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Peroneal tendon tears: associated arthroscopic findings and results after repair.
Arthroscopy 2009 November
PURPOSE: The purpose of this study was to identify the intra-articular pathology associated with peroneal tendon tears and report the outcomes after tendon repair or tenodesis with arthroscopic treatment.
METHODS: Thirty patients were evaluated who underwent ankle arthroscopy followed by peroneal tendon repair. Intra-articular pathology was treated arthroscopically before peroneal tendon surgery was performed. All patients were available for a minimum 2-year follow-up. Preoperative and postoperative American Orthopaedic Foot & Ankle Society and Karlsson scores were analyzed for all patients.
RESULTS: A total of 60 intra-articular lesions were treated arthroscopically in 30 ankles. We diagnosed 13 lesions preoperatively (22%), and 47 lesions (78%) were discovered during arthroscopy. Of the patients, 5 (17%) had associated anterolateral instability requiring an open reconstruction. Soft-tissue impingement was seen in 6 patients (20%), anterior osteophytes in 4 (13%), loose bodies in 4 (13%), osteochondral lesions in 4 (13%), extensive scar tissue in 24 (80%), extensive synovitis in 7 (23%), chondral injuries in 2 (7%), and a torn posterior transverse tibiofibular ligament in 2 (5%). Postoperative American Orthopaedic Foot & Ankle Society and Karlsson scores were significantly improved compared with preoperative scores. Patients with chronic complaints before surgery had better outcome scores than patients with an isolated, acute twisting injury. It is unclear whether the incidental pathology discovered at the time of arthroscopic examination influenced outcome measures.
CONCLUSIONS: All patients with peroneal tendon tears had associated intra-articular pathology, with the majority of patients having more than 1 intra-articular lesion. For patients meeting surgical criteria, correction of the tendon tears and arthroscopic treatment of the intra-articular lesions produced statistically significantly improved results and patient satisfaction, paralleling historical controls.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.
METHODS: Thirty patients were evaluated who underwent ankle arthroscopy followed by peroneal tendon repair. Intra-articular pathology was treated arthroscopically before peroneal tendon surgery was performed. All patients were available for a minimum 2-year follow-up. Preoperative and postoperative American Orthopaedic Foot & Ankle Society and Karlsson scores were analyzed for all patients.
RESULTS: A total of 60 intra-articular lesions were treated arthroscopically in 30 ankles. We diagnosed 13 lesions preoperatively (22%), and 47 lesions (78%) were discovered during arthroscopy. Of the patients, 5 (17%) had associated anterolateral instability requiring an open reconstruction. Soft-tissue impingement was seen in 6 patients (20%), anterior osteophytes in 4 (13%), loose bodies in 4 (13%), osteochondral lesions in 4 (13%), extensive scar tissue in 24 (80%), extensive synovitis in 7 (23%), chondral injuries in 2 (7%), and a torn posterior transverse tibiofibular ligament in 2 (5%). Postoperative American Orthopaedic Foot & Ankle Society and Karlsson scores were significantly improved compared with preoperative scores. Patients with chronic complaints before surgery had better outcome scores than patients with an isolated, acute twisting injury. It is unclear whether the incidental pathology discovered at the time of arthroscopic examination influenced outcome measures.
CONCLUSIONS: All patients with peroneal tendon tears had associated intra-articular pathology, with the majority of patients having more than 1 intra-articular lesion. For patients meeting surgical criteria, correction of the tendon tears and arthroscopic treatment of the intra-articular lesions produced statistically significantly improved results and patient satisfaction, paralleling historical controls.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.
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