Split Lesions of the Peroneus Brevis Tendon in Chronic Ankle Laxity

Abstract

Between 1993 and 1995, we operated on 18 patients for split lesions of the peroneal brevis tendon associated with chronic ankle instability. Five patients were competitive athletes, seven were recreational athletes, and six were persons. Symptoms developed in three phases: ankle sprain, chronic instability, and posterolateral pain. The mean delay between sprain and posterolateral pain was 6 years. At the time of surgery the main complaint was retromalleolar pain in nine patients, pain and instability in eight patients, and instability only in one patient. Diagnosis of tendinous lesions was based on clinical examination in three cases, preoperative magnetic resonance imaging in eight cases, preoperative tenography in one case, and surgical exploration in six cases. The lesion was localized at the tip of the lateral malleolus and was visible only after opening the peroneal retinaculum. In three cases an accessory peroneal muscle was present. A Chrisman-Snook procedure was performed in 13 cases and a simple tendinous repair in 5 cases. The split lesion of the peroneus brevis tendon may be the result of chronic ankle laxity. This lesion needs a specific surgical treatment and the peroneal tendon must be checked in case of surgical procedure for ankle laxity. After ligamentous repair, residual pain can be due to a neglected peroneus brevis tear.

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

“…Radiologists were less able to detect a peroneal tear than the attending surgeon, but this may represent an advantage of the clinician who can examine the patient. The tendons should be inspected routinely during the ligament reconstruction, as suggested by others [1,2].…”

Split Peroneus Brevis Tendon: An Unusual Cause of Ankle Pain and Instability

“…Split lesions of the PBT were thought to be relatively rare; however, a study of 112 cadaveric ankles found a prevalence of 37.5% based on thinning or longitudinal splitting of PBT. 10,11 The peroneus can split because of the stress of stretching that occurs from the inversion of the lateral ankle injury. The PLT overlies and presses on the PBT, possibly resulting in a split.…”

“…10 With repetitive trauma or contraction of the peroneal muscles, the PBT may split. Splitting of the PBT can be caused by misalignment of the fibula following an ankle injury.…”

“…1,10 Treatment Initial supportive therapy is important and may enhance the healing process and avoid chronic ligamentous laxity and surgery. This includes nonsteroidal antiinflammatory drugs (NSAIDs), rest, ice, compression, elevation, and early mobilization.…”

Peroneal Tendon Lesions in Athletes (Review)

“…подобные расстройства распространены среди бегунов, балерин и пациентов с хронической нестабиль-ностью голеностопного сустава [7,12]. Другими причинами являются сильные растяжения свя-зок голеностопного сустава, его переломы или переломы пяточной кости, а также гипертрофия малоберцового бугорка [8,24,29].…”