Peroneus longus tendon rupture: A case report

BACKGROUND Peroneal tendinopathies are an under-diagnosed and potentially under-treated pathology. If left untreated it can be a cause of chronic lateral hindfoot pain. Its diagnosis is challenging owing to its low incidence and vague clinical presentation.CASE SUMMARY We share a case of a patient who experienced a chronic lateral ankle pain exacerbated after alighting from a bus. This patient came to our attention only after failing conservative management on two separate occasions. Plain radiographs and magnetic resonance imaging revealed rupture of the peroneus longus tendon(PLT). Findings were confirmed intra-operatively and tenodesis of the PLT to the peroneus brevis was performed. Patient was kept non-weight-bear with his foot everted and in plantarflexion before being converted to an offloading boot at two weeks. Patient was started on a progressive rehabilitation programme at six weeks and was able to return to work shortly after with excellent outcomes.CONCLUSION We aim to share our experience in managing this patient and propose some pointers guided by available literature to avoid missing this commonly overlooked pathology.

Minimally invasive tenodesis for peroneus longus tendon rupture: A case report and review of literature

BACKGROUND Peroneal tendon disorders are common causes of lateral hindfoot pain.However,total rupture of the peroneal longus tendon is rare.Surgical treatment for this condition is usually a side-to-side tenodesis of the peroneal longus tendon to the peroneal brevis tendon.While the traditional procedure involves a long lateral curved incision,this approach is associated with damage to the lateral soft tissues(up to 24%incidence).CASE SUMMARY A 50-year-old female had developed pain at the lateral aspect of the hindfoot 1 mo after an ankle sprain while walking in the street.Previous treatments were anti-inflammatory drugs,ice,rest and Cam-walker boot.At physical exam,there was pain and swelling over the course of the peroneal tendons.Ankle instability and cavovarus foot deformity were ruled out.Eversion strength was weak(4/5).Imaging showed complete rupture of the peroneal longus tendon associated with a sharp hypertrophic peroneal tubercle.Surgical repair was indicated after failure of conservative treatment(physiotherapy,rest,analgesics,and ankle stabilizer).A less invasive approach was performed for peroneal longus tendon debridement and side-to-side tenodesis to the adjacent peroneal brevis tendon,with successful clinical and functional outcomes.CONCLUSION Peroneus longus tendon tenodesis can be performed through a less invasive approach with preservation of the lateral soft tissue integrity.

Applied distally based peroneus brevis muscle flaps for coverage of the soft tissue defects over the lower one-third of the leg, ankle and foot

Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applied for coverage of the soft tissue defects over the lower one-third of the leg,the ankle and the foot. The muscle flaps were covered with split-thickness skin grafts. Results The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot in 16 cases. The larges area of the soft tissue defect was 5 cm × 7 cm. The smallest was 3 cm × 4 cm. Primary healing occured in 14 cases undergoing muscle flap construction, second-stage healing occured in 2 cases, no total flap necrosis occured in any cases. Conclusion ThisChina Medical Abstracts(Surgery) technigue is a simple and complication are lesser. The successful rates are higher. This muscle flap is suitable to the mudium or small soft tissue

Distally based peroneus brevis muscle flap: A single centre experience

Purpose: Defects aro und the distal one third of the leg and ankle are difficult to man age by con servative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects. Methods: This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and an kle, which were treated using distally based per on eus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery. Results: There were 21 males and 4 females with the mean age of 39 (5-76) years. The most comm on cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4—50) cm^2. The mean operating time was 75 (60-90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patie nts have graft loss due to un derlyi ng hematoma and required sec on dary split thickness skin grafting. Conclusion: The distally based peroneus brevis muscle flap is a safe optio n w 让h reliable an atomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.

When free flaps are not the first choice: is the distally based peroneus brevis still an option for foot and ankle reconstruction in the era of microsurgery?

Aim: Soft tissue defects with or without exposed bones in the lower extremity, ankle and the foot-with or without bone defects or exposed hardware-often require coverage with vascularized flaps. Free flaps, which add healthy tissue especially to the lower extremity instead of further injuring a limb, are the first choice in high volume microsurgical centres. Nevertheless, in some instances pedicled flaps may have indications when free flaps are not suitable. Methods: The distally based peroneus brevis flap is harvested from the lateral compartment of the leg based on the distal perforating arterial supply and covered with split skin. Results: We performed a total of 69 peroneus flaps between 2003 and 2017. Minor flap necroses at the distal tip were noted in 8% of the peroneus brevis reconstructions. Total flap loss occurred in 1 peroneus flap. Defect etiology and patient age were not associated with surgical outcome. Conclusion: While nowadays the first choice of lower extremity reconstruction is an appropriate free flap solution,the peroneus brevis muscle flap can also be seen as a valuable tool to reconstruct small to medium sized defects at the ankle, distal tibia, and the heel with an acceptable donor site morbidity. Despite the easily available variety of free flaps to achieve this purpose, still proper indications remain where a local flap can be a viable option in the hand of experienced plastic surgeons. However, caution is advisable in patients with peripheral arterial occlusive disease or venous insufficiency.

Treatment of knee osteochondritis dissecans with autologous tendon transplantation:Clinical and radiological results

BACKGROUND Defect treatment with tendon autograft in osteochondral lesions has been published in the literature with an experimental study in dogs.To demonstrate that it is possible to treat knee osteochondral lesions with the technique of autologous tendon transplantation.AIM To evaluate the clinical and radiological results of patients with knee osteochondral lesions who were treated with autologous tendon transplantation.METHODS Twenty patients(22 knees)with osteochondritis dissecans(OCD)lesions involving the knee were treated with autologous tendon transplantation between 2005-2018.All lesions were International Cartilage Repair Society grade IV.All patients were evaluated clinically at final follow-up with knee injury and osteoarthritis outcome score(KOOS);and radiologically with magnetic resonance observation and cartilage repair tissue(MOCART)and Kellgren-Lawrence(KL)classification.RESULTS A total of 20 patients(22 knees)with a mean age of 25.5±6.8 years were included.The average defect size was 4.2±2.1 cm^(2),and the average defect depth was 0.9±0.4 cm.Total KOOS score was preoperatively 29.4±5.5 and was later found to be 81.5±5.9 after an average of 68.7±37.7 mo follow-up.The mean MOCART score was 56.2±10.7.Preoperatively,all of the patients had KL grades of 0-1;during the follow-up period,80% of the patients showed no radiological progress of osteoarthritis.Patients with less than 4 cm^(2) lesion had statistically significantly better overall KOOS than patients whose more than 4 cm^(2) lesion,particularly in sport and quality of life subscales.CONCLUSION The autologous tendon transplantation is a single-step,safe,simple,cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes,particularly in patients with less than 4 cm^(2) lesion.