Reliability of MRI Findings of Peroneal Tendinopathy in Patients with Lateral Chronic Ankle Instability

Abstract

BackgroundPatients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability.MethodsMRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study.ResultsOf the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%.ConclusionsMRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.

Treatment of longitudinal mid-substance tears of the peroneal tendons

“…Radiologists reported a 56% accuracy of peroneus brevis tendon tears associated with ankle instability compared with intraoperative findings, while treating orthopaedic surgeons reported 71% accuracy. 6 Park et al 7 described MRI evaluations of peroneal tendon pathology associated with ankle instability and concluded that the MRI was a useful tool but offered nonspecific findings. They stressed the importance of a careful physical examination.…”

“…Recent reports support the occurrence of peroneal tendon tears with coexisting pathology. 2,5,6,7,10,11,12,15,25,27,28 Raikin 8 evaluated peroneal tendon subluxation using preoperative dynamic ultrasound. He described two subtypes of intrasheath subluxation: type A involved rolling intact tendons and type B involved split tears of the peroneus brevis.…”

“…Dynamic ultrasound also can be helpful. 5,6,7,11,16 TREATMENT Without any evidence of acute rupture, most agree on conservative management, although the duration varies among authors ranging from 2--6 months. 1--5,6,7,14,15,22 Conservative management consists of anti-inflammatory medication, bracing, orthotics, and physical therapy.…”

“…16 Recent studies have shown that MRI remains the most reliable objective measure of tears, although inaccuracies still remain. 6,7,13 Dynamic ultrasound also has proven to be a useful tool. 16 Initial conservative treatment is recommended unless an acute tear or rupture is evident.…”

“…Preoperative and intraoperative diagnostics can assist in the execution of a surgical plan. 6,7,13,14 …”