Operative Treatment for Peroneal Tendon Disorders

Abstract

Peroneal tendon disorders are rare, are frequently missed, and can be a source of lateral ankle pain. Magnetic resonance imaging is the standard method of radiographic evaluation of peroneal tendon disorders; however, diagnosis and treatment are based primarily on the history and physical examination. Peroneal tenosynovitis typically responds to conservative therapy, and operative treatment is reserved for refractory cases. Operative treatment is frequently required for peroneal tendon subluxation and consists of anatomic repair or reconstruction of the superior peroneal retinaculum with or without deepening of the retromalleolar groove. Operative treatment of peroneal tendon tears is based on the amount of remaining viable tendon. Primary repair and tubularization is indicated for tears involving <50% of the tendon, and tenodesis is indicated for tears involving >50% of the tendon.

Lasso Stitch with Peroneal Retinaculoplasty for Repair of Fractured Os Peroneum: A Report of Two Cases

“…If the fracture is nondisplaced, treatment with immobilization and nonweightbearing may prove adequate [18]. In patients where the ossicle fractures and retracts proximally, repair is recommended [6]. Treatment recommendations and techniques of repair are limited to small series and expert opinion.…”

“…In patients where tendon ruptures are left untreated, secondary deformity may develop including varus of the hindfoot and first metatarsal elevatus can occur [6,17,18]. The described repair technique has two distinct advantages over more standard repair strategies.…”

“…Sammarco reported the use of a free fascial graft in one patient where after excision of a large os peroneum, a 1-cm gap was present that required reconstruction with a free tendon graft with better pain relief and strength than excision of the fragments with direct repair performed in another patient [15]. Addressing foot deformity and adequate decompression of the retinaculum are also important considerations [2,6]. Treatment of the fractured, displaced os peroneum has been described primarily in small series and in larger series of peroneus longus tendon pathology (Table 1).…”

Anatomy of the long peroneal muscle of the leg

“…The first part, also known as superficial or the superficial head [1], has its origin on the head of the peroneal bone, the lateral condyle of tibia and the capsule of tibiofibular syndesmosis, whereas the second part, called a deep head [1,2], begins in the upper part of lateral surface of the peroneal bone from appropriate parts of the anterior and posterior intermuscular septum of the leg and from deep fascia of the leg [1,11].…”

Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report

“…[2][3][4] Peroneal tendon dysfunction can be attributed to tendonitis, chronic tenosynovitis, subluxation, fraying, longitudinal fissuring, partial tears and complete tears. [5][6][7][8][9] These abnormalities can be observed with concomitant chronic ankle instability, cavovarus foot deformities, low-lying peroneus brevis muscle bellies, superior peroneal retinacular insufficiency, fibular bone spurs, and following severe ankle sprains. 6,[10][11][12] Several classification systems have been described to characterize peroneal tendon tears in order to improve the decision-making in operative management.…”