Superior peroneal retinaculum reattachment for an atraumatic peroneus brevis tendon subluxation: a case report.

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.

Bilateral tripartite insertion of the fibularis (peroneus) brevis muscle: a case report / Inserción tripartita bilateral del músculo fibular corto: reporte de caso

SUMMARY: The fibularis brevis muscle typically inserts by a single long, robust, flat tendon upon the base of the fifth metatarsal. In this case report, we demonstrate two comparatively small accessory tendons of insertion in both the right and left limbs of an elderly cadaver. In each limb, the superior and inferior accessory tendons arose from the distal end of the main tendon of insertion to attach to, respectively, the shaft and neck of the fifth metatarsal. The bilateral presence of this comparatively rare condition is a new finding. Review of the literature reveals that these accessory tendons are most probably remnants of the inserting tendons of the atavistic muscle peroneus digiti minimi. The presence of this anomaly could affect reconstruction surgeries that utilize the inserting tendon of fibularis brevis, and treatment of avulsion fractures of the base of the fifth metatarsal.

RESUMEN: El músculo fibularis corto generalmente se inserta por un solo tendón largo, robusto y plano en la base del quinto metatarsiano. En este trabajo demostramos dos tendones accesorios de inserción comparativamente pequeños en ambos miembros inferiores de un cadáver de edad avanzada. En cada miembro inferior, los tendones accesorios superiores e inferiores surgieron de la porción distal del tendón principal de inserción para adherirse, respectivamente, al eje y al cuello del quinto metatarsiano. La presencia bilateral de éste músculo, comparativamente raro, es un nuevo hallazgo. La revisión de la literatura revela que estos tendones accesorios son probablemente remanentes de los tendones de inserción del músculo peroneus digiti minimi. La presencia de esta anomalía podría afectar las cirugías de reconstrucción que utilizan el tendón de inserción del músculo fibular corto, y el tratamiento de las fracturas por avulsión de la base del quinto hueso metatarsiano.

Effectiveness of Allograft Reconstruction vs Tenodesis for Irreparable Peroneus Brevis Tears: A Cadaveric Model.

BACKGROUND: Irreparable peroneus brevis tendon tears are uncommon, and there is scant evidence on which to base operative treatment. Options include tendon transfer, segmental resection with tenodesis to the peroneus longus tendon, and allograft reconstruction. However, the relative effectiveness of the latter 2 procedures in restoring peroneus brevis function has not been established. METHODS: Custom-made strain gage-based tension transducers were implanted into the peroneus longus and brevis tendons near their distal insertions in 10 fresh-frozen cadaver feet. Axial load was applied to the foot, and the peroneal tendons and antagonistic tibialis anterior and posterior tendons were tensioned to 50% and 100% of physiologic load. Distal tendon tension was recorded in this normal condition and after sequential peroneus brevis-to-longus tenodesis and peroneus brevis allograft reconstruction. Measurements were made in 5 foot inversion/eversion and plantarflexion/dorsiflexion positions. RESULTS: Distal peroneus brevis tendon tension after allograft reconstruction significantly exceeded that measured after tenodesis in all tested loading conditions (P ≤ 0.022). With 50% of physiologic load applied, peroneus brevis tension was 1% to 28% of normal (depending on foot position) after tenodesis and 73% to 101% of normal after allograft reconstruction. Under the 100% loading condition, peroneus brevis tension was 6% to 43% of normal after tenodesis and 88% to 99% of normal after reconstruction with allograft. Distal peroneus longus tension remained within 20% of normal under all operative and loading conditions. CONCLUSION: Allograft reconstruction of a peroneus brevis tendon tear in this model substantially restored distal tension when the peroneal tendons and their antagonists were loaded to 50% and 100% of physiologic load. Tenodesis to the peroneus longus tendon did not effectively restore peroneus brevis tension under the tested conditions. CLINICAL RELEVANCE: Because tenodesis was demonstrated to be ineffective for restoration of peroneus brevis function, this procedure may result in an imbalanced foot clinically.

Long-term effects of chronic achilles tendon rupture treatment, using reconstruction with peroneus brevis transfer, on sports activities / Efectos a largo plazo del tratamiento de la ruptura crónica del tendón de aquiles mediante reconstrucción con transferencia del peroneo corto en las actividades deportivas

OBJECTIVE: This study reports long-term effects of chronic Achilles tendon rupture treatment, using reconstruction with peroneus brevis transfer (PBT), on sports activities based on an approximate 10-year follow-up study. METHODS: Twenty patients (6 women and 14 men; mean age, 43 ± 12.85 years at the time of operation) underwent chronic Achilles tendon repair with an average follow-up of 164.05 ± 5.07 months. Seven were involved in competitive sports, 10 participated in recreational activities and three were not involved in any sporting activities. All patients were Asians. Results were assessed using Cybex strength testing and the American Othopaedic Foot and Ankle Society (AOFAS) Score, the muscle manual test (MMT), sports activities and comprehensive satisfaction assessment. RESULTS: Cybex strength testing resulted in an average gain of 87.05 ± 14.83% in dorsiflexion strength (range 65-110%) and 98.05 ± 9.02% in plantar flexion strength (range 85%-120%). The AOFAS score average was 86.9 ± 7.27. There were no postoperative re-ruptures, no recurrences and no wound complications. Plantar flexion strength and the AOFAS score were negatively correlated with the age at the time of operation (r = "0.566, r = -0.669, respectively). Seventeen patients (85%) were level five of MMT in eversion strength. Following treatment, six patients (30%) returned to competitive sports, while 10 (50%) who, prior to the injury and surgery, were involved in recreational activities, returned to similar activities. The relatively younger group tended to continue sport activities as competitive athletes (p < 0.05). Significant differences were observed in age at the operation between non-satisfaction group and excellent group (p < 0.05). The under 40-year age group tended to show a poor value. CONCLUSION: Recreational athletes and non-athletes could return to their sports activities satisfactorily, while young competitive athletes found difficulties in certain actions, especially related to eversion.

OBJETIVO: Este estudio reporta efectos a largo plazo del tratamiento de la ruptura crónica del tendón de Aquiles mediante reconstrucción con transferencia del peroneo corto (TPC) en actividades deportivas, sobre la base de un estudio de seguimiento de aproximadamente 10 años. MÉTODOS: Veinte pacientes (6 mujeres y 14 hombres; edad promedio, 43 ± 12.85 años en el momento de la operación) fueron sometidos a una reparación de ruptura crónica del tendón de Aquiles con un seguimiento promedio de 164.05 ± 5.07 meses. Siete estaban en medio de competencias deportivas, 10 participaban en actividades recreativas, y tres estaban fuera de toda actividad deportiva. Todos los pacientes eran los asiáticos. Los resultados se evaluaron usando la prueba de Cybex para medir la fuerza, la puntuación de la escala de la Sociedad Ortopédica Americana de Pie y Tobillo (AOFAS) para la valoración quirúrgica, la prueba muscular manual (PMM), y la evaluación integral de la satisfacción y las actividades deportivas. RESULTADOS: La prueba de Cybex indicó una ganancia promedio de 87.05 ± 14.83% en fuerza de dorsiflexión (rango 65-110%) y 98.05 ± 9.02% en fuerza de flexión plantar (rango 85%-120%). El promedio de la puntuación de la escala de AOFAS fue 86.9 ± 7.27. No se produjeron re-rupturas post-operatorias, ni recurrencias, ni complicaciones de heridas. La fuerza de flexión plantar y la puntuación de la escala AOFAS fueron puestas en correlación negativa con la edad al momento de la operación (r = "0.566, r = -0.669, respectivamente). Diecisiete pacientes (85%) alcanzaron el nivel cinco de la PMM en fuerza de eversión. Tras el tratamiento, seis pacientes (30%) se reintegraron a las competencias deportivas, mientras que 10 (50%) que antes de la lesión y la cirugía participaban en actividades recreativas, se reincorporaron a actividades similares. El grupo relativamente más joven tiende a continuar las actividades deportivas como atletas de competencia (p < 0.05). Se observaron diferencias significativas en edad en la operación entre el grupo sin satisfacción y el grupo excelente (p < 0.05). El grupo por debajo de los 40 años de edad mostró valores más pobres como tendencia. CONCLUSIÓN: Tanto los atletas de actividades recreativas como los no atletas, pudieron regresar a sus actividades deportivas satisfactoriamente, mientras que los competidores jóvenes encontraron dificultades en ciertas acciones, en particular las relacionadas con la eversión.