.45 mm2 in the PBT group. PBT patients had significantly greater PBTT (P < .001) and PBTCSA (P < .001) than the normal group did. A receiver operating characteristic curve analysis revealed that the most suitable cutoff value of the PBTT was 2.51 mm, with 81.8% sensitivity and 81.8% specificity, and an AUC for the score was 0.93. The most suitable cutoff value of the PBTCSA was 10.08 mm2, with 90.9% sensitivity and 90.9% specificity, and AUC for the score was 0.98. Even though the PBTT and PBTCSA were both significantly associated with PBT, the PBTCSA was a more sensitive diagnostic parameter.
Collapse
Affiliation(s)
- Jiyeon Park
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medicine, Graduate School, Catholic University of Korea, Seoul, Republic of Korea
| | - Yun-Hong Kim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Jun Choi
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Uk Jin Hong
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Su Lim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| |
Collapse
|
|
17
|
Taparia A, Kumar S, Saran S. Lateral Retromalleolar Swelling and Pain - Peroneus Brevis Tendon Tear (Boomerang Sign). J Med Ultrasound 2022; 30:237-238. [PMID: 36484052 PMCID: PMC9724469 DOI: 10.4103/jmu.jmu_31_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anuj Taparia
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sunil Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sonal Saran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
|
18
|
Grandberg C, de Oliveira DP, Gali JC. Superior peroneal retinaculum reattachment for an atraumatic peroneus brevis tendon subluxation: a case report. J Med Case Rep 2022; 16:239. [PMID: 35705971 PMCID: PMC9202114 DOI: 10.1186/s13256-022-03455-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Peroneal tendon subluxation is a rare pathology, generally associated with sport-induced trauma, that occurs due to the rupture of the superior peroneal retinaculum. The diagnosis is mainly clinical, but the use of imaging techniques, such as dynamic ultrasound and magnetic resonance imaging, may contribute to its clarification. Treatment may be conservative or surgical, although there is no consensus on the most appropriate technique to be employed. We report a case of subluxation of the peroneus brevis tendon, with no apparent traumatic cause, in which there was a need for a surgical approach after the failure of conservative treatment. Case presentation A 25-year-old White woman presented pain and locking of the lateral side of the left foot 2 years earlier, with no history of trauma. The patient felt pain upon palpation and presented snapping during flexion–extension of the left ankle. On dynamic ultrasonography, an anterior subluxation of the peroneus brevis tendon occurred when the ankle was in dorsiflexion, suggesting superior peroneal retinaculum injury. Surgical correction was recommended after 2 months of conservative treatment with no improvement. The chosen surgical technique was isolated reattachment of the superior peroneal retinaculum, which proved successful. Conclusions Peroneal tendon subluxation has no established preferred surgical technique. This case demonstrates superior peroneal retinaculum repair as an efficient surgical approach for this condition. Furthermore, the atraumatic mechanism of injury in this case, along with the unknown true incidence of peroneal tendon subluxation, highlights the need to consider this pathology in cases of ankle injuries.
Collapse
Affiliation(s)
- Camila Grandberg
- Faculty of Medical and Health Sciences, Pontifical Catholic University of São Paulo, Rua Joubert Wey, 290, Sorocaba, SP, Brazil.
| | | | - Julio Cesar Gali
- Department of Surgery, Faculty of Medical and Health Sciences, Pontifical Catholic University of São Paulo, Rua Joubert Wey, 290, Sorocaba, SP, Brazil
| |
Collapse
|
|
19
|
Crim J. The painful lateral column of the foot: from back to front. Skeletal Radiol 2022; 51:1115-1125. [PMID: 34642777 DOI: 10.1007/s00256-021-03936-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to focus attention on the abnormalities which the radiologist may encounter in patients presenting with lateral ankle or foot pain outside of the context of acute trauma. These include anterolateral impingement, subfibular impingement, subtalar instability and tarsal sinus syndrome, tarsal coalition, sural neuromas, peroneal tendon abnormalities, calcaneocuboid instability and occult cuboid fractures, and painful accessory ossicles. The expected and unexpected findings on radiographs, CT, US, and MRI are discussed.
Collapse
Affiliation(s)
- Julia Crim
- University of Missouri, Hospital Drive, Columbia, MO, 65212, USA.
| |
Collapse
|
|
20
|
Kim YH, Chai JW, Kim DH, Kim HJ, Seo J. A problem-based approach in musculoskeletal ultrasonography: heel pain in adults. Ultrasonography 2021; 41:34-52. [PMID: 34674456 PMCID: PMC8696136 DOI: 10.14366/usg.21069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Musculoskeletal ultrasonography (US) has unique advantages, such as excellent spatial resolution for superficial structures, the capability for dynamic imaging, and the ability for direct correlation and provocation of symptoms. For these reasons, US is increasingly used to evaluate problems in small joints, such as the foot and ankle. However, it is almost impossible to evaluate every anatomic structure within a limited time. Therefore, US examinations can be faster and more efficient if radiologists know where to look and image patients with typical symptoms. In this review, common etiologies of heel pain are discussed in a problem-based manner. Knowing the common pain sources and being familiar with their US findings will help radiologists to perform accurate and effective US examinations.
Collapse
Affiliation(s)
- Yong Hee Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
|
21
|
Papadakis SA, Pallis D, Ampadiotaki MM, Tsivelekas K, Trygonis N, Artsitas D, Triantafyllou E, Badekas T. Peroneus brevis tendon injuries: Report of two cases and review of literature. Trauma Case Rep 2021; 35:100524. [PMID: 34504934 PMCID: PMC8414180 DOI: 10.1016/j.tcr.2021.100524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/04/2022] Open
Abstract
The incidence of peroneal tendon disorders in the population is unknown and they are usually overlooked. We report two cases of peroneus brevis injuries and a comprehensive literature review was performed. The first case was a 53-year-old man presented with persistent pain on the lateral aspect on the left ankle during the last four years and difficulty to bear weight during the last year. MRI showed longitudinal tear of peroneus brevis tendon and the patient underwent surgical treatment. The second case was a 46-year-old woman with persistent pain on the lateral aspect of the ankle with a history of a road traffic accident two years ago. Although MRI showed a peroneus brevis tendon tear, this was a false positive finding. Surgical treatment revealed no tear and symphysiolysis managed to relieve patient's symptoms. Even though MRI is the most effective diagnostic tool in depicting peroneal tendon injuries, there are false positive findings. In cases when symptoms persist, surgical exploration is indicated.
Collapse
Affiliation(s)
| | - Dimitrios Pallis
- B' Department of Orthopaedics, KAT General Hospital of Attica, Greece
| | | | | | | | | | | | | |
Collapse
|
|
22
|
Sy JW, Lopez AJ, Lausé GE, Deal JB, Lustik MB, Ryan PM. Correlation of stress radiographs to injuries associated with lateral ankle instability. World J Orthop 2021; 12:710-719. [PMID: 34631454 PMCID: PMC8472445 DOI: 10.5312/wjo.v12.i9.710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/17/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability.
AIM To determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability.
METHODS A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed. These manual radiographic stress views were then correlated with magnetic resonance imaging and operative findings.
RESULTS A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology (P = 0.008 for tendonitis and P = 0.020 for peroneal tendon tears). A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability (P = 0.043).
CONCLUSION Although valuable in the clinical evaluation of ankle instability, stress radiographs are not an independent predictor of conditions associated with ankle instability.
Collapse
Affiliation(s)
- Joshua W Sy
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI 96859, United States
| | - Andrew J Lopez
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI 96859, United States
| | - Gregory E Lausé
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI 96859, United States
| | - J Banks Deal
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI 96859, United States
| | - Michael B Lustik
- Department of Statistics, Tripler Army Medical Center, Honolulu, HI 96859, United States
| | - Paul M Ryan
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI 96859, United States
| |
Collapse
|
|
23
|
Abballe VD, Samim M, Gavilá ER, Walter WR, Alaia EF, Rosenberg ZS. Fibular Tip Periostitis: New Radiographic Sign Predictive of Chronic Peroneal Tendon Subluxation-Dislocation in Pes Planovalgus. AJR Am J Roentgenol 2021; 217:439-449. [PMID: 32936017 DOI: 10.2214/ajr.20.23964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Tearing of the superior peroneal retinaculum is a known cause of peroneal tendon subluxation-dislocation. However, with the exception of cortical avulsions at the fibular attachment, superior peroneal retinaculum injury and subsequent peroneal tendon subluxation-dislocation are typically radiographically occult. OBJECTIVE. The purpose of this study was to evaluate the previously undescribed association between radiographic fibular tip periostitis and MRI evidence of peroneal tendon subluxation-dislocation in patients with hindfoot valgus. METHODS. Thirty-five patients with radiographic fibular tip periostitis and 35 ageand sex-matched individuals without periostitis were selected from among 220 consecutively registered patients with hindfoot valgus who had undergone both ankle radiography and MRI. Studies were retrospectively assessed by two musculoskeletal radiologists in consensus and by two additional blinded radiologists independently for the presence of peroneal tendon subluxation-dislocation, presence of subfibular impingement, and hindfoot valgus angle measurements. Interobserver agreement and accuracy, sensitivity, and specificity in the detection of fibular periostitis, peroneal tendon subluxation-dislocation, and subfibular impingement were calculated, and Fischer exact, Mann-Whitney, kappa coefficient, and intraclass correlation tests were performed. RESULTS. Both the consensus and the two independent interpretations showed that the frequency of peroneal tendon subluxation-dislocation was significantly greater in the group with periostitis (62.9%, 65.7%, and 85.7%) than in the group without periostitis (5.7%, 0%, and 14.3%) (p < .001). The finding of periostitis was specific and highly sensitive for predicting peroneal tendon subluxation-dislocation. The frequency of subfibular impingement was also statistically higher in the group with periostitis than in the group without it (p < .001). The hindfoot valgus angle was statistically larger in the group with periostitis than in the control group (p = .01-.002) and among patients with versus those without peroneal tendon subluxation-dislocation (p = .002 to p < .001). The blinded readers had substantial or almost perfect agreement on all imaging interpretations (concordance rate, 82.9-95.7%; κ = 0.66-0.91). CONCLUSION. The radiographic finding of fibular tip periostitis in patients with hindfoot valgus can be a predictor of peroneal tendon subluxation-dislocation and may also suggest advanced hindfoot valgus and subfibular impingement. These radiographic associations should be recognized by the radiologist, and MRI may be recommended as clinically indicated. CLINICAL IMPACT. Chronic undiagnosed peroneal tendon subluxation-dislocation can be a persistent cause of lateral ankle pain, leading to further degeneration and the possibility of complete peroneal tendon tears. Distal fibular periostitis in patients with hindfoot valgus can be a reliable radiographic indicator of this entity and may suggest the presence of subfibular impingement.
Collapse
Affiliation(s)
- Valentino D Abballe
- Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, 6th Fl, New York, NY 10003
| | - Mohammad Samim
- Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, 6th Fl, New York, NY 10003
| | - Elisa Ramos Gavilá
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, New York, NY
- Present affiliation: Departmento de Radiología, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - William R Walter
- Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, 6th Fl, New York, NY 10003
| | - Erin F Alaia
- Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, 6th Fl, New York, NY 10003
| | - Zehava Sadka Rosenberg
- Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, 6th Fl, New York, NY 10003
| |
Collapse
|
|
24
|
Abstract
Peroneal tendon disorders remain an often overlooked source of lateral hindfoot pain and tenderness. Medical professionals who specialize in foot and ankle care are still far more likely to diagnose a peroneal tendon disorder as an ankle injury. In fact, acute peroneal dislocations are misdiagnosed in up to 40% of cases. The major subsets of peroneal disorders include peroneal tendonitis and tenosynovitis, painful os peroneum syndrome, subluxation, and tearing of the peroneal tendons. Proper history and physical exam maneuvers must be performed to help identify the source of the injury and differentiate these categories. Detailed imaging through X-ray and magnetic resonance imaging must also be used to diagnose the etiology of the patient's condition in order to direct management. Currently, there is very limited knowledge on peroneal pathologies, and treatment protocol is highly variable and limited to expert opinion. Despite the individual preferences and nuances held by each surgeon when it comes to operating, the overarching principles that guide appropriate management of tendonitis, subluxation, and tendon tear should maintain a higher level of consistency. Therefore, the authors of this review aim to elucidate the most current methods to diagnose these disorders as well as evidence-based practices for optimal management.Levels of Evidence: Level V.
Collapse
Affiliation(s)
- Akhil Sharma
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
| |
Collapse
|
|
25
|
Drakonaki EE, Gataa KG, Solidakis N, Szaro P. Anatomical variations and interconnections of the superior peroneal retinaculum to adjacent lateral ankle structures: a preliminary imaging anatomy study. J Ultrason 2021; 21:12-21. [PMID: 33791112 PMCID: PMC8008200 DOI: 10.15557/jou.2021.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/04/2021] [Indexed: 12/28/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Eleni E Drakonaki
- Musculoskeletal Radiology Practice, Heraklion Crete Greece & Medical School, European University of Cyprus, Cyprus
| | - Khaldun Ghali Gataa
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Nektarios Solidakis
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Paweł Szaro
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Clinical and Descriptive Anatomy, Medical University of Warsaw, Poland
| |
Collapse
|
|
26
|
Martin K, Wake J, Van Buren JP. Ultrasound Evaluation of the Peroneal Tendons in an Asymptomatic Elite Military Population: A Prospective Cohort Study. Mil Med 2020; 185:420-422. [PMID: 32074358 DOI: 10.1093/milmed/usz258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The purpose of this study was to identify the location of the peroneal tendons in relationship to the fibular groove in an asymptomatic population of elite U.S. Military Service members. MATERIALS AND METHODS The peroneal tendons of 41 active duty U.S. Army Rangers were examined. Subjects were placed in a lateral recumbent position with the ankle in a resting neutral position to visualize the tendon in a retromalleolar short-axis view. Maximum active ankle eversion followed by gravity inversion was facilitated while the ultrasound probe was maintained in its original position. Distance from the fibrous lateral ridge of the retromalleolar groove to the anterior aspect of the peroneal brevis was measured in the short axis in neutral, eversion, and inversion. RESULTS The mean sagittal distance and standard deviation was 0.48 ± 0.9 mm. No subjects demonstrated greater than 1 mm difference between positions, and no dislocations were identified. Side-to-side difference and dominant vs nondominant differences were not statistically significant. CONCLUSION The study demonstrates that the distance between the peroneal brevis and the lateral fibular ridge is consistent throughout extremes of motion. These results further the understanding of peroneal tendon function under dynamic examination. Our findings also establish side-to-side consistency prompting a bilateral examination to help identify abnormal pathology.
Collapse
Affiliation(s)
- Kevin Martin
- Evans Army Community Hospital, 650 Cochrane Cir, Fort Carson, CO 80913
| | - Jeffrey Wake
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431
| | | |
Collapse
|
|
27
|
Abstract
This article reviews the magnetic resonance imaging (MRI) findings of the normal anatomy and various pathologic conditions of the ankle and foot commonly encountered in clinical practice. The spectrum of entities discussed includes osseous and osteochondral injuries, ligamentous injuries, common traumatic and degenerative tendon pathology, abnormalities of transverse tarsal joint (Chopart) and tarsometatarsal joint (Lisfranc) complexes, pathological conditions affecting capsuloligamentous structures of the great toe and lesser toes, as well as pedal infection, with a focus on diabetic osteomyelitis and neuropathic osteoarthropathy.
Collapse
|
|
28
|
Chronic Lower Leg Pain in Athletes: Overview of Presentation and Management. HSS J 2020; 16:86-100. [PMID: 32015745 PMCID: PMC6973789 DOI: 10.1007/s11420-019-09669-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Athletes with chronic lower leg pain present a diagnostic challenge for clinicians due to the differential diagnoses that must be considered. PURPOSE/QUESTIONS We aimed to review the literature for studies on the diagnosis and management of chronic lower leg pain in athletes. METHODS A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The PubMed, Scopus, and Cochrane library databases were searched, and articles that examined chronic lower leg pain in athletes were considered for review. Two independent reviewers conducted the search utilizing pertinent Boolean operations. RESULTS Following two independent database searches, 275 articles were considered for initial review. After the inclusion and exclusion criteria were applied, 88 were included in the final review. These studies show that the most common causes of lower leg pain in athletes include medial tibial stress syndrome, chronic exertional compartment syndrome, tibial stress fractures, nerve entrapments, lower leg tendinopathies, and popliteal artery entrapment syndrome. Less frequently encountered causes include saphenous nerve entrapment and tendinopathy of the popliteus. Conservative management is the mainstay of care for the majority of cases of chronic lower leg pain; however, surgical intervention may be necessary. CONCLUSIONS Multiple conditions may result in lower leg pain in athletes. A focused clinical history and physical examination supplemented with appropriate imaging studies can guide clinicians in diagnosis and management. We provide a table to aid in the differential diagnosis of chronic leg pain in the athlete.
Collapse
|
|
29
|
Bianchi S, Becciolini M. Ultrasound Features of Ankle Retinacula: Normal Appearance and Pathologic Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3321-3334. [PMID: 31119773 DOI: 10.1002/jum.15026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/28/2019] [Indexed: 06/09/2023]
Abstract
Disorders of retinacula are frequent in acute and repetitive microtrauma of the ankle. Ultrasound (US), thanks to its spatial resolution and dynamic capabilities, is routinely used in the evaluation of the posttraumatic ankle for accurate delineation of ligaments and tendons. In addition, US can provide a depiction of normal retinacula and a detailed assessment of their pathologic changes. An accurate US assessment of ankle retinacula is helpful in choosing the proper treatment. In this pictorial essay, we briefly review the normal anatomy of ankle retinacula, describe their normal US appearance, and present a wide range of US pathologic abnormalities.
Collapse
|
|
30
|
Lau BC, Moore LK, Thuillier DU. Evaluation and Management of Lateral Ankle Pain Following Injury. JBJS Rev 2019; 6:e7. [PMID: 30153244 DOI: 10.2106/jbjs.rvw.17.00143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Brian C Lau
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Laura K Moore
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Daniel U Thuillier
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| |
Collapse
|
|
31
|
Anteroposterior Radiograph of the Ankle with Cross-Sectional Imaging Correlation. Magn Reson Imaging Clin N Am 2019; 27:701-719. [PMID: 31575401 DOI: 10.1016/j.mric.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The focus of this article is to illustrate various pathologic entities and variants, heralding disease about the ankle, based on scrutiny of AP radiographs of the ankle, with correlative findings on cross-sectional imaging. Many of these entities can only be detected on the AP ankle radiograph and, if not recognized, may lead to delayed diagnosis and persistent morbidity to the patient. However, a vigilant radiologist, equipped with the knowledge of the characteristic appearance and typical locations of the imaging findings, should be able to make the crucial initial diagnosis and surmise additional findings to be confirmed on cross-sectional imaging.
Collapse
|
|
32
|
Lohrer H. Distal Peroneus Longus Dislocation and Pseudohypertrophy of the Peroneal Tubercle: A Systematic Review. J Foot Ankle Surg 2019; 58:969-973. [PMID: 31350138 DOI: 10.1053/j.jfas.2019.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Indexed: 02/03/2023]
Abstract
Peroneal tendon injuries at the peroneal tubercle are rare. No systematic research regarding this pathology is currently available. In this systematic literature review, the author evaluated the present knowledge about peroneal tendon lesions at the lateral calcaneal wall. These lesions are predominantly associated with peroneal tubercle enlargement. Information on 25 respective patients (26 cases) has been published in 14 articles. Until now, only 3 reports presented 5 patients with dislocation of the peroneus longus tendon combined with inferior peroneal retinaculum lesions. In these cases, the peroneal tubercle was not enlarged. All reviewed patients were treated surgically. Enlarged peroneal tubercles were resected. Groove deepening and inferior peroneal retinaculum reconstruction addressed distal peroneus longus tendon dislocations. The reported results were either excellent or good. Recurrent dislocations can cause lesions of the peroneus longus tendon at the peroneal tubercle. This pathology is rare and can be addressed surgically. In cases without tendon dislocation, the enlarged peroneal tubercles are removed or shaped, whereas dislocations in normal shaped peroneal tubercles require groove deepening and inferior peroneal retinaculum reconstruction.
Collapse
Affiliation(s)
- Heinz Lohrer
- Consultant, European SportsCare Network, Zentrum für Sportorthopädie, Wiesbaden-Nordenstadt, Germany; Orthopedic surgeon, European SportsCare Network, Zentrum für Sportorthopädie, Wiesbaden-Nordenstadt, Germany; Medical director, Lilium Klinik, Wiesbaden-Nordenstadt, Germany; Professor, Department for Sports and Sport Science, Albert-Ludwigs-Universität Freiburg im Breisgau, Freiburg, Germany.
| |
Collapse
|
|
33
|
The peroneus longus muscle and tendon: a review of its anatomy and pathology. Skeletal Radiol 2019; 48:1329-1344. [PMID: 30770941 DOI: 10.1007/s00256-019-3168-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/10/2019] [Accepted: 01/16/2019] [Indexed: 02/02/2023]
Abstract
This article will review the anatomy and common pathologies affecting the peroneus longus muscle and tendon. The anatomy of the peroneus longus is complex and its long course can result in symptomatology referable to the lower leg, ankle, hindfoot, and plantar foot. Proximally, the peroneus longus muscle lies within the lateral compartment of the lower leg with its distal myotendinous junction arising just above the level of the ankle. The distal peroneus longus tendon has a long course and makes two sharp turns at the lateral ankle and hindfoot before inserting at the medial plantar foot. A spectrum of pathology can occur in these regions. At the lower leg, peroneus longus muscle injuries (e.g., denervation) along with retromalleolar tendon instability/subluxation will be discussed. More distally, along the lateral calcaneus and cuboid tunnel, peroneus longus tendinosis and tears, tenosynovitis, and painful os peroneum syndrome (POPS) will be covered. Pathology of the peroneus longus will be illustrated using clinical case examples along its entire length; these will help the radiologist understand and interpret common peroneus longus disorders.
Collapse
|
|
34
|
Abstract
Chronic disorders of the peroneal tendons are a common cause of posterolateral ankle pain, including tendinopathy, tendon instability, and chronic tendon tears. They are often preceded by ligamentous instability or predisposing anatomic abnormalities such as a shallow fibular groove or a cavovarus foot deformity. Given the substantial disability associated with chronic peroneal tendon disorders, it is important for orthopaedic surgeons to optimize the diagnostic and treatment strategies of these entities based on contemporary studies. This article reviews both classic and recent scientific evidence regarding the diagnosis and treatment of patients with chronic peroneal tendon disorders.
Collapse
|
|
35
|
Abstract
Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.
Collapse
Affiliation(s)
| | | | - Yu Deng
- Department of Foot and Ankle Surgery, Wuhan University, Hubei, China
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson
- San Antonio Military Medical Center, TX
| |
Collapse
|
|
36
|
Tawk S, Lecouvet F, Putineanu DC, Acid S. Unusual proximal fragment migration of an os peroneum fracture with associated peroneus longus tendon injury-a tree often hides a forest. Skeletal Radiol 2019; 48:317-322. [PMID: 29951798 DOI: 10.1007/s00256-018-3019-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 02/02/2023]
Abstract
We report the case of a 55-year-old male patient who presented to the emergency department after sustaining a right ankle trauma. Swelling and tenderness of the lateral aspect of the right ankle were present on physical examination without evidence of motor or sensory deficit. Ankle radiographs were performed and showed two bony fragments, the first located postero-inferiorly to the cuboid bone while the second was adjacent to the tip of the lateral malleolus. The diagnosis of an os peroneum fracture was made with high suspicion of an associated peroneus longus tendon rupture. Computed tomography (CT) and magnetic resonance imaging (MRI) of the right ankle confirmed the diagnosis of a subtotal retracted tendinous rupture. Successful surgical repair of the injured tendon was performed. This article illustrates the imaging findings of an os peroneum fracture with its associated tendinous injury and reviews the literature.
Collapse
Affiliation(s)
- Sammy Tawk
- Radiology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
| | - Frédéric Lecouvet
- Radiology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Dan Constantin Putineanu
- Orthopedics and Traumatology of Locomotor System Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Souad Acid
- Radiology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
|
37
|
Draghi F, Bortolotto C, Draghi AG, Gitto S. Intrasheath Instability of the Peroneal Tendons: Dynamic Ultrasound Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2753-2758. [PMID: 29672895 DOI: 10.1002/jum.14633] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 06/08/2023]
Abstract
Peroneal intrasheath instability is a painful snapping condition of the lateral ankle. It consists of a transient retromalleolar subluxation of the peroneal tendons without disruption of the superior peroneal retinaculum or evidence of a previous definite trauma. In type A intrasheath instability, the peroneus longus and brevis tendons are intact, and there is an intertendinous intrasheath switch. In type B intrasheath instability, the peroneus brevis tendon has a longitudinal split tear through which the peroneus longus subluxates. Both types can be missed on a physical examination because there is no displacement of the peroneal tendons over the lateral malleolus. Dynamic ultrasound is the imaging modality of choice for evaluating retromalleolar subluxation of the peroneal tendons. This review article aims to provide an overview of the anatomic basis for peroneal intrasheath instability and provide physicians with guidelines for its ultrasound assessment.
Collapse
Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Chandra Bortolotto
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Anna Guja Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| |
Collapse
|
|
38
|
van Dijk PA, Miller D, Calder J, DiGiovanni CW, Kennedy JG, Kerkhoffs GM, Kynsburtg A, Havercamp D, Guillo S, Oliva XM, Pearce CJ, Pereira H, Spennacchio P, Stephen JM, van Dijk CN. The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surg Sports Traumatol Arthrosc 2018; 26:3096-3107. [PMID: 29767272 PMCID: PMC6154028 DOI: 10.1007/s00167-018-4971-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Pim A van Dijk
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands.
- Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.
| | | | | | | | | | - Gino M Kerkhoffs
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Akos Kynsburtg
- National Institute for Sports Medicine, Budapest, Hungary
| | | | | | | | - Chris J Pearce
- Division of Foot and Ankle Surgery, National University Hospital, Singapore, Singapore
| | - Helder Pereira
- Centro Hospitalar Póvoa de Varzim-Vila do Conde, Póvoa de Varzim, Portugal
- Ripoll y De Prado Sports Clinic: Murcia-Madrid-FIFA Medical Center of Excellence, Madrid, Spain
| | | | | | - C Niek van Dijk
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Ripoll y De Prado Sports Clinic: Murcia-Madrid-FIFA Medical Center of Excellence, Madrid, Spain
| |
Collapse
|
|
39
|
The location of the peroneus longus tendon in the cuboid groove: sonographic study in various positions of the ankle-foot in asymptomatic volunteers. Skeletal Radiol 2018; 47:1277-1284. [PMID: 29637249 DOI: 10.1007/s00256-018-2936-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the normal location of the peroneus longus tendon (PL) in the cuboid groove in various ankle-foot positions by ultrasonography in asymptomatic volunteers. MATERIALS AND METHODS Ultrasonographic assessment of the PL in the cuboid groove was performed in 20 feet of ten healthy volunteers. Each PL was examined in five ankle-foot positions (i.e., neutral, dorsiflexion, plantar-flexion, supination, and pronation). The PL location was qualitatively categorized as "inside" when the PL was entirely within the cuboid groove, as "overlying" when some part of the PL was perched on the cuboid tuberosity, and as "outside" when the PL was entirely on the cuboid tuberosity. For quantitative evaluation of the PL location, the distance between the PL and the cuboid groove was measured. The width of the cuboid groove was measured in the neutral position. RESULTS The PL location did not significantly change with changes in the ankle-foot position. Qualitatively, an "overlying" PL was the most common type, regardless of the ankle-foot position. "Inside" PLs were found in only 35, 20, 30, 25, and 35% of feet in neutral, dorsiflexion, plantar-flexion, supination, and pronation positions, respectively. The quantitative PL location was also not significantly different among all ankle-foot positions and it was significantly negatively correlated with the cuboid groove width. CONCLUSIONS In healthy volunteers, 65% or more of the PLs were partially or completely located outside of the cuboid groove, regardless of the ankle-foot position. The PL location relative to the cuboid groove was related to the cuboid groove width.
Collapse
|
|
40
|
De Maeseneer M, Madani H, Lenchik L, De Mey J, Provyn S, Shahabpour M. Ultrasound of the Distal Insertions of the Ankle and Foot Tendons With Anatomical Correlation: A Review. Can Assoc Radiol J 2018; 69:282-292. [PMID: 29773337 DOI: 10.1016/j.carj.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/28/2022] Open
Abstract
The distal insertions of the tendons crossing the ankle as well as the tendons originating in the foot are less well known by radiologists. We review the anatomy and ultrasound appearance of these insertions using our own cadaveric sectioning and dissection. The ultrasound images were correlated with anatomical slices. Occasionally magnetic resonance images were also used for better understanding. Understanding the normal appearance of these tendon insertions is important for diagnosing pathology in this region.
Collapse
Affiliation(s)
- Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - Hardi Madani
- Department of Radiology, Royal Free NHS Trust, London, United Kingdom
| | - Leon Lenchik
- Department of Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Steven Provyn
- Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| |
Collapse
|
|
41
|
Fischetti A, Zawaideh JP, Orlandi D, Belfiore S, SIlvestri E. Traumatic peroneal split lesion with retinaculum avulsion: Diagnosis and post-operative multymodality imaging. World J Radiol 2018; 10:46-51. [PMID: 29876022 PMCID: PMC5985235 DOI: 10.4329/wjr.v10.i5.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/23/2018] [Accepted: 05/23/2018] [Indexed: 02/06/2023] Open
Abstract
Tears of peroneus brevis tendon represent a cause of underdiagnosed lateral ankle pain and instability. The typical clinical presentation is retro-malleolar pain, in some cases associated with palpable swelling around the fibular malleolus, pain during activities and difficulty in walking. We present a case of peroneus brevis split lesion with superior peroneal retinaculum avulsion in a young athlete who referred to the emergency ward of our hospital for left ankle pain after an inversion injury. An early diagnosis allowed treating the injury and promptly resuming sport activity, after rehabilitation training. Surgical reconstruction key-points and post-surgical follow-up were also discussed. A late diagnosis would have caused a symptomatology worsening and an increased recovery time.
Collapse
Affiliation(s)
- Aldo Fischetti
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa 16100, Italy
| | - Jeries P Zawaideh
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa 16100, Italy
| | - Davide Orlandi
- Radiology Department, Ospedale Evangelico Internazionale, Genova 16122, Italy
| | - Stefano Belfiore
- Orthopedic and Trauma Department, Ospedale Evangelico Internazionale, Genova 16122, Italy
| | - Enzo SIlvestri
- Radiology Department, Ospedale Evangelico Internazionale, Genova 16122, Italy
| |
Collapse
|
|
42
|
The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2018. [PMID: 29767272 DOI: 10.1007/s00167-018-4971-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
Collapse
|
|
43
|
Guelfi M, Vega J, Malagelada F, Baduell A, Dalmau-Pastor M. Tendoscopic Treatment of Peroneal Intrasheath Subluxation: A New Subgroup With Superior Peroneal Retinaculum Injury. Foot Ankle Int 2018; 39:542-550. [PMID: 29595062 DOI: 10.1177/1071100718764674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Snapping peroneal tendons is a rare cause of lateral ankle pain. Two subgroups have been described: chronic subluxation with superior peroneal retinaculum (SPR) injury and intrasheath subluxation with SPR intact. The aim of the study was to report the tendoscopic findings and results in patients affected by snapping peroneal tendons without evident dislocation. METHODS Between 2010 and 2015, a total of 18 patients with a retromalleolar "click" sensation and no clinical signs of peroneal tendon dislocation underwent tendoscopy. Mean age was 29 years (range, 18-47). Mean follow-up was 45 months (range, 18-72). RESULTS Tendoscopic examination revealed an intact SPR in 12 patients. Of these 12, a space-occupying lesion was present in 7, a superficial tear of peroneus brevis in 4, and a shallow fibular groove in 7. An SPR injury without peroneal tendon dislocation was observed in the remaining 6 patients. All these 6 patients presented a shallow fibular groove. Although the SPR was injured, they had been diagnosed as intrasheath subluxation. Patients with intrasheath subluxation and intact SPR underwent debridement of a space-occupying lesion in 11 cases and fibular groove deepening in 5 cases. Patients with intrasheath subluxation and SPR injury underwent fibular groove deepening without addressing the SPR. At follow-up, the mean American Orthopaedic Foot & Ankle Society score increased from 76 (range, 69-85) preoperatively to 97 (range, 84-100). No recurrence or major complications were reported. Conclusion Intrasheath subluxation of peroneal tendons was successfully treated tendoscopically. A new subgroup of intrasheath subluxation with SPR injury but no clinically evident peroneal tendon dislocation is reported. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Matteo Guelfi
- 1 Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Chieti, Italy
| | - Jordi Vega
- 2 Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain.,3 Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
| | - Francesc Malagelada
- 4 Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Albert Baduell
- 2 Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain.,5 Department of Orthopaedic and Traumatology, Hospital of Figueres-Funcació Salut Empordà, Figueres, Girona, Spain
| | - Miki Dalmau-Pastor
- 3 Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.,6 Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain
| |
Collapse
|
|
44
|
Abstract
This article is a comprehensive review of the current utilizations of ultrasound in the treatment of orthopedic conditions of the foot and ankle. It reviews the diagnostic and interventional applications to commonly encountered lower-extremity ailments, including plantar fasciosis, tendinosis, and peripheral nerve disorders. It also outlines minimally invasive ultrasound-guided procedures and emerging therapies as alternatives to current treatments. These emerging therapies can be used to assist surgeons and provide options for patients needing intervention. Techniques such as hydrodissection, injection, aspiration, tenotomy, and fasciotomy are discussed, giving readers insight into different treatment modalities and options to help manage their patients.
Collapse
Affiliation(s)
- Nahum Michael Beard
- Department of Family Medicine, University of Tennessee Health Science Center, Saint Francis Family Medicine, 1301 Primacy Parkway, Memphis, TN 38119, USA; Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue Suite 520, Memphis, TN 38104.
| | - Robert Patrick Gousse
- Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue Suite 520, Memphis, TN 38104
| |
Collapse
|
|
45
|
Favinger JL, Richardson ML, Chew FS. Progressive retraction of a fractured os peroneum suggesting repetitive injury to the peroneus longus tendon. Radiol Case Rep 2017; 13:216-219. [PMID: 29487659 PMCID: PMC5826682 DOI: 10.1016/j.radcr.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 10/24/2022] Open
Abstract
The os peroneum is an accessory ossicle within the peroneus longus tendon. Prior reports have discussed fracture of the os peroneum with associated tears of the peroneus longus tendon. When the ossicle fractures, there can be varying degrees of retraction of the tendon, which can be diagnosed by malposition of the ossicle or the ossicle fragments. We report a case of a man with recurrent eversion ankle injuries with progressive retraction of a fractured os peroneum, implying injuries to the superior and inferior peroneal retinacula and the peroneus longus tendon.
Collapse
Affiliation(s)
- Jennifer L Favinger
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Michael L Richardson
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| |
Collapse
|
|
46
|
LiMarzi GM, Scherer KF, Richardson ML, Warden DR, Wasyliw CW, Porrino JA, Pettis CR, Lewis G, Mason CC, Bancroft LW. CT and MR Imaging of the Postoperative Ankle and Foot. Radiographics 2017; 36:1828-1848. [PMID: 27726748 DOI: 10.1148/rg.2016160016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A variety of surgical procedures exist for repair of both traumatic and degenerative osseous and soft-tissue pathologic conditions involving the foot and ankle. It is necessary for the radiologist to be familiar with these surgical procedures, so as to assess structural integrity, evaluate for complicating features, and avoid diagnostic pitfalls. Adequate interpretation of postoperative changes often requires access to surgical documentation to evaluate not only the surgery itself but the expected timeline for resolution of normal postoperative changes versus progressive disease. Appropriate use of surgical language in radiology reports is another important skill set to hone and is instrumental in providing a high-quality report to the referring surgeons. The pathophysiology of a myriad of surgical complaints, beginning from the Achilles tendon and concluding at the plantar plate, are presented, as are their common appearances at computed tomography and magnetic resonance imaging. Commonly encountered entities include Achilles tendon tear, spastic equinus, nonspastic equinus, talar dome osteochondral defect, tarsal tunnel syndrome, plantar fasciitis, pes planovalgus, pes cavovarus, peroneal tendinosis, lateral ligament complex pathology, Morton neuroma, plantar plate tear, and metatarsophalangeal joint instability. Computer-generated three-dimensional models are included with many of the procedures to provide a more global view of the surgical anatomy. Correlation with intraoperative photographs is made when available. When appropriate, discussion of postoperative complications, including entities such as infection and failure of graft integration, is presented, although a comprehensive review of postoperative complications is beyond the scope of this article. Notably absent from the current review are some common foot and ankle procedures including hallux valgus and hammertoe corrections, as these are more often evaluated radiographically than with cross-sectional imaging. ©RSNA, 2016.
Collapse
Affiliation(s)
- Gary M LiMarzi
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Kurt F Scherer
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Michael L Richardson
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - David R Warden
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher W Wasyliw
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Jack A Porrino
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher R Pettis
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Gideon Lewis
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher C Mason
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Laura W Bancroft
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| |
Collapse
|
|
47
|
Yıldız D, Ekiz T, Doğan A. Lateral ankle pain and peroneal tendon subluxation in a patient with peroneal quartus muscle and superior peroneal retinaculum injury. J Back Musculoskelet Rehabil 2017; 30:1147-1148. [PMID: 28505958 DOI: 10.3233/bmr-169608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Davut Yıldız
- Department of Orthopedics, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Timur Ekiz
- Department of Physical and Rehabilitation Medicine, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Adil Doğan
- Department of Radiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| |
Collapse
|
|
48
|
Kumar Y, Alian A, Ahlawat S, Wukich DK, Chhabra A. Peroneal tendon pathology: Pre- and post-operative high resolution US and MR imaging. Eur J Radiol 2017. [PMID: 28624011 DOI: 10.1016/j.ejrad.2017.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Peroneal tendon pathology is an important cause of lateral ankle pain and instability. Typical peroneal tendon disorders include tendinitis, tenosynovitis, partial and full thickness tendon tears, peroneal retinacular injuries, and tendon subluxations and dislocations. Surgery is usually indicated when conservative treatment fails. Familiarity with the peroneal tendon surgeries and expected postoperative imaging findings is essential for accurate assessment and to avoid diagnostic pitfalls. Cross-sectional imaging, especially ultrasound and MRI provide accurate pre-operative and post-operative evaluation of the peroneal tendon pathology. In this review article, the normal anatomy, clinical presentation, imaging features, pitfalls and commonly performed surgical treatments for peroneal tendon abnormalities will be reviewed. The role of dynamic ultrasound and kinematic MRI for the evaluation of peroneal tendons will be discussed. Normal and abnormal postsurgical imaging appearances will be illustrated.
Collapse
Affiliation(s)
- Yogesh Kumar
- Radiology, Yale New Haven Health at Bridgeport Hospital, CT, USA.
| | - Ali Alian
- Musculoskeletal Radiology, UT Southwestern Medical Center, TX, USA
| | - Shivani Ahlawat
- Musculoskeletal Radiology, Johns Hopkins University, MD, USA
| | - Dane K Wukich
- Orthopaedic Surgery, UT Southwestern Medical Center, TX, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology, UT Southwestern Medical Center, TX, USA; Orthopaedic Surgery, UT Southwestern Medical Center, TX, USA.
| |
Collapse
|
|
49
|
Meehan TM, Martinez-Salazar EL, Torriani M. Aftermath of Ankle Inversion Injuries. Magn Reson Imaging Clin N Am 2017; 25:45-61. [DOI: 10.1016/j.mric.2016.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
|
50
|
Pesquer L, Guillo S, Poussange N, Pele E, Meyer P, Dallaudière B. Dynamic ultrasound of peroneal tendon instability. Br J Radiol 2016; 89:20150958. [PMID: 26943704 DOI: 10.1259/bjr.20150958] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ankle snapping may be caused by peroneal tendon instability. Anterior instability occurs after traumatic superior peroneal retinaculum injury, whereas peroneal tendon intrasheath subluxation is atraumatic. Whereas subluxation is mainly dynamic, ultrasound allows for the diagnosis and classification of peroneal instability because it allows for real-time exploration. The purpose of this review is to describe the anatomic and physiologic bases for peroneal instability and to heighten the role of dynamic ultrasound in the diagnosis of snapping.
Collapse
Affiliation(s)
- Lionel Pesquer
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| | - Stéphane Guillo
- 2 Foot and Ankle Department, Orthopaedic Surgery Center, Clinique du Sport de Bordeaux, Mérignac, France
| | - Nicolas Poussange
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| | - Eric Pele
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| | - Philippe Meyer
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| | - Benjamin Dallaudière
- 1 Musculoskeletal Imaging Department, Clinique du Sport de Bordeaux, Mérignac, France
| |
Collapse
|