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Diagnosis and Operative Treatment of Peroneal Tendon Tears.

ABSTRACT: Peroneal tendon tears are a common but under-recognized source of ankle pain and dysfunction. Recognition of the characteristic symptoms, physical findings, and imaging results of peroneal tendon tears is essential for accurate diagnosis and appropriate treatment. Acute, limited tears of a single peroneal tendon may be debrided and repaired. However, by the time operative treatment is undertaken, many tears of a single tendon are sufficiently advanced that the surgeon may need to consider excision of the nonviable segment and tenodesis of the damged tendon to the to the adjacent peroneal tendon. Irreparable tearing of both peroneal tendons may be treated with flexor tendon transfer and/or allograft reconstruction. This review article focuses on diagnosis and operative treatment of peroneal tendon tears, including the treatment algorithms, operative technique, and published outcomes.

SUBMITTER: Danna NR

PROVIDER: S-EPMC8697126 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Diagnosis and Operative Treatment of Peroneal Tendon Tears.

Danna Natalie R NR Brodsky James W JW

Foot & ankle orthopaedics 20200409 2

Peroneal tendon tears are a common but under-recognized source of ankle pain and dysfunction. Recognition of the characteristic symptoms, physical findings, and imaging results of peroneal tendon tears is essential for accurate diagnosis and appropriate treatment. Acute, limited tears of a single peroneal tendon may be debrided and repaired. However, by the time operative treatment is undertaken, many tears of a single tendon are sufficiently advanced that the surgeon may need to consider excisi ...[more]

PMID: 35097372

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Project description:The peroneus muscles, consisting of the peroneus longus (PL) and peroneus brevis (PB) tendons, are vulnerable to injury at anatomically specific sites or within tendon sheaths. Peroneal tendon dislocation (PTD) is often misdiagnosed as a lateral ankle sprain as it occurs at a lower frequency than a lateral ankle sprain. Anatomical variations in the retromalleolar groove, soft tissue overstuffing, and presence of accessory peroneal muscles contribute to the etiology of PTD. PTD has been classified into four types based on injury patterns involving the superior peroneal retinaculum (SPR) and fibrocartilaginous ridge. Diagnosis involves recognizing tender points and using imaging including magnetic resonance imaging (MRI) and ultrasonography. Conservative treatments, including below-knee plaster casts, have varying success rates, and some patients progress to recurrent PTD (RPTD), prompting consideration of surgical interventions. Diagnosis is easy in patients with RPTD who can reproduce the dislocation by themselves; however, in many cases, this is not possible. In such cases, ultrasonography after intrasheath injection is effective in confirming the presence of a pseudo-pouch. RPTD can be diagnosed if a pseudo-pouch is identified during ultrasonography. Surgical approaches such as osteotomy, soft tissue procedures, and groove deepening techniques are used to stabilize the peroneal tendons. Soft tissue procedures, especially SPR reattachment, have emerged as a preferred option, demonstrating outcomes comparable to those of osteotomy, with fewer complications. Intrasheath subluxation, a unique PTD subtype, is diagnosed using ultrasonography. In this type of subluxation, no damage to the SPR is observed, and the positions of the PL and PB tendons are interchanged. Surgical intervention may involve excision of the synovium and SPR repair. In cases of PTD complicated by a longitudinal rupture of the PB tendon, suturing of the torn area or tubularization of the remaining tendon for partial resection of the degenerated tendon can be performed. The purpose of this article is to describe the methods for diagnoses and management of PTD.

Project description:BackgroundThere are only a few isolated studies that have examined ultrasound-guided magnetic resonance arthrography (USMRA) of the glenohumeral joint and subacromial bursa with the use of gadolinium contrast agent. This study aimed to determine the clinical value of USMRA in the diagnosis of supraspinatus tendon tears and its subtypes.MethodsMusculoskeletal ultrasound (MSKUS) was performed in 207 patients with shoulder pain as confirmed by arthroscopic examination, 103 of whom underwent shoulder joint magnetic resonance imaging (MRI), and 104 of whom underwent USMRA. Based on tear subtypes and grading matching, the diagnostic value of MSKUS, MRI, and USMRA was assessed in terms of identifying the presence of supraspinatus tendon tears and its subtypes.ResultsThe results demonstrated statistically significant differences between the three groups in terms of diagnostic sensitivity, specificity, positive and negative predictive values, and accuracy in identifying supraspinatus tendon tears (P<0.05). The analysis of area under the receiver operating characteristic curve (AUC) indicated that MSKUS (AUC =0.76) and MRI (AUC =0.86) had moderate diagnostic value, while USMRA (AUC =0.95) had a higher diagnostic value. Regarding the tear subtypes in the MSKUS, MRI, and USMRA groups, the AUCs for articular-sided tears were 0.62, 0.75, and 0.87, respectively, while those for intratendinous tears were 0.57, 0.72, and 0.89, respectively, indicating moderate diagnostic value across the three groups; meanwhile, the AUCs for bursal-sided tears were 0.71, 0.73, and 0.92, respectively, while those for full-thickness tears were 0.75, 0.87, and 0.93, respectively, indicating moderate diagnostic values in the MSKUS group and MRI group and high diagnostic values in the USMRA group. The incidence of adverse reactions in the USMRA group was 1.92% (2/104).ConclusionsUSMRA demonstrated high diagnostic value for the diagnosis of supraspinatus tendon tears and bursal-sided and full-thickness tears.

Project description:ObjectivesTo compare re-rupture rate, complication rate, and functional outcome after operative versus nonoperative treatment of Achilles tendon ruptures; to compare re-rupture rate after early and late full weight bearing; to evaluate re-rupture rate after functional rehabilitation with early range of motion; and to compare effect estimates from randomised controlled trials and observational studies.DesignSystematic review and meta-analysis.Data sourcesPubMed/Medline, Embase, CENTRAL, and CINAHL databases were last searched on 25 April 2018 for studies comparing operative versus nonoperative treatment of Achilles tendon ruptures.Study selection criteriaRandomised controlled trials and observational studies reporting on comparison of operative versus nonoperative treatment of acute Achilles tendon ruptures.Data extractionData extraction was performed independently in pairs, by four reviewers, with the use of a predefined data extraction file. Outcomes were pooled using random effects models and presented as risk difference, risk ratio, or mean difference, with 95% confidence interval.Results29 studies were included-10 randomised controlled trials and 19 observational studies. The 10 trials included 944 (6%) patients, and the 19 observational studies included 14 918 (94%) patients. A significant reduction in re-ruptures was seen after operative treatment (2.3%) compared with nonoperative treatment (3.9%) (risk difference 1.6%; risk ratio 0.43, 95% confidence interval 0.31 to 0.60; P<0.001; I2=22%). Operative treatment resulted in a significantly higher complication rate than nonoperative treatment (4.9% v 1.6%; risk difference 3.3%; risk ratio 2.76, 1.84 to 4.13; P<0.001; I2=45%). The main difference in complication rate was attributable to the incidence of infection (2.8%) in the operative group. A similar reduction in re-rupture rate in favour of operative treatment was seen after both early and late full weight bearing. No significant difference in re-rupture rate was seen between operative and nonoperative treatment in studies that used accelerated functional rehabilitation with early range of motion (risk ratio 0.60, 0.26 to 1.37; P=0.23; I2=0%). No difference in effect estimates was seen between randomised controlled trials and observational studies.ConclusionsThis meta-analysis shows that operative treatment of Achilles tendon ruptures reduces the risk of re-rupture compared with nonoperative treatment. However, re-rupture rates are low and differences between treatment groups are small (risk difference 1.6%). Operative treatment results in a higher risk of other complications (risk difference 3.3%). The final decision on the management of acute Achilles tendon ruptures should be based on patient specific factors and shared decision making. This review emphasises the potential benefits of adding high quality observational studies in meta-analyses for the evaluation of objective outcome measures after surgical treatment.

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Diagnosis and Operative Treatment of Peroneal Tendon Tears.

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Diagnosis and Operative Treatment of Peroneal Tendon Tears.

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