Skip to main content

Advertisement

SpringerLink
Log in

MRI findings of peroneal tendon tears do not necessarily correlate to clinical findings in paediatric and adolescent patients

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Pathologic abnormality of the peroneal tendons are thought to be an under-appreciated source of vague ankle and hindfoot pain in paediatric patients, partly because they can be difficult to diagnose and differentiate from lateral ankle ligament injuries. While magnetic resonance imaging (MRI) is the primary imaging modality used to detect peroneal tendon pathology, previous studies in adults have found that positive MRIs demonstrate a positive predictive value (PPV) of associated clinical findings around 48%. There are no similar known published studies in the paediatric population. Our objective was to determine the positive predictive value of peroneal tendon pathology as diagnosed by MRI as related to positive clinical exam findings in the paediatric and adolescent population.

Methods

This IRB approved retrospective study was conducted at a tertiary children’s hospital. Inclusion criteria included patients under 18 years from our tertiary care institution with (a) ankle MRI findings indicating pathology of the peroneus brevis/longus tendons confirmed by a board certified paediatric musculoskeletal radiologist and (b) formal review of the clinical examination by a fellowship trained paediatric orthopaedic surgeon. Patients with congenital deformities or previous surgical intervention of the lateral ankle were excluded.

Results

Forty-seven patients (with 48 MRIs) met inclusion criteria over a ten year period. The majority of the positive MRI scans (70%) demonstrated a peroneus brevis split tear. Of the patients with positive findings on MRI, 17 patients had an associated positive clinical exam. The positive predictive value of MRI for peroneal tendon tears with positive clinical findings was 35.41% (95% confidence interval = 31.1% to 41.6%). There were 31 patients with MRI positive findings with a negative clinical exam.

Conclusion

Despite having a negative clinical exam, a high percentage of patients had positive MRI findings suggestive of peroneal tendon pathology which confirms findings of adult populations demonstrating a high rate of incidental finding of peroneal tendon pathology on MRI in paediatric patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Code availability

Not applicable.

References

  1. Philbin TM, Landis GS, Smith B (2009) Peroneal tendon injuries. J Am Acad Orthop Surg 17(5):306–317. https://doi.org/10.5435/00124635-200905000-00005

    Article  PubMed  Google Scholar 

  2. Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR (2003) Peroneal tendon tears: a retrospective review. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 42(5):250–258. https://doi.org/10.1016/s1067-2516(03)00314-4

    Article  PubMed  Google Scholar 

  3. Mercer NP, Gianakos AL, Mercurio AM, Kennedy JG (2021) Clinical outcomes of peroneal tendon tears: a systematic review. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 60(5):1008–1013. https://doi.org/10.1053/j.jfas.2021.03.003

    Article  PubMed  Google Scholar 

  4. Roster B, Michelier P, Giza E (2015) Peroneal tendon disorders. Clin Sports Med 34(4):625–641. https://doi.org/10.1016/j.csm.2015.06.003

    Article  PubMed  Google Scholar 

  5. McGoldrick NP, Bergin D, Kearns SR (2017) Peroneus tertius tendon tear causing lateral ankle pain in a child. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 56(4):854–856. https://doi.org/10.1053/j.jfas.2017.02.014

    Article  PubMed  Google Scholar 

  6. Davda K, Malhotra K, O’Donnell P, Singh D, Cullen N (2017) Peroneal tendon disorders EFORT open reviews 2(6):281–292. https://doi.org/10.1302/2058-5241.2.160047

    Article  PubMed  Google Scholar 

  7. Brandes CB, Smith RW (2000) Characterization of patients with primary peroneus longus tendinopathy: a review of twenty-two cases. Foot Ankle Int 21(6):462–468. https://doi.org/10.1177/107110070002100602

    Article  CAS  PubMed  Google Scholar 

  8. Neustadter J, Raikin SM, Nazarian LN (2004) Dynamic sonographic evaluation of peroneal tendon subluxation. AJR Am J Roentgenol 183(4):985–988. https://doi.org/10.2214/ajr.183.4.1830985

    Article  PubMed  Google Scholar 

  9. Grant TH, Kelikian AS, Jereb SE, McCarthy RJ (2005) Ultrasound diagnosis of peroneal tendon tears. A surgical correlation. The Journal of bone and joint surgery. American volume 87(8):1788–1794. https://doi.org/10.2106/JBJS.D.02450

    Article  PubMed  Google Scholar 

  10. Giza E, Mak W, Wong SE, Roper G, Campanelli V, Hunter JC (2013) A clinical and radiological study of peroneal tendon pathology. Foot Ankle Spec 6(6):417–421. https://doi.org/10.1177/1938640013501544

    Article  PubMed  Google Scholar 

  11. Walt J, Massey P (2023) Peroneal tendon syndromes. In StatPearls. StatPearls Publishing

  12. Johnson CH, Christensen JC (1999) Biomechanics of the first ray. Part I. The effects of peroneus longus function: a three-dimensional kinematic study on a cadaver model. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 38(5):313–321. https://doi.org/10.1016/s1067-2516(99)80002-7

    Article  CAS  PubMed  Google Scholar 

  13. Brunt D, Andersen JC, Huntsman B, Reinhert LB, Thorell AC, Sterling JC (1992) Postural responses to lateral perturbation in healthy subjects and ankle sprain patients. Med Sci Sports Exerc 24(2):171–176

    Article  CAS  PubMed  Google Scholar 

  14. Konradsen L, Voigt M, Højsgaard C (1997) Ankle inversion injuries. The role of the dynamic defense mechanism. The American journal of sports medicine 25(1):54–58. https://doi.org/10.1177/036354659702500110

    Article  CAS  PubMed  Google Scholar 

  15. Sarrafian SK (1993) Anatomy of the foot and ankle: descriptive, topographic, functional, 2nd edn. JB Lippincott, Philadelphia

    Google Scholar 

  16. Sobel M, Pavlov H, Geppert MJ, Thompson FM, DiCarlo EF, Davis WH (1994) Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int 15(3):112–124. https://doi.org/10.1177/107110079401500306

    Article  CAS  PubMed  Google Scholar 

  17. Wang XT, Rosenberg ZS, Mechlin MB, Schweitzer ME (2005) Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics : a review publication of the Radiological Society of North America, Inc 25(3):587–602. https://doi.org/10.1148/rg.253045123

    Article  PubMed  Google Scholar 

  18. Petersen W, Bobka T, Stein V, Tillmann B (2000) Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand 71(2):168–174. https://doi.org/10.1080/000164700317413148

    Article  CAS  PubMed  Google Scholar 

  19. Park HJ, Cha SD, Kim HS, Chung ST, Park NH, Yoo JH, Park JH, Kim JH, Lee TW, Lee CH, Oh SM (2010) Reliability of MRI findings of peroneal tendinopathy in patients with lateral chronic ankle instability. Clin Orthop Surg 2(4):237–243. https://doi.org/10.4055/cios.2010.2.4.237

    Article  PubMed  PubMed Central  Google Scholar 

  20. Galli MM, Protzman NM, Mandelker EM, Malhotra AD, Schwartz E, Brigido SA (2015) An examination of anatomic variants and incidental peroneal tendon pathologic features: a comprehensive MRI review of asymptomatic lateral ankles. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 54(2):164–172. https://doi.org/10.1053/j.jfas.2014.11.005

    Article  PubMed  Google Scholar 

  21. O’Neil JT, Pedowitz DI, Kerbel YE, Codding JL, Zoga AC, Raikin SM (2016) Peroneal tendon abnormalities on routine magnetic resonance imaging of the foot and ankle. Foot Ankle Int 37(7):743–747. https://doi.org/10.1177/1071100716635645

    Article  PubMed  Google Scholar 

  22. Kijowski R, De Smet A, Mukharjee R (2007) Magnetic resonance imaging findings in patients with peroneal tendinopathy and peroneal tenosynovitis. Skeletal Radiol 36(2):105–114. https://doi.org/10.1007/s00256-006-0172-7

    Article  PubMed  Google Scholar 

  23. Horn DB, Meyers S, Astor W (2015) True pathologic abnormality versus artifact foot position and magic angle artifact in the peroneal tendons with 3T imaging. J Am Podiatr Med Assoc 105(5):443–450. https://doi.org/10.7547/14-068

    Article  PubMed  Google Scholar 

  24. Ieong E, Rafferty M, Khanna M, Walker M, Rosenfeld P (2019) Use of fat-suppressed T2-weighted MRI images to reduce the magic angle effect in peroneal tendons. Foot Ankle Spec 12(6):513–517. https://doi.org/10.1177/1938640018819783

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge Stacey Isidro MD for their assistance with the chart review.

Author information

Authors and Affiliations

  1. Texas Children’s Hospital, Department of Orthopedics, Houston, TX, USA

    Barkha Chhabra & Indranil Kushare

  2. UTHealth McGovern Medical School, Houston, TX, USA

    Nikhil Gattu

  3. Baylor College of Medicine, Department of Orthopedics, Houston, TX, USA

    Indranil Kushare

Authors
  1. Barkha Chhabra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikhil Gattu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Indranil Kushare
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by B.C. The first draft of the manuscript was written by N.G. and B.C., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Barkha Chhabra.

Ethics declarations

Ethics approval

This is a retrospective study authorized by the Institutional Review Board for Baylor College of Medicine and Affiliated Hospitals under reference H-45616.

Consent for publication

Not applicable.

Informed consent

This is a retrospective series of chart review, and informed consent was not required.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence: III.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chhabra, B., Gattu, N. & Kushare, I. MRI findings of peroneal tendon tears do not necessarily correlate to clinical findings in paediatric and adolescent patients. International Orthopaedics (SICOT) 48, 1561–1567 (2024). https://doi.org/10.1007/s00264-024-06110-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-024-06110-x

Keywords

Search

Navigation