Comparison of Preoperative MRI With Intraoperative Findings for Peroneal Tendon Pathologies.

Magnetic resonance imaging (MRI) is commonly used to evaluate soft tissue pathology of the foot and ankle. Prior investigations have reported limitations of this modality, however, in evaluation of pathologies related to the peroneal tendons. This article investigates the correlation of pre-operative MRI studies with intraoperative findings. Five board-certified radiologists interpreted MRIs of 80 ankles that subsequently underwent surgical procedures performed by one board-certified foot and ankle surgeon, after which comparison was made between their findings. Statistically significant disagreement was found between radiologist and surgeon findings of a normal peroneus brevis (PB), PB and peroneus longus (PL) tendinosis, PB and PL hypertrophy, PB and PL partial linear tears, PB and PL flattening, PB longitudinal split tears, and the PB attritional spectrum (combined analysis of flattening, partial linear tearing, and longitudinal split tears). These results suggest that given the disconcordance between MRI and intraoperative findings, surgeons should remain cautious in their reliance upon this imaging modality when evaluating this anatomic region.

Systematic Review of Nonoperative Functional Protocols for Acute Achilles Ruptures Utilizing a Formal Rehabilitation Protocol Showing Lowest Rerupture Rates.

AIM: To lay out a comprehensive protocol for practitioners and physical therapists that has the lowest rerupture rates for nonoperative treatment of acute Achilles ruptures. METHOD: Relevant articles were searched in PubMed, CINAHL Plus, and Cochrane Library using keyword combinations: nonoperative AND/OR Achilles rupture AND functional AND/OR protocol or functional AND/OR rehabilitation. To be included in the full analysis, the studies had to have detailed functional protocols with physical therapy program details and outcome scores of rupture rates and/or Achilles Tendon Rupture Score (ATRS). We ultimately found 7 articles that fit our inclusion criteria for analysis. All of them had rerupture rates, and 4 had ATRS scores and functional protocols with mention of formal physical therapy programs. RESULTS: Lowest rerupture rates were found in strict functional rehabilitation protocols that were full weightbearing in boot immediately at full equinus or 30° plantar flexed. They started active range of motion at 5 to 8 weeks and started formal physical therapy at 10 weeks.Levels of Evidence: Level III: Evidence obtained from well-designed non-experimental descriptive studies.

The Role of the Accessory Malleolar Ossicles and Malleolar Avulsion Fractures in Lateral Ankle Ligament Reconstruction.

While it is well known that ankle sprains are one of the most common injuries in the United States, predictive factors regarding failure of conservative treatment are not well known. There are many biomechanical and epidemiological factors that play a role in recurrence and failure of conservative treatment, but most cases are able to be treated with immobilization and/or rest, ice, elevation, physical therapy, and bracing. We propose that one important risk factor is often overlooked simply due to the fact that a vast majority of these cases resolve without the need for surgery. Accessory ossicles and avulsion fractures of the malleoli or talus may represent a predisposition or marker for ligamentous damage that may lead to the need for lateral ankle ligament repair or reconstruction in the future. We have identified 61 consecutive patients who underwent lateral ankle ligament repair or reconstruction by the primary surgeon from the years 2007 to 2017. Out of those patients who met our inclusion and exclusion criteria, 66% had the presence of osseous pathology consisting of accessory ossicles or avulsion fractures of the medial or lateral malleolus or talus. The proportion of osseous pathology seen with lateral ankle ligament repair or reconstruction was higher than what has been previously reported in both operative and nonoperative settings. This may help identify a risk factor for failure of conservative treatment in patients presenting with acute ankle sprains or ankle instability especially in the active cohort. LEVELS OF EVIDENCE: Level IV: Case series.

Severe bone wax foreign-body reaction causing peroneal tendon destruction.

Bone wax is commonly used in orthopedic procedures for the hemostatic control of cancellous bone bleeding. Herein, ordinary bone wax was used to stop bleeding intraoperatively at the site of a peroneal tubercle resection. Five months postoperatively, a symptomatic retrofibular mass was removed. Gross examination showed severe peroneal tendon destruction associated with the mass. Microscopic examination diagnosed a bone wax granuloma. To our knowledge, this is the first case of significant tendon and nerve damage resulting from a bone wax foreign-body granuloma.

Medial Malleolar Osteotomy and Osteochondral Autograft Transfer for Osteochondritis Dissecans of the Distal Tibial Plafond.

UNLABELLED: The literature on the surgical treatment of osteochondritis dissecans of the distal tibial plafond is significantly limited. The purpose of this case study is to present a novel surgical technique to repair osteochondritis dissecans of the distal medial tibial plafond. A retrospective chart and radiographic review of a 15-year-old male was performed with a 24-month follow-up along with a review of the literature. A right angled medial malleolar osteotomy provides adequate exposure, width, and depth of the medial distal tibial plafond allowing for the successful transfer of osteochondral autograft plugs. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case report.