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No additional surgical intervention needed
5%
56/1155
Debridement, repair, and tubularization of the peroneus brevis
41%
472/1155
Peroneal tendon groove deepening
2%
22/1155
Peroneus brevis tenodesis
50%
576/1155
Superior peroneal retinaculum (SPR) imbrication
19/1155
Select Answer to see Preferred Response
This patient underwent a modified Brostrom lateral ankle ligament reconstruction with peroneal tendon exploration. Tenodesis is recommended for larger tears of >50%-60%, irreparable tears, or severe tendinopathy. Residual lateral ankle instability following failed nonoperative management may necessitate surgical intervention. A modified Brostrom lateral ankle ligament reconstruction, which involves imbrication of the anterior talofibular (ATFL) and calcaneofibular ligaments (CFL) with the advancement of the inferior extensor retinaculum, is most commonly employed. In the presence of a concomitant peroneal tendon tear exceeding 50-60% involvement, a tenodesis is additionally recommended. Maffulli et al. reviewed chronic lateral ankle instability following untreated acute lateral ankle ligament injuries. They report that failed nonsurgical management after appropriate rehabilitation is an indication for surgery, with the anatomic repair of the ATFL and CFL being recommended. They concluded that anatomic reconstruction with autograft or allograft should be performed when the ruptured ligaments are attenuated, and tenodesis procedures are not recommended because they may disturb ankle and hindfoot biomechanics. Philbin et al. reviewed peroneal tendon injuries in patients with chronic lateral ankle pain. They report that addressing concomitant peroneal tendons tears, subluxing or dislocating tendons, and peroneal tenosynovitis are of great importance in achieving a favorable outcome. They conclude that low-demand patients do well with a nonsurgical approach but high-demand patients may benefit from surgery. Illustration A demonstrates a modified Brostrum reconstruction. Incorrect Answers: Answers 1: A tear of >50-60% should be treated with a tenodesis Answer 2: Debridement, repair, and tubularization of the peroneus brevis is recommended in smaller tears that are repairable in the absence of severe tendinopathy Answer 3: A groove deepening procedure may be indicated with peroneal tendon instability, but the management of a large tear should include a tenodesis Answer 5: The SPR may need to be released and repaired following peroneal tendon management, but an isolated SPR imbrication would not adequately address a large tendon tear
3.0
(5)
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