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Peroneus brevis tendon tear after acute ankle sprain

Pr. Penev, D. Raykov, B. Belchev, M. Raykov, K. Ganchev, V. Simeonova

Abstract

Background: Longitudinal peroneus brevis tendon (PBT) tears are very uncommon. Bassett and Speer hypothesized that the cause of a longitudinal peroneus brevis tear is likely an extrinsic phenomenon, with the tendon injured by a portion of the distal fibula after inversion trauma of the ankle. The typical patient describes the pain localized posterior to the lateral malleolus and palpable swelling behind the lateral malleolus can raise the suspicion of a tear. There is no specific diagnostic and treatment algorithm. Operative treatments include repair of the tendon, resection of the tear, debridement of the tendon, or tenodesis of the peroneus brevis to the peroneus longus.Case Presentation: Case AA 27 year old man practicing amateur football complained of persistent swelling and pain on the posterolateral aspect of his right ankle. He reported for ankle sprain before 6 weeks. Retrofibular tenderness and palpable popping with dorsiflexion eversion stress was found on physical examination, but without peroneal luxation or subluxation. Peroneal compression test was positive. An MRI showed longitudinal tear and thickening of the right peroneus brevis tendon with increased fluid in the peroneal sheath. Conservative treatments such as phisiotherapy and steroid injections were not effective. Case BA 22 year old waiter in night club complained of persistent pain in the lateral aspect of the right foot despite any recent history of trauma. He had a history of ankle sprains before 6 months of his right ankle. The patient underwent physical therapy including manipulations and steroid injections.Outcomes: A longitudinal incision is centered over the course of the peroneal tendons, beginning above the ankle 1 cm posterior and proximal to the tip of the fibula and then extending distally to the base of the fifth metatarsal. We identified the superior peroneal retinaculum and it was noted to be uninjured in both cases. After that we incised the retinaculum and peroneal tendons are carefully examined. We found longitudinal tear of peroneus brevis tendon about 5 cm long in the first case and 4 cm long in the second case, but with more expansion of the synovium. In the first case we did suture with 3-0 polypropylene and in the second, an effusion was noted in the synovial sheath, and after debridment we made side-to-side suture of the tendon with 4-0 polypropylene. Postoperatively we applied a plaster cast for 3 weeks for both patients. After two months the patients have no pain, and they evaluated surgery as very good. They returned to full activity about three months after the operation.Discussion: PBT longitudinal tears are conjunction in almost cases with lateral ankle sprains. Symptoms similar to those demonstrated with peroneal tendon tenosynovitis. The injury may be combined with ruptures of the lateral ankle ligaments. MRI and sonography are the best examinations for visualising the peroneal tendon. In our two cases the pain was localized to the posterolateral aspect of the lateral malleolus and the patients had stable ankles. MRI and sonography showed longitudinal tear of the PBT. Operative treatment was successful and recovery was in normal time. Patients with persistent posterolateral foot or ankle pain with a history of an ankle sprain or injury should be considered susceptible to a peroneus brevis tendon injury. However, it should be used to evaluate other associated disorders, which can then be dealt at the time of the peroneal tendon repair.




DOI: http://dx.doi.org/10.14748/ssm.v48i0.2331

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About The Authors

Pr. Penev

D. Raykov

B. Belchev

M. Raykov

K. Ganchev

V. Simeonova

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