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Peroneal Tendons Injuries

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Tendon and Ligament Injuries of the Foot and Ankle

Abstract

Pathologic disorders of the peroneal tendons are an uncommon but underappreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from other lateral ankle injuries. Peroneal tendon disorders can lead to persistent lateral ankle pain and substantial functional problems, if they are not correctly approached and treated. Unfortunately, current recommendations for treatment (conservative and surgical) are based on small case series and experts’ opinion. The aims of this chapter are to develop a current understanding of the anatomy and clinical evaluation of the peroneal tendons and to establish a treatment algorithm. The authors’ preferred surgical techniques for management of peroneal tendon injuries are presented.

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References

  1. Demetracopoulos CA, Vineyard JC, Kiesau CD, Nunley JA. Long-term results of debridement and primary repair of peroneal tendon tears. Foot Ankle Int. 2014;35(3):252–7.

    Article  PubMed  Google Scholar 

  2. van Dijk CN, Kort N. Tendoscopy of the peroneal tendons. Arthroscopy. 1998;14:471–8.

    Article  PubMed  Google Scholar 

  3. Lui TH. Arthroscopy and endoscopy of the foot and ankle: indications for new techniques. Arthroscopy. 2007;23:889–902.

    Article  PubMed  Google Scholar 

  4. Panchbhavi VK, Trevino SG. The technique of peroneal tendoscopy and its role in management of peroneal tendón anomalies. Tech Foot Ankle Surg. 2003;2:192–8.

    Article  Google Scholar 

  5. Vega J, Golanó P, Batista JP, Malagelada F, Pellegrino A. Tendoscopic procedure associated with peroneal tendons. Tech Foot Ankle. 2013;12:39–48.

    Article  Google Scholar 

  6. Freccero DM, Berkowitz MJ. The relationship between tears of the peroneus brevis tendon and the distal extent of its muscle belly: an MRI study. Foot Ankle Int. 2006;27:236–9.

    Article  PubMed  Google Scholar 

  7. Lamm BM, Myers DT, Dombek M, Mendicino RW, Catanzariti AR, Saltrick K. Magnetic resonance imaging and surgical correlation of peroneus brevis tears. J Foot Ankle Surg. 2004;43:30–6.

    Article  PubMed  Google Scholar 

  8. Cheung YY, Rosenberg ZS, Ramsinghani R, Beltran J, Jahss MH. Peroneus quartus muscle: MR imaging features. Radiology. 1997;202:745–50.

    Article  CAS  PubMed  Google Scholar 

  9. Sobel M, Levy ME, Bohne WH. Congenital variations of the peroneus quartus muscle: an anatomic study. Foot Ankle. 1990;11:81–9. Erratum in: Foot Ankle. 1991;11:342.

    Article  CAS  PubMed  Google Scholar 

  10. Zammit J, Singh D. The peroneus quartus muscle. Anatomy and clinical relevance. J Bone Joint Surg Br. 2003;85:1134–7.

    Article  CAS  PubMed  Google Scholar 

  11. Molloy R, Tisdel C. Failed treatment of peroneal tendon injuries. Foot Ankle Clin. 2003;8:115–29. ix

    Article  PubMed  Google Scholar 

  12. Brage ME, Hansen ST Jr. Traumatic subluxation/dislocation of the peroneal tendons. Foot Ankle. 1992;13:423–31.

    Article  CAS  PubMed  Google Scholar 

  13. Roster B, Michelier P, Giza E. Peroneal tendon disorders. Clin Sports Med. 2015;34(4):625–41.

    Article  PubMed  Google Scholar 

  14. Edwards ME. The relations of the peroneal tendons to the fibula, calcaneus, and cuboideum. Am J Anat. 1928;42:213–53.

    Article  Google Scholar 

  15. Kumai T, Benjamin M. The histological structure of the malleolar groove of the fibula in man: its direct bearing on the displacement of peroneal tendons and their surgical repair. J Anat. 2003;203:257–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Eckert WR, Davis EA Jr. Acute rupture of the peroneal retinaculum. J Bone Joint Surg Am. 1976;58:670–2.

    Article  CAS  PubMed  Google Scholar 

  17. Sobel M, Geppert MJ, Olson EJ, Bohne WH, Arnoczky SP. The dynamics of peroneus brevis tendon splits: a proposed mechanism, technique of diagnosis, and classification of injury. Foot Ankle. 1992;13(7):413–22.

    Article  CAS  PubMed  Google Scholar 

  18. Adachi N, Fukuhara K, Kobayashi T, et al. Morphologic variations of the fibular malleolar groove with recurrent dislocation of the peroneal tendons. Foot Ankle Int. 2009;30(6):540–4.

    Article  PubMed  Google Scholar 

  19. Davis WH, Sobel M, Deland J, Bohne WH, Patel MB. The superior peroneal retinaculum: an anatomic study. Foot Ankle Int. 1994;15:271–5.

    Article  CAS  PubMed  Google Scholar 

  20. Anatomical Society. Collective investigations, sesamoids in the gastrocnemius and peroneus longus. J Anat Physiol. 1897;32:182–6.

    Google Scholar 

  21. Sobel M, Pavlov H, Geppert MJ, Thompson FM, DiCarlo EF, Davis WH. Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int. 1994;15:112–24.

    Article  CAS  PubMed  Google Scholar 

  22. Burman M. Stenosing tendovaginitis of the foot and ankle. Arch Surg. 1953;67:686–98.

    Article  CAS  Google Scholar 

  23. Sobel M, Geppert MJ, Warren RF. Chronic ankle instability as a cause of peroneal tendon injury. Clin Orthop Relat Res. 1993;296:187–91.

    Article  Google Scholar 

  24. Wind WM, Rohrbacher BJ. Peroneus longus and brevis rupture in a collegiate athlete. Foot Ankle Int. 2001;22:140–3.

    Article  CAS  PubMed  Google Scholar 

  25. Petersen W, Bobka T, Stein V, Tillmann B. Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand. 2000;71:168–74.

    Article  CAS  PubMed  Google Scholar 

  26. Sobel M, Geppert MJ, Hannafin JA, Bohne WH, Arnoczky SP. Microvascular anatomy of the peroneal tendons. Foot Ankle. 1992;13:469–72.

    Article  CAS  PubMed  Google Scholar 

  27. van Dijk PA, Madirolas FX, Carrera A, Kerkhoffs GM, Reina F. Peroneal tendons well vascularized: results from a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1140–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Maffulli N, Longo U, Loppini M, Spiezia F, Denaro V. New options in the management of tendinophaty. Open Access J Sports Med. 2010;1:29–37.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Abraham E, Stirnaman JE. Neglected rupture of the peroneal tendons causing recurrent sprains of the ankle. Case report. J Bone Joint Surg Am. 1979;61:1247–8.

    Article  CAS  PubMed  Google Scholar 

  30. Bonnin M, Tavernier T, Bouysset M. Split lesions of the peroneus brevis tendon in chronic ankle laxity. Am J Sports Med. 1997;25:699–703.

    Article  CAS  PubMed  Google Scholar 

  31. Karlsson J, Brandsson S, Kalebo P, Eriksson BI. Surgical treatment of concomitant chronic ankle instability and longitudinal rupture of the peroneus brevis tendon. Scand J Med Sci Sports. 1998;8:42–9.

    Article  CAS  PubMed  Google Scholar 

  32. Rosenberg ZS, Feldman F, Singson RD. Peroneal tendon injuries: CT analysis. Radiology. 1986;161:743–8.

    Article  CAS  PubMed  Google Scholar 

  33. Gray JM, Alpar EK. Peroneal tenosynovitis following ankle sprains. Injury. 2001;32:487–9.

    Article  CAS  PubMed  Google Scholar 

  34. Redfern D, Myerson M. The management of concomitant tears of the peroneus longus and brevis tendons. Foot Ankle Int. 2004;25:695–707.

    Article  PubMed  Google Scholar 

  35. Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg. 2003;42:250–8.

    Article  PubMed  Google Scholar 

  36. Alanen J, Orava S, Heinonen OJ, Ikonen J, Kvist M. Peroneal tendon injuries. Report of thirty-eight operated cases. Ann Chir Gynaecol. 2001;90(1):43–6.

    CAS  PubMed  Google Scholar 

  37. Philbin T, Landis G, Smith B. Peroneal tendon injuries. J Am Acad Orthop Surg. 2009;17:306–17.

    Article  PubMed  Google Scholar 

  38. Bruce WD, Christofersen MR, Phillips DL. Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle. Foot Ankle Int. 1999;20:464–7.

    Article  CAS  PubMed  Google Scholar 

  39. Boles MA, Lomasney LM, Demos TC, Sage RA. Enlarged peroneal process with peroneus longus tendon entrapment. Skelet Radiol. 1997;26:313–5.

    Article  CAS  Google Scholar 

  40. Pierson JL, Inglis AE. Stenosing tenosynovitis of the peroneus longus tendon associated with hypertrophy of the peroneal tubercle and an os peroneum. A case report. J Bone Joint Surg Am. 1992;74:440–2.

    Article  CAS  PubMed  Google Scholar 

  41. Taki K, Yamazaki S, Majima T, Ohura H, Minami A. Bilateral stenosing tenosynovitis of the peroneus longus tendon associated with hypertrophied peroneal tubercle in a junior soccer player: a case report. Foot Ankle Int. 2007;28:129–32.

    Article  PubMed  Google Scholar 

  42. Brandes CB, Smith RW. Characterization of patients with primary peroneus longus tendinopathy: a review of twenty-two cases. Foot Ankle Int. 2000;21:462–8.

    Article  CAS  PubMed  Google Scholar 

  43. DiGiovanni BF, Fraga CJ, Cohen BE, et al. Associated injuries found in chronic lateral ankle instability. Foot Ankle Int. 2000;21(10):809–15.

    Article  CAS  PubMed  Google Scholar 

  44. Bassett FH 3rd, Speer KP. Longitudinal rupture of the peroneal tendons. Am J Sports Med. 1993;21:354–7.

    Article  PubMed  Google Scholar 

  45. Munk RL, Davis PH. Longitudinal rupture of the peroneus brevis tendon. J Trauma. 1976;16:803–6.

    Article  CAS  PubMed  Google Scholar 

  46. Cerrato RA, Myerson MS. Peroneal tendon tears, surgical management and its complications. Foot Ankle Clin. 2009;14(2):299–312.

    Article  PubMed  Google Scholar 

  47. Krause JO, Brodsky JW. Peroneus brevis tendon tears: pathophysiology, surgical reconstruction, and clinical results. Foot Ankle Int. 1998;19(5):271–9.

    Article  CAS  PubMed  Google Scholar 

  48. Sammarco GJ. Peroneal tendon injuries. Orthop Clin North Am. 1994;25:135–45.

    Article  CAS  PubMed  Google Scholar 

  49. Pelet S, Saglini M, Garofalo R, Wettstein M, Mouhsine E. Traumatic rupture of both peroneal longus and brevis tendons. Foot Ankle Int. 2003;24:721–3.

    Article  PubMed  Google Scholar 

  50. Hyer CF, Dawson JM, Philbin TM, Berlet GC, Lee TH. The peroneal tubercle: description, classification, and relevance to peroneus longus tendon pathology. Foot Ankle Int. 2005;26:947–50.

    Article  PubMed  Google Scholar 

  51. Grant TH, Kelikian AS, Jereb SE, McCarthy RJ. Ultrasound diagnosis of peroneal tendon tears. A surgical correlation. J Bone Joint Surg Am. 2005;87:1788–94.

    PubMed  Google Scholar 

  52. Tehranzadeh J, Stoll DA, Gabriele OM. Case report 271. Posterior migration of the os peroneum of the left foot, indicating a tear of the peroneal tendon. Skelet Radiol. 1984;12:44–7.

    Article  CAS  Google Scholar 

  53. Peacock KC, Resnick EJ, Thoder JJ. Fracture of the os peroneum with rupture of the peroneus longus tendon. A case report and review of the literature. Clin Orthop Relat Res. 1986;202:223–6.

    Article  Google Scholar 

  54. Bianchi S, Abdelwahab IF, Tegaldo G. Fracture and posterior dislocation of the os peroneum associated with rupture of the peroneus longus tendon. Can Assoc Radiol J. 1991;42:340–4.

    CAS  PubMed  Google Scholar 

  55. Borton DC, Lucas P, Jomha NM, et al. Operative reconstruction after transverse rupture of the tendons of both peroneus longus and brevis. Surgical reconstruction by transfer of the flexor digitorum longus tendon. J Bone Joint Surg Br. 1998;80(5):781–4.

    Article  CAS  PubMed  Google Scholar 

  56. Safran MR, O’Malley D Jr, Fu FH. Peroneal tendon subluxation in athletes: new exam technique, case reports, and review. Med Sci Sports Exerc. 1999;31(7 Suppl):S487–92.

    Article  CAS  PubMed  Google Scholar 

  57. Zoellner G, Clancy W Jr. Recurrent dislocation of the peroneal tendon. J Bone Joint Surg Am. 1979;61:292–4.

    Article  CAS  PubMed  Google Scholar 

  58. Maffulli N, Ferran NA, Oliva F, Testa V. Recurrent subluxation of the peroneal tendons. Am J Sports Med. 2006;34:986–92.

    Article  PubMed  Google Scholar 

  59. Geppert MJ, Sobel M, Bohne WH. Lateral ankle instability as a cause of superior peroneal retinacular laxity: an anatomic and biomechanical study of cadaveric feet. Foot Ankle. 1993;14:330–4.

    Article  CAS  PubMed  Google Scholar 

  60. Selmani E, Gjata V, Gjika E. Current concepts review: peroneal tendon disorders. Foot Ankle Int. 2006;27:221–8.

    Article  PubMed  Google Scholar 

  61. Purnell ML, Drummond DS, Engber WD, Breed AL. Congenital dislocation of the peroneal tendons in the calcaneovalgus foot. J Bone Joint Surg Br. 1983;65:316–9.

    Article  CAS  PubMed  Google Scholar 

  62. Altchek DW, DiGiovanni CW, Dines JS, et al. Foot and ankle sports medicine. Philadelphia: LippinCott Williams & Wilkins; 2013.

    Google Scholar 

  63. Rosenberg ZS, Feldman F, Singson RD, Price GJ. Peroneal tendon injury associated with calcaneal fractures: CT findings. AJR Am J Roentgenol. 1987;149:125–9.

    Article  CAS  PubMed  Google Scholar 

  64. Truong DT, Dussault RG, Kaplan PA. Fracture of the os peroneum and rupture of the peroneus longus tendon as a complication of diabetic neuropathy. Skelet Radiol. 1995;24:626–8.

    Article  CAS  Google Scholar 

  65. Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005;87:187–202.

    PubMed  Google Scholar 

  66. Church CC. Radiographic diagnosis of acute peroneal tendon dislocation. AJR Am J Roentgenol. 1977;129:1065–8.

    Article  CAS  PubMed  Google Scholar 

  67. Mitchell M, Sartoris DJ. Magnetic resonance imaging of the foot and ankle: an updated pictorial review. J Foot Ankle Surg. 1993;32:311–42.

    CAS  PubMed  Google Scholar 

  68. Major NM, Helms CA, Fritz RC, Speer KP. The MR imaging appearance of longitudinal split tears of the peroneus brevis tendon. Foot Ankle Int. 2000;21:514–9.

    Article  CAS  PubMed  Google Scholar 

  69. Wang XT, Rosenberg ZS, Mechlin MB, Schweitzer ME. Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics. 2005;25:587–602. Erratum in: Radiographics. 2005;25:1436. Radiographics. 2006;26:640

    Article  PubMed  Google Scholar 

  70. Squires N, Myerson MS, Gamba C. Surgical treatment of peroneal tendon tears. Foot Ankle Clin. 2007;12(4):675–95. vii

    Article  PubMed  Google Scholar 

  71. Lee SJ, Jacobson JA, Kim SM, et al. Ultrasound and MRI of the peroneal tendons and associated pathology. Skelet Radiol. 2013;42(9):1191–200.

    Article  Google Scholar 

  72. Rademaker J, Rosenberg ZS, Delfaut EM, Cheung YY, Schweitzer ME. Tear of the peroneus longus tendon: MR imaging features in nine patients. Radiology. 2000;214:700–4.

    Article  CAS  PubMed  Google Scholar 

  73. Khoury NJ, el-Khoury GY, Saltzman CL, Kathol MH. Peroneus longus and brevis tendon tears: MR imaging evaluation. Radiology. 1996;200:833–41.

    Article  CAS  PubMed  Google Scholar 

  74. Stover CN, Bryan DR. Traumatic dislocation of the peroneal tendons. Am J Surg. 1962;103:180–6.

    Article  CAS  PubMed  Google Scholar 

  75. Chiodo CP. Acute and chronic tendon injury. In: Richardson EG, editor. Orthopaedic knowledge update: foot and ankle 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2003. p. 81–9.

    Google Scholar 

  76. Roser B, Michelier P, Giza E. Peroneal tendon disorders. Clin Sports Med. 2015;34(4):625–41.

    Article  Google Scholar 

  77. Porter D, McCarroll J, Knapp E, Torma J. Peroneal tendon subluxation in athletes: fibular groove deepening and retinacular reconstruction. Foot Ankle Int. 2005;26:436–41.

    Article  PubMed  Google Scholar 

  78. Raikin SM, Elias I, Nazarian LN. Intrasheath subluxation of the peroneal tendons. J Bone Joint Surg Am. 2008;90:992–9.

    Article  PubMed  Google Scholar 

  79. Adachi N, Fukuhara K, Tanaka H, Nakasa T, Ochi M. Superior retinaculoplasty for recurrent dislocation of peroneal tendons. Foot Ankle Int. 2006;27:1074–8.

    Article  PubMed  Google Scholar 

  80. Anderson R, Shawen S. Indirect groove deepening in the management of chronic peroneal tendon dislocation. Tech Foot Ankle Surg. 2004;3(2):118–25.

    Article  Google Scholar 

  81. Title CI, Jung HG, Parks BG, Schon LC. The peroneal groove deepening procedure: a biomechanical study of pressure reduction. Foot Ankle Int. 2005;26:442–8.

    Article  PubMed  Google Scholar 

  82. Kelly RE. An operation for the chronic dislocation of the peroneal tendons. Br J Surg. 1920;7:502–4.

    Article  Google Scholar 

  83. Vega J, Batista JP, Golanó P, Dalmau A, Viladot R. Tendoscopic groove deepening for chronic subluxation of the peroneal tendons. Foot Ankle Int. 2013;34:832–40.

    Article  PubMed  Google Scholar 

  84. Lui TH. Endoscopic peroneal retinaculum reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006;14:478–81.

    Article  PubMed  Google Scholar 

  85. Thomas JL, Lopez-Ben R, Maddox J. A preliminary report on intrasheath peroneal tendón subluxation: a prospective review of 7 patients with ultrasound verification. J Foot Ankle Surg. 2009;48:323–9.

    Article  PubMed  Google Scholar 

  86. Vega J, Golanó P, Dalmau A, Viladot R. Tendoscopic treatment of intrasheath subluxation of the peroneal tendons. Foot Ankle Int. 2011;32:1147–51.

    Article  PubMed  Google Scholar 

  87. Kollias SL, Ferkel RD. Fibular grooving for recurrent peroneal tendon subluxation. Am J Sports Med. 1997;25:329–35.

    Article  CAS  PubMed  Google Scholar 

  88. Mook WR, Parekh SG, Nunley JA. Allograft reconstruction of peroneal tendons: operative technique and clinical outcomes. Foot Ankle Int. 2013;34(9):1212–20.

    Article  PubMed  Google Scholar 

  89. Cooper ME, Selesnick FH, Murphy BJ. Partial peroneus longus rupture in professional basketball players: a report of 2 cases. Am J Orthop. 2002;31(12):691–4.

    PubMed  Google Scholar 

  90. Sammarco GJ. Peroneus longus tendon tears: acute and chronic. Foot Ankle Int. 1995;16:245–53.

    Article  CAS  PubMed  Google Scholar 

  91. Wapner KL, Taras JS, Lin SS, et al. Staged reconstruction for chronic rupture of both peroneal tendons using hunter rod and flexor hallucis longus tendon transfer: a long-term followup study. Foot Ankle Int. 2006;27(8):591–7.

    Article  PubMed  Google Scholar 

  92. Saxena A, Cassidy A. Peroneal tendon injuries: an evaluation of 49 tears in 41 patients. J Foot Ankle Surg. 2003;42(4):215–20.

    Article  PubMed  Google Scholar 

  93. Mercer NP, Gianakos AL, Mercurio AM, Kennedy JG. Clinical outcomes of Peroneal tendon tears: a systematic review. J Foot Ankle Surg. 2021;60(5):1008–13. https://doi.org/10.1053/j.jfas.2021.03.003.

    Article  PubMed  Google Scholar 

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Muñoz, F., Chaparro, F., Escudero, M., Bastías, G.F., Pellegrini, M.J. (2022). Peroneal Tendons Injuries. In: Cain, J.D., Hogan, M.V. (eds) Tendon and Ligament Injuries of the Foot and Ankle. Springer, Cham. https://doi.org/10.1007/978-3-031-10490-9_6

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