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. 2002 Dec;37(4):463-466.

Longitudinal Split of the Peroneus Brevis Tendon and Lateral Ankle Instability: Treatment of Concomitant Lesions

Jon Karlsson  1 , Per Wiger
Affiliations

Longitudinal Split of the Peroneus Brevis Tendon and Lateral Ankle Instability: Treatment of Concomitant Lesions

Jon Karlsson et al. J Athl Train. 2002 Dec.

Abstract

OBJECTIVE: To describe the clinical picture, pathophysiology, and treatment of concomitant lesions of the peroneus brevis tendon and lateral ligament injuries to the ankle. BACKGROUND: In some cases, chronic lateral ankle instability is associated with a longitudinal partial tear in the peroneus brevis tendon. Patients who suffer from this lesion usually have atypical posterolateral ankle pain combined with signs of recurrent ligament instability ("giving way"). The tendon injury is often overlooked because it is combined with the ligament injury, and the injury mechanisms are similar. DESCRIPTION: Tears or laxity in the superior peroneal retinaculum allow the anterior part of the injured peroneus brevis tendon to ride over the sharp posterior edge of the fibula, leading to a longitudinal tear in the tendon. This combined injury should be suspected in patients with recurrent giving way of the ankle joint and retromalleolar pain. The diagnosis can be established using either ultrasonography or magnetic resonance imaging. DIFFERENTIAL DIAGNOSIS: Ligament injury, tenosynovitis, peroneus longus tendon lesion, os peroneum fracture, distal peroneus brevis tendon tear, or anomalous peroneus tertius tendon. TREATMENT: The tendon injury and the ligament insufficiency should be repaired at the same time. CONCLUSIONS: We recommend reconstruction of the superior peroneal retinaculum, combined with repair of the tendon, using side-to-side sutures and anatomical reconstruction of the lateral ankle ligaments.

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Figures

Figure 1
Figure 1
Relationship among the longitudinal tear in the peroneus brevis tendon, the sharp posterior edge of the fibula, and the superior peroneal retinaculum. 1, Torn peroneus brevis tendon. 2, The sharp posterior edge of the fibula. 3, Superior peroneal retinaculum. 4, Normal peroneus longus tendon (retracted).
Figure 2
Figure 2
Sagittal oblique spin-echo proton density-weighted magnetic resonance image showing high signal intensity within the peroneus brevis tendon at the lateral malleolar level (black arrow). The peroneus longus tendon (white arrow) is normal.
Figure 3
Figure 3
Lateral view of the left ankle. A longitudinal tear is present in the peroneus brevis tendon. The peroneus longus tendon is normal.
Figure 4
Figure 4
Reconstruction of the superior peroneal retinaculum is performed after the peroneus brevis tendon has been debrided and sutured (see Figure 5). The superior peroneal retinaculum is attached to the posterior fibular edge with nonabsorbable sutures through 2-mm drill holes. 1, Superior peroneal retinaculum. 2, Anterior talofibular ligament.
Figure 5
Figure 5
A side-to-side suture (repair) of the partial longitudinal tear of the peroneus brevis tendon.
See this image and copyright information in PMC

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