Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 9 , ISSUE 3 ( July-September, 2022 ) > List of Articles


Tendoscopic Advantages for Managing Peroneal Intrasheath Subluxations

Damjan Dimnjaković, Igor Knežević, Ivan Bojanić

Keywords : Intrasheath subluxation, Peroneal tendons, Tendoscopy

Citation Information : Dimnjaković D, Knežević I, Bojanić I. Tendoscopic Advantages for Managing Peroneal Intrasheath Subluxations. J Foot Ankle Surg Asia-Pacific 2022; 9 (3):116-122.

DOI: 10.5005/jp-journals-10040-1240

License: CC BY-NC 4.0

Published Online: 01-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: Peroneal intrasheath subluxations are recalcitrant to nonsurgical management. Surgical treatment can be either open or tendoscopic. This study aimed to explore the advantages of tendoscopic treatment for peroneal intrasheath subluxations. Materials and methods: Patients who underwent peroneal tendoscopy to treat the intrasheath subluxations in our department between January 2013 and December 2020 were included in the study. The procedures were performed in a standardized fashion, in a lateral decubitus position, with a 4.5-mm and 30-degree arthroscope, gravity irrigation system, and standard arthroscopic instruments. A thigh tourniquet was always set in place but was not inflated in all patients. The procedures were performed consistently through standard portals described by van Dijk and Kort. The performed procedures included removing low-lying peroneus brevis muscle belly (LLMB), removing peroneus quartus (PQ) muscle, or retrofibular groove deepening. Results: Eleven consecutive patients (5 males and 6 females) with a mean age of 20.0 (range 10–40) years were included in the study. Low-lying peroneus brevis muscle belly was identified in nine patients, while PQ muscle was identified in one case. A flat or convex retrofibular groove was noticed in three cases, one of them without any evident space-occupying lesions. No perioperative complications were reported. The mean American Orthopedic Foot and Ankle Society (AOFAS) score increased from 81 preoperatively to 99 postoperatively. Conclusion: Although some believe that peroneal tendoscopy is a highly technically demanding procedure with limited utility, its efficacy and safety were demonstrated in this study supported by published literature results. Therefore, we believe that it is the method of choice for treating intrasheath peroneal subluxations. Clinical significance: The results of this study suggest that peroneal tendoscopy could be effectively used for treatment of peroneal intrasheath subluxations, as it has been used for the treatment of various peroneal tendons’ pathology.

PDF Share
  1. Raikin SM, Elias I, Nazarian LN. Intrasheath subluxation of the peroneal tendons. J Bone Joint Surg Am 2008;90(5):992–999. DOI: 10.2106/JBJS.G.00801
  2. Roth JA, Taylor WC, Whalen J. Peroneal tendon subluxation: the other lateral ankle injury. Br J Sports Med 2010;44(14):1047–1053. DOI: 10.1136/bjsm.2008.057182
  3. Bahad SR, Kane JM. Peroneal tendon pathology: treatment and reconstruction of peroneal tears and instability. Orthop Clin North Am 2020;51(1):121–130. DOI: 10.1016/j.ocl.2019.09.001
  4. Sharma A, Parekh SG. Pathologies of the peroneals: a review. Foot Ankle Spec 2021;14(2):170–177. DOI: 10.1177/1938640020916278
  5. Davda K, Malhotra K, O'Donnell P, et al. Peroneal tendon disorders. EFORT Open Rev 2017;2(6):281–292. DOI: 10.1302/2058-5241.2.160047
  6. Freccero DM, Berkowitz MJ. The relationship between tears of the peroneus brevis tendon and the distal extent of its muscle belly: an MRI study. Foot Ankle Int 2006;27(4):236–239. DOI: 10.1177/107110070602700402
  7. Geller J, Lin S, Cordas D, et al. Relationship of a lowlying muscle belly to tears of the peroneus brevis tendon. Am J Orthop (Belle Mead NJ) 2003;32(11):541–544.
  8. van Dijk CN, Kort N. Tendoscopy of the peroneal tendons. Arthroscopy 1998;14(5):471–478. DOI: 10.1016/s0749-8063(98)70074-x
  9. Vega J, Batista JP, Golanó P, et al. Tendoscopic groove deepening for chronic subluxation of the peroneal tendons. Foot Ankle Int 2013;34(6):832–840. DOI: 10.1177/1071100713483098
  10. Lui TH. Tendoscopic resection of low-lying muscle belly of peroneus brevis or quartus. Foot Ankle Int 2012;33(10):912–914. DOI: 10.3113/FAI.2012.0912
  11. Lui TH, Li HM. Endoscopic resection of peroneus quartus. Arthrosc Tech 2020;9(1):e35–e38. DOI: 10.1016/j.eats.2019.08.007
  12. Raikin, Steven M,: Fox, Rabun. Intrasheath Subluxation of the Peroneal Tendons. In: Sobel, Mark, editor. The Peroneal Tendons. Cham: Springer 2020. pp. 253-264.
  13. Scholten PE, van Dijk CN. Tendoscopy of the peroneal tendons. Foot Ankle Clin 2006;11(2):415–420. DOI: 10.1016/j.fcl.2006.03.004
  14. Jerosch J, Aldawoudy A. Tendoscopic management of peroneal tendon disorders. Knee Surg Sports Traumatol Arthrosc 2007;15(6):806–810. DOI: 10.1007/s00167-006-0227-2
  15. Bravo-Gimenez B, Garcia-Lamas L, Jimenez-Diaz V, et al. Peroneal tendoscopy: our experience. Rev Esp Cir Ortop Traumatol 2013;57(4):268–275. DOI: 10.1016/j.recot.2013.02.006
  16. Vega J, Golanó P, Batista JP, et al. Tendoscopic procedure associated with peroneal tendons. Tech Foot Ankle Surg 2013;12(1):39–48. DOI: 10.1097/BTF.0b013e31828521a9
  17. Bojanić I, Dimnjaković D, Bohaček I, et al. Peroneal tendoscopy-more than just a solitary procedure: case-series. Croat Med J 2015;56(1):57–62. DOI: 10.3325/cmj.2015.56.57
  18. Kennedy JG, van Dijk PA, Murawski CD, et al. Functional outcomes after peroneal tendoscopy in the treatment of peroneal tendon disorders. Knee Surg Sports Traumatol Arthrosc 2016;24(4):1148–1154. DOI: 10.1007/s00167-016-4012-6
  19. Urguden M, Gulten IA, Civan O, et al. Results of peroneal tendoscopy with a technical modification. Foot Ankle Int 2019;40(3):356–363. DOI: 10.1177/1071100718809350
  20. Guelfi M, Vega J, Malagelada F, et al. Tendoscopic treatment of peroneal intrasheath subluxation: a new subgroup with superior peroneal retinaculum injury. Foot Ankle Int 2018;39(5):542–550. DOI: 10.1177/1071100718764674
  21. Bojanić I, Knežević I, Dimnjaković D. Importance of space-occupying anatomical variations in peroneal tendoscopy. Foot Ankle Int 2021;42(4):448–457. DOI: 10.1177/1071100720966325
  22. Michels F, Jambou S, Guillo S, et al. Endoscopic treatment of intrasheath peroneal tendon subluxation. Case Rep Med 2013;2013:274685. DOI: 10.1155/2013/274685
  23. Draghi F, Bortolotto C, Draghi AG, et al. Intrasheath instability of the peroneal tendons: dynamic ultrasound imaging. J Ultrasound Med 2018;37(12):2753–2758. DOI: 10.1002/jum.14633
  24. Hsiao MY, Shyu SG, Wu CH, et al. Dynamic ultrasound imaging for type A intrasheath subluxation of the peroneal tendons. Am J Phys Med Rehabil 2015;94(6):53–54. DOI: 10.1097/PHM.000 0000000000297
  25. Pesquer L, Guillo S, Poussange N, et al. Dynamic ultrasound of peroneal tendon instability. Br J Radiol 2016;89(1063):20150958. DOI: 10.1259/bjr.20150958
  26. Taljanovic MS, Alcala JN, Gimber LH, et al. High-resolution US and MR imaging of peroneal tendon injuries. Radiographics 2015;35(1):179–199. DOI: 10.1148/rg.351130062
  27. Kumar Y, Alian A, Ahlawat S, et al. Peroneal tendon pathology: pre- and post-operative high resolution US and MR imaging. Eur J Radiol 2017;92:132–144. DOI: 10.1016/j.ejrad.2017.05.010
  28. Opdam KT, van Dijk PA, Stufkens SA, et al. The peroneus quartus muscle in a locking phenomenon of the ankle: a case report. J Foot Ankle Surg 2017;56(1):108–111. DOI: 10.1053/j.jfas.2016.07.016
  29. Thomas JL, Lopez-Ben R, Maddox J. A preliminary report on intra-sheath peroneal tendon subluxation: a prospective review of 7 patients with ultrasound verification. J Foot Ankle Surg 2009;48(3):323–329. DOI: 10.1053/j.jfas.2009.02.003
  30. Vega J, Golanó P, Dalmau A, et al. Tendoscopic treatment of intrasheath subluxation of the peroneal tendons. Foot Ankle Int 2011;32(12):1147–1151. DOI: 10.3113/FAI.2011.1147
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.