Foot Ankle Int. If you desire to humorous books, lots of novels, tale, jokes, and more fictions collections are as a 5, 11 October 2016 | RadioGraphics, Vol. [8,23-25] In such cases, differentiating between pathologic thinning and the normal flattening in the retromalleolar groove is challenging and likely reflects a continuum of degenerative change. Res et al. Chief Medical Officer, ProScan Imaging. Recognition of the characteristic symptoms, physical findings, and imaging results of peroneal tendon tears is essential for accurate diagnosis and appropriate treatment. [3] Given the non-specific clinical presentation, the diagnosis of peroneal tendon injury is often delayed. This site needs JavaScript to work properly. activity after the trauma. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. have tried resting (boot) and pt. The Mann Whitney U test was used to assess for significant differences in mean peroneus brevis muscle quality. Five patients had concomitant tears of both peroneal tendons. 27, No. Axial intermediate-weighted fast spin echo; TR 3500 ms, TE 40 ms, slice thickness 4.0 mm, and FOV 16 16 cm. Intraoperative photo showing the continuous interlocking suture of peroneus brevis tendon. There is a longitudinally-oriented partial tear of the peroneus brevis tendon extending from the level of the talofibular ligaments (proximally) to the calcaneo-cuboid joint (distally). The correlation between peroneus brevis fatty atrophy and tendon tears was also examined. The peroneus brevis (PB) tendon is more likely to get injured than the peroneus longus (PL) due to its crowded location at the level of the retromalleolar groove. muscle belly to tears of the peroneus brevis tendon. Dec 19 - Dec 20. The split medial and lateral tendon fibers wrap around the intact peroneus longus tendon, and there is a small amount of fluid signal within the common peroneal tendon sheath. Peroneus brevis split tears should not be confused with anatomic variants (i.e. The split medial and lateral tendon fibers wrap around the intact peroneus longus tendon, and there is a small amount of fluid signal within the common peroneal . The MRI examinations of the surgical and control subjects were randomized and independently reviewed by two musculoskeletal fellows who were blinded to the original MRI and operative reports. Founder, MRI Online. A longitudinal split tear is the most frequent type. The peroneus tertius (PT) muscle, also referred to as the fibularis tertius muscle, is a small muscle of the lower extremity whose principal action is weak dorsiflexion and eversion of the foot [1]. 2015 Sep-Oct;54(5):872-5. doi: 10.1053/j.jfas.2015.02.012. Posts: 21. Multiple studies have analyzed normal and anomal. To improve the diagnostic accuracy of MRI for peroneus brevis tendon injuries, recent authors have suggested analyzing the peroneus muscle belly for signs of fatty infiltration. All clinical data were accessed through the electronic patient record. CLICK ICON BELOW TO SEE ALL OUR INSTAGRAM POSTS OTHER POPULAR WHAT'S THE DX POSTS: CLICK ON THE IMAGES BELOW ARTHRITIS This was done to account for insufficient sample sizes for each tear type and to reflect the surgical data, which recorded peroneal pathology as tears versus no tear but did not consistently distinguish between tear types or tendinosis. Peroneal tendon tears can be challenging to diagnose on MRI, with an overlap in appearance with tendinosis. Non-visualized calcaneofibular ligament with some associated edema likely representing full-thickness tear . Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. 5, Journal of Athletic Training, Vol. A peroneus longus tendon tear is a discontinuity (longitudinal or transverse) in the tendon morphology. .switcher .option {position:relative;z-index:9998;border-left:1px solid #ccc;border-right:1px solid #ccc;border-bottom:1px solid #ccc;background-color:#eee;display:none;width:161px;max-height:198px;-webkit-box-sizing:content-box;-moz-box-sizing:content-box;box-sizing:content-box;overflow-y:auto;overflow-x:hidden;} Anat. When the ankle ligaments are loose, the peroneal tendons are overused causing strain and eventual tear of either tendon. The https:// ensures that you are connecting to the Enjoy free WiFi, breakfast, and a fitness center. Bethesda, MD 20894, Web Policies A magnetic resonance imaging (MRI) study by Adachi and colleagues . Dombek MF, Orsini R, Mendicino RW, Saltrick K. Clin Podiatr Med Surg. CME Eligible. Please enable it to take advantage of the complete set of features! There is more diffuse thickening and edema of the hypodermal fat about the entire ankle. The brevis, medial on the left image and anterior on the right, also has . Coronal intermediate-weighted fast spin echo; TR 3500 ms, TE 40 ms, slice thickness 4.0 mm, and FOV 14 14 cm. Am J Orthop. Multimodality imaging in shoulder arthroplasties Part 2:, Snake Sign Secondary Sign of Achilles Tendon Rupture, Sonographic and MRI presentation of geyser sign in rotator, Traditional MRI and cleft sign performance for peroneal tendon tears, Peroneus brevis muscle quality assessment. (From Tank PW, Gest TR. For analysis of pre-operative MRI performance, we combined the reviewers selections into binary categories of tear (including partial tear longitudinal split and transverse tears and complete tears) and no tear (including normal, tendon thickening, and thinning). MATERIALS AND METHODS: MR images, medical records, and surgical findings were retrospectively reviewed in the cases of 12 patients who underwent surgery because of suspected peroneal tendon tear (14 tendons). See this image and copyright information in PMC. Surg. In challenging clinical cases, further evaluation with ultrasound may add value due to its superior spatial resolution and potential for dynamic assessment. The patients were scanned supine with ankle dorsiflexion of 90 degrees with the following protocol: Sagittal T2-weighted fast spin echo with fat saturation; TR 3000 ms, TE 80 ms, slice thickness 4.0 mm, and field of view (FOV) 16 16 cm. High-resolution 1.5-T and 3-T magnetic resonance (MR) imaging with use of dedicated extremity coils and high-resolution ultrasonography (US) with high-frequency linear transducers and dynamic imaging are proved to adequately depict the peroneal tendons for evaluation and can aid the orthopedic surgeon in injury management. I was told today, after 2 weeks of an unsuccessful ankle bracing, surgery is now a must. Application of the cleft sign significantly increased sensitivity in reader 1 to 95%, with a non-significant increase in accuracy in both readers. Purpose: To evaluate magnetic resonance (MR) findings of surgically proved peroneal tendon tears. .switcher a img {vertical-align:middle;display:inline;border:0;padding:0;margin:0;opacity:0.8;} 1063, RadioGraphics Similar to criteria used in the diagnosis of meniscal tears, the cleft sign requires an intermediate to high intrasubstance signal that breaches the tendon surface. The readers assessed for abnormalities of the peroneus brevis and longus tendons and the peroneus brevis muscle belly quality. This website uses cookies to improve your experience while you navigate through the website. Complete tears were characterized by discontinuity of the tendon. Partial thickness tears were subdivided into longitudinal split tears and transverse tears. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Axial T2-weighted fast spin echo with fat saturation; TR 4000 ms, TE 85 ms, slice thickness 4.0 mm, and FOV 16 16 cm. Necessary cookies are absolutely essential for the website to function properly. Finally, despite excluding cases with excessively long intervals between preoperative MRI and surgery, the intervals in some included cases may still have contributed to false positive or negative MRI reads, potentially related to tendon healing or tearing. The interobserver reliability for peroneal tendon tears on MRI was moderate for peroneus brevis (0.45) and fair for peroneus longus (0.33). Peroneus longus & brevis tendons pass just posterior to the lateral malleolus These muscles are the primary foot everters & assist with plantar flexion Palpate the tendons for tenderness Continue to palpate posteriorly to the calcaneus Gastrocnemius & soleus muscles form a common tendon (Achilles) that inserts into the posterior calcaneus . Peroneal tendon tears are a common but under-recognized source of ankle pain and dysfunction. Complete tendon tears were defined as abnormal intermediate or T2-weighted signal replacing the entire cross-sectional area of the tendon, with no visible intact tendon fibers. MRI examinations from 38 control subjects were also reviewed for peroneus brevis muscle quality. Plantar flexion and inversion are the most. The strength of agreement based on coefficient values was defined as follows: 0, poor; 0.010.20, slight; 0.210.40, fair; 0.410.60, moderate; 0.610.80, substantial; and 0.811.0, almost perfect.[18]. is surgery needed? Additionally, the PT muscle counters the inverting force of the tibialis anterior, effectively leveling the foot. $74. Of the 26 patients with tears, 25 patients had peroneus brevis tears and six patients had peroneus longus tendon tears. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Despite the value of MRI, diagnosing peroneal tendon pathology can be challenging due to various anatomic and technical considerations. With Reader 1, using the cleft sign for assessment in tendons without prior surgery resulted in two additional false positives. True split tears typically manifest with a "boomerang" appearance of the brevis tendon enveloping the longus tendon, and there is often accompanying fluid within the tendon sheath. mri [4,5,6] . The first case was a 53-year-old man presented with persistent pain on the lateral aspect on the left ankle during the last four years and difficulty to bear weight during the last year. -, Philbin M., Landis S., Smith B. Peroneal tendon injuries. Cuboidal tunnel; peroneus brevis tendon; peroneus longus; Retinoculum stripping; Content reviewed: December . In cases where a peroneal tendon tear is undoubtedly present, such as in longitudinal split tearing of peroneus brevis with two distinct bundles, the cleft sign need not be assessed and in fact, may not be present. If the address matches an existing account you will receive an email with instructions to reset your password. Stephen J Pomeranz, MD. , Vol 35, No. We also use third-party cookies that help us analyze and understand how you use this website. Note the positive cashew nut/boomerang sign. There was also no significant difference between the peroneus brevis muscle belly quality of surgical patients and controls (Reader 1: U = 834.0, P = 0.77; Reader 2: U = 768.0, P = 0.55). In addition, we have observed the peroneus longus tendon to variably contain surfacing linear intrasubstance signal distal to the peroneal tubercle, as it courses plantar to the cuboid. 1, Journal of Back and Musculoskeletal Rehabilitation, Vol. Thirty-eight age- and sex-matched controls from the same study period were selected through a search of the radiology information system. 2000;21:809815. Sports injuries are common at the . 168 (1): 141-7. PERONEUS BREVIS TENDON TEAR MRI ANKLE MRI - Radedasia PERONEUS BREVIS TENDON TEAR MRI DISCUSSION: WHAT'S THE dX WHAT ARE THE FINDINGS PERONEUS BREVIS TENDON TEAR MRI: MOVE SLIDER TO VIEW IMAGES ARE FROM OUR INSTAGRAM ACCOUNT. Split tear of Peroneus Brevis Visualization of the tear The portion diseased tendon removed After the removal of tissue, the tendon sits nicely behind the groove and the area is debulked Pic during debaulking of peroneus brevis muscle and tendon Split tear of P. Brevis Pic after repair. Concerning the peroneus brevis, we do not endorse the use of the cleft sign in the retromalleolar location given the routine flattening in this location, increasing susceptibility to partial volume average effects. Peroneus brevis split syndrome (PBSS) refers to the longitudinal tear of the peroneus brevis (PB) tendon at the retrofibular groove near the distal tip of lateral malleolus with frequent proximal and distal extension. Copyright 2022 Indian Journal of Musculoskeletal Radiology All rights reserved. Two blinded readers retrospectively and independently evaluated pre-operative ankle MRI studies of 38 patients who had undergone peroneal tendon surgery for peroneal tendon tears, peroneus brevis muscle quality, and the cleft sign. Ultimately, our goal was to describe MRI findings that could accurately predict a surgically proven tear. In patients without prior peroneal tendon surgery, the cleft sign can significantly improve reader diagnostic sensitivity for peroneus brevis tears. We have found the greatest value from the sign in distinguishing between tendinopathy and partial thickness tears and utilizing the sign can significantly improve sensitivity for diagnosing a tear [Figure 3]. Advert Medically reviewed by Dr Chaminda Goonetilleke, 4th Jan. 2022 Peroneal tendon tear symptoms Symptoms of a peroneus brevis tendon tear include: .switcher .selected a.open:after {-webkit-transform: rotate(-180deg);transform:rotate(-180deg);} (female) Join Date: Mar 2013. From the Departments of Medical Imaging (M.S.T., L.H.G.) The sutures can be seen in the tendon post repair You can use Radiopaedia cases in a variety of ways to help you learn and teach. [26,27] More recently, imaging the peroneal tendons in oblique planes has shown potential for improved diagnostic performances compared to traditional orthogonal planes. There is a longitudinally-oriented partial tear of the peroneus brevis tendon extending from the level of the talofibular ligaments (proximally) to the calcaneo-cuboid joint (distally). The peroneus brevis, sometimes called the fibularis brevis muscle, is the shorter and smaller of two lateral leg muscles running down the outer sides of each lower leg. 1, Journal of Medical Ultrasound, Vol. 8600 Rockville Pike This short muscle is situated right beneath the Peroneus Longus Muscle and belongs to the muscles of the peroneal group which extend to the outer portion of the lower legs and foot. The interobserver reliability for the cleft sign was moderate for peroneus brevis ( = 0.57). Fig. This category only includes cookies that ensures basic functionalities and security features of the website. 26, No. Axial T2-weighted fat-suppressed image demonstrates a split tear of the peroneus brevis tendon (white arrow) with a boomeranglike configuration at the level of the peroneal tubercle with . 2014 Mar-Apr;27(2):297-302. doi: 10.3122/jabfm.2014.02.130009. No significant difference in peroneus brevis muscle quality was present between subjects with and without peroneus brevis tendon tears and between surgical and control patients. However, one important limitation of their study was the lack of surgical confirmation of tendon status. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-62075, Mallinckrodt Institute of Radiology at Washington University. 2017;120(12):10201030. The mean Goutallier grades of peroneus brevis muscles in surgical and control patients are shown in [Table 5]. In our experience, the peroneus longus tendon often contains increased intrasubstance signal with surface breach as it enters the fibro-osseous tunnel plantar to the cuboid, possibly due to a fanning-out morphology or concurrent tendinosis/tenosynovitis [Figure 4]. Care should be taken when using the foot posture index to associate pronation with injury risk, and the Achilles tendon and . 9, No. An understanding of current treatment approaches for partial- and full-thickness peroneal tendon tears, subluxation and dislocation of these tendons with superior peroneal retinaculum (SPR) injuries, intrasheath subluxations, and peroneal tendonopathy and tenosynovitis can help physicians achieve a favorable outcome. The lower limb. Our objective is to describe the characteristic MR imaging features of longitudinal tears of the peroneus brevis tendon and to describe pathologic conditions and normal variants that are associated with these tears which may require surgical intervention at the time of primary tendon repair. . 3, Orthopedic Clinics of North America, Vol. Distinctly separated hemi-tendons (red arrows) enveloping the intact peroneus longus tendon (teal arrow). Peroneus longus tears are less common than peroneus brevis tears, with much smaller cohorts in the literature, resulting in fewer and even wider variation in reported MRI performance indicators in the literature, with sensitivities ranging from 20% to 80%. 27, No. In the diagnosi s of peroneal subluxation, ultrasound had a sensitivity of 100 % and a specificity of 100% compared to MRI, which had a sensitivity of 33% and . Log-in above or renew your membership today. 25, No. Tags: peroneal tendon rupture , peroneal tendon , leg pain , Improving pre-operative MRI diagnosis of peroneal tendon tears with a new objective sign and assessing the value of peroneus brevis fatty atrophy. reported diagnostic performances of pre-operative mri for peroneus brevis tendon tears have varied widely, with sensitivities and specificities ranging between 55-97% and 63-90%, respectively. Case 2. Inclusion criteria were patients who had a complete pre-operative ankle MRI before peroneal tendon surgery. Our guests praise the breakfast and the spacious . High grade partial thickness tearing of the deltoid and spring ligaments . Case 2. and Orthopaedic Surgery (M.M.C., L.D.L. Stay at this 4-star business-friendly hotel in Clermont-Ferrand. Within the entire surgical cohort, the MRI sensitivity, specificity, and accuracy of peroneus brevis tendon tears were 52.0%, 92.3%, and 65.8% for Reader 1 and 76.0%, 69.2%, and 73.7% for Reader 2, respectively [Table 3]. J Foot Ankle Surg. In the subset of patients without prior peroneal surgery, the performance measures improved slightly as a whole for both readers. We report two cases of peroneus brevis injuries and a comprehensive literature review was performed. By clicking Accept, you consent to the use of ALL the cookies. 5 and 9). We also present the radiographic evaluation of the injury using magnetic resonance imaging (MRI) pre and post-operatively. [1] Injuries are most commonly traumatic but can also result from inflammatory conditions such as rheumatoid arthritis. Mastery Series: Ankle MRI . We developed a practical set of objective criteria for the assessment of peroneal tendon tears, which we termed the cleft sign. This is defined as an intratendinous intermediate to high T2-weighted signal, involving at least 50% of the tendon diameter, that breaches the tendon surface and is present on at least two consecutive axial slices [Figures 2 and 3]. MRI showed longitudinal tear of peroneus brevis tendon and the patient underwent surgical treatment. In patients without prior peroneal surgery, the performance measures were essentially unchanged for Reader 1 and slightly improved for Reader 2. 5, World Journal of Radiology, Vol. The objectives of this study are to further investigate the performance of pre-operative MRI for peroneal tendon tears and to establish a set of practical and objective imaging criteria for diagnosing peroneal tendon tears. Because of the vague pain associated with structures of the lateral ankle, peroneal tears are frequently misdiagnosed. For the peroneus longus, we do not endorse the use of the cleft sign beyond the peroneal tubercle. MR imaging enabled detection of peroneus brevis and peroneu longus tendon tears in patients who underwent surgery because of suspected peroneal tendon tear. A report on two cases. Peroneus Brevis Origin: Inferior 2/3 of lateral fibular surface; also anterior and posterior intermuscular septa of leg Insertion: Lateral surface of styloid process of 5th metatarsal base Action: Everts foot and plantar flexes ankle Innervation: Superficial peroneal nerve (L5, S1, S2) Arterial Supply: Muscular branches of peroneal artery 16, No. Etiology Causes of peroneus longus tendon tears include the following 1,2: acute injury (typically inversion injury) We hypothesize that this may be a combination of tendinosis/ tenosynovitis and a natural fanning out morphology before the presence of an os peroneum. . Supportive therapy with ankle bracing and analgesics is the mainstay of therapy, but surgical repair is often required in patients with ongoing symptoms. Peroneus brevis (PB) tendinosis was found in 48 patients (87 % of all patients with peroneal tendinosis), and peroneus longus (PL) tendi-nosis was observed in 42 cases (76 %). We had a large proportion of tendon tears in the surgical cohort, a selection bias that is difficult to avoid without subjecting control patients to unnecessary lateral ankle surgery. Given the low number of individual tear types, we limited our analysis in a binary fashion to peroneal tendon tears versus no tears and did not explore the difference in imaging appearance between tendon tears types and other pathologies. The control subjects were included for comparison of peroneal muscle morphology between surgical and non-surgical patients. Peroneus longus tears usually occur with brevis tears and have a similar appearance on MRI (Fig 10). Am. Split Peroneus Brevis Tendon-MRI. .switcher a {text-decoration:none;display:block;font-size:10pt;-webkit-box-sizing:content-box;-moz-box-sizing:content-box;box-sizing:content-box;} Analogous to post-operative meniscus and rotator cuff cases, the presence of intrasubstance signal is non-specific and can represent granulation tissue and/or fibrosis. Split peroneus brevis tendon: an unusual cause of ankle pain and instability. A peroneus quartus muscle was found in two patients (22%). FOIA From a practical perspective, as with the assessment of various other musculoskeletal structures, the cleft sign can be falsely identified in peroneal tendons by increasing image contrast with extreme windowing and such alterations are strongly discouraged. Keywords: .switcher a:hover img {opacity:1;} We describe a 64-year-old woman . Within the rotator cuff, the degree of fatty atrophy significantly correlates with tear size and chronicity, with the highest degrees of fatty atrophy present in chronic massive full-thickness rotator cuff tears. The site is secure. #selected_lang_name {float: none;} Within the entire surgical group, the MRI sensitivity, specificity, and accuracy of peroneus longus tendon tears were 16.7%, 93.8%, and 81.6% for Reader 1 and 50.0%, 87.5%, and 81.6% for Reader 2, respectively [Table 4]. No acute fracture. To look for other markers of tendon injury, Res et al. I ended up having a fracture in my malleolus and having minimally displaced bone fragments from my talus. No tears of the peroneus longus tendon were identified. These injuries occur as a result of trauma (including ankle sprains), in tendons with preexisting tendonopathy, and with repetitive microtrauma due to instability. 5, Trauma und Berufskrankheit, Vol. PBSS is commonly found in young adults after spontaneous tear or sports related trauma (soccer players and ballet dancers), but . 9, Military Medicine, Vol. 1. Surg. An additional five operative reports described prior lateral ankle surgery not involving the peroneal tendons (two ORIF for lateral malleolar fractures, one accessory peroneus tertius resection without affecting the peroneus brevis/longus tendons, one fibular groove deepening, and one lateral column lengthening). A couple of years ago, I had an MRI done on my left foot. sharing sensitive information, make sure youre on a federal Posterior tibialis tenosynovitis and tendinosis . The tendinous insertion on the base of the fifth metatarsal will be intact. 12, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Split tear peroneus brevis tendon A 36-year-old female asked: I have 2 cm tear in peroneus brevis tendon (mri). In Reader 2, all measures improved (without significance), except specificity, which remained unchanged. These cookies track visitors across websites and collect information to provide customized ads. Abstract Diseases of the peroneal tendons and superior peroneal retinaculum (SPR) are frequently underdiagnosed causes of lateral ankle pain and instability. 49, No. The huge hematoma indicates a traumatic etiology. [31,32] The evaluation of peroneal tendon tears on MRI in the post-operative setting likely requires surfacing fluid-signal to improve specificity, a topic for future research. Institutional Review Board (IRB) permission obtained for the study. 3, Journal of Foot and Ankle Surgery (Asia Pacific), Vol. Physical signs such as swelling along the course of the peroneal tendon sheath, pain with eversion, and subluxing tendons are diagnostic of . official website and that any information you provide is encrypted The peroneus longus and brevis are much more similar to each other than they are to the peroneus tertius Toyota Brevis Manual If you ally infatuation such a referred Toyota Brevis Manual ebook that will allow you worth, get the unquestionably best seller from us currently from several preferred authors. Published by Scientific Scholar on behalf of Musculoskeletal Society (MSS), India, 2022 Published by Scientific Scholar on behalf of Indian Journal of Musculoskeletal Radiology. [19] Although MRI is the gold standard diagnostic imaging tool for assessing the peroneal tendons, distinguishing between pathologies can be challenging. Neglected tendoachilles tear are difficulty to manage compared to longus, peroneus brevis Corresponding Author: Dr. M Gurumoorthy Assistant Professor, Department of Orthopaedics, Rajah Muthiah Medical College and Hospital, Chidambaram, Tamil Nadu, India Neglected tendoachilles tear treated with flexor hallucis Clipboard, Search History, and several other advanced features are temporarily unavailable. The peroneus brevis muscle (which is also known as the fibularis brevis muscle) finds its origin more distally on the fibula and inserts at the tuberosity of the fifth metatarsal. Surgical treatment revealed no tear and symphysiolysis managed to relieve patient's symptoms. But opting out of some of these cookies may affect your browsing experience. .l_name {float: none !important;margin: 0;} Epub 2015 May 19. Often, peroneal tendon tears are due to ankle sprains or ankle instability. still painful to exercise, not all the time. The patients sex and age were recorded. No evidence of fracture. government site. Online supplemental material is available for this article. Peroneus Longus and Brevis Tendons Tear 4 min. Unable to process the form. 30, No. MATERIALS AND METHODS MR images, medical records, and surgical findings were retrospectively reviewed in the cases of 12 patients who . Fortunately, in this location, previously designated Zone C, tears of peroneus longus have been found to have a higher proportion of complete ruptures and partial thickness tears are more likely to involve proximal segments. Peroneal pathologies include tendinosis/tenosynovitis, tear, and subluxation/ retinaculum injury, with commonly associated soft-tissue findings including lateral collateral ligament complex tears, anterolateral impingement lesions, and synovitis. .switcher .selected a {border:1px solid #ccc;color:#666;padding:3px 5px;width:151px;} ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. There is diffuse soft tissue swelling of the lateral ankle, with focal area of hyperdensity superficial to the fibulotalar interval (best seen on AP view) suggestive of hematoma. How to cite this article: Wang DJ, Harris G, Boubalos JJ, Swami VG, Lau JT, Naraghi AM, et al. Longitudinal attrition of the peroneus brevis tendon in the fibular groove: an anatomic study. [ 1, 8 - 14] these previous studies have been limited by small sample sizes and heterogeneous study designs, most notably with inconsistent imaging Accessibility The incidence of peroneal tendon disorders in the population is unknown and they are usually overlooked. Given these challenges, there has been wide variation in the reported performance of MRI in diagnosing peroneal tendon tears. The peroneus muscles originates from lower two-thirds of the lateral surface of the shaft of the fibula and the anterior and posterior inter-muscular septa of the leg.It inserts onto the metatarsals. did not distinguish between partial thickness and full thickness tears in their study. Interobserver correlation was assessed using a weighted Cohen kappa coefficient for categorical items. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Approval from the Research Ethics Board was obtained and patient consent was waived. Materials and methods: MR images, medical records, and surgical findings were retrospectively reviewed in the cases of 12 patients who underwent surgery because of suspected peroneal tendon tear (14 tendons). Bookshelf 30, No. The peroneus brevis and peroneus longus tendons are rarely torn simultaneously. Intraoperative findings for the peroneus brevis and peroneus longus tendons were recorded as tear and no tear as the types of tendon tears were not consistently described. 4, The Journal of Foot and Ankle Surgery, Vol. I'm worried but I'm so ready to be out of pain and be able to walk, jog, run and so on without pain. Axial proton desity fat sat MRI shows splitting (has an inverted 'u' shape) in the peronius brevis and an intact peronial longus. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:116.) Several ankle ligaments ensure the static and dynamic stability of the ankle joint, but they are prone to injury due to acute trauma as well as repetitive ankle sprains. In patients without prior peroneal surgery, the sensitivity and specificity of MRI for peroneus brevis tendon tears were 60%/89% and 80%/78% for readers 1 and 2, respectively. Disclaimer, National Library of Medicine The artificial intelligence was found to be a useful metric of foot posture but was less useful in developing and obese individuals. Zhonghua Yi Xue Za Zhi. Dr Jbara also develops a step-wise approach to help evaluate any MRI ankle study to assess for pathologies. The cleft sign was introduced to the readers 2 months following the initial assessment of the peroneal tendons. The age, sex, and laterality of the surgical and control groups are shown in [Table 1]. -, Di Giovanni B., Fraga C., Cohen B., Shereff M. Associated injuries found in chronic lateral ankle instability. The oblique inframalleolar course of the tendons can predispose to magic angle and partial volume averaging effects. 12, Magnetic Resonance Imaging Clinics of North America, Vol. Intraoperative photo showing the longitudinal split of peroneus brevis tendon. Peroneus brevis tendon tears can present with lateral ankle pain with or without a history of trauma. Overlying superior peroneal retinaculum is intact. PURPOSE To evaluate magnetic resonance (MR) findings of surgically proved peroneal tendon tears. Case Discussion Peroneus brevis tendon tears can present with lateral ankle pain with or without a history of trauma. Given the variable criteria for tendinosis and partial tears, readers assessed tendon morphology as tendon thickening +/ increased signal, reflecting tendinosis and intrasubstance tears, and tendon flattening, reflecting the expected flattening of the peroneus brevis in the retromalleolar groove. Split tear peroneus brevis. The addition of the cleft sign as a diagnostic criteria for peroneus brevis tears, in conjunction with the traditional reads in patients without prior peroneal surgery, resulted in an increase in the number of true and false positives for Reader 1, with a significant improvement in sensitivity (P = 0.016), a non-significant decrease in specificity and a non-significant improvement in accuracy. HHS Vulnerability Disclosure, Help The peroneus brevis muscle belly was assessed using the Goutallier classification for rotator cuff atrophy. Proton density weighted axial magnetic resonance image showing the flattened PB and a small longitudinal split right under the lateral malleolus. 89, No. Peroneous Brevis Tendon running the length of it. PURPOSE: To evaluate magnetic resonance (MR) findings of surgically proved peroneal tendon tears. Muscles of interest include abductor hallucis, abductor digiti minimi, flexor digitorum brevis and longus, tibialis anterior and peroneus muscles. abdominal trauma or pulmonary injury (which . Acad. .switcher .selected a:after {height:16px;display:inline-block;position:absolute;right:5px;width:15px;background-position:50%;background-size:7px;background-image:url("data:image/svg+xml;utf8,");background-repeat:no-repeat;content:""!important;transition:all .2s;} Unable to load your collection due to an error, Unable to load your delegates due to an error. 2020 May 5;100(17):1305-1309. doi: 10.3760/cma.j.cn112137-20191125-02559. Other injuries have to be sought, e.g. We also investigated the relationship between peroneus brevis tendon tears and muscle quality. Indian J Musculoskelet Radiol 2022;4:18-25. [1-3] In patients with known pathology who have failed conservative management, MRI also plays an important role in pre-operative planning. We aimed to compare the diagnostic performance of an objective set of magnetic resonance imaging (MRI) criteria named the cleft sign with traditional reads for pre-operative diagnosis of peroneal tendon tears. Peroneal tendon pathology is common, with the prevalence of peroneus brevis tears estimated at 1137% in cadaveric studies. Tears of the peroneus brevis tendon may cause ankle pain, swelling, and instability. Peroneus brevis tendon split tear at the level of the lateral malleolus. Surgical options include debridement, tubularization, or, in severe cases, resection of the damaged tendon and tenodesis. Federal government websites often end in .gov or .mil. [16,17] Assessment was based on non-fat saturated axial intermediate-weighted images as we do not routinely include an axial T1-weighted sequence on standard ankle MRI examinations [Figure 1]. Peroneal tendon tears are found equally between men and women. However, after 12 weeks my ankle was still swelling and very painful. -. The mean interval between the pre-operative MRI and subsequent surgery was 130 days with a standard deviation of 94 days. .switcher .option::-webkit-scrollbar-track{-webkit-box-shadow:inset 0 0 3px rgba(0,0,0,0.3);border-radius:5px;background-color:#f5f5f5;} Subscribe now (individual subscription: $237.00), (This functionality works only for purchases made as a guest), The Journal of Foot and Ankle Surgery, Vol. In four (80%) of these five cases, the peroneal tendons were either subluxed or dislocated. Peroneus Brevis: Axial and Sagittal View - MRI Online Library Library Neuroradiology(1387) View All Neuro(1387) Brain(444) Spine(215) Head & Neck(613) Pediatrics(115) Head & Neck(613) View All Head & Neck(613) Brachial Plexus(19) Carotid Space(60) Aerodigestive System(123) Orbit(75) Salivary Glands(66) Sella(60) Temporal Bone(119) diagnosis of peroneus brevis tears, MRI was marginally better with a sensitivity and specificity of 100% versus ultrasound, which had a sensitivity of 90% and specificity of 100%. Case report and literature review, Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain, Dynamic sonographic evaluation of peroneal tendon subluxation, Musculoskeletal sonography: a dynamic tool for usual and unusual disorders, Ultrasound-guided interventions of the foot and ankle, Normal variants and pitfalls in MR imaging of the ankle and foot, Magic angle effect in MR imaging of ankle tendons: influence of foot positioning on prevalence and site in asymptomatic subjects and cadaveric tendons, Imaging evaluation of traumatic ligamentous injuries of the ankle and foot, MR imaging features of diseases of the peroneal tendons, Magnetic resonance imaging of the peroneal tendons, Magnetic resonance imaging findings in patients with peroneal tendinopathy and peroneal tenosynovitis, Bilateral stenosing tenosynovitis of the peroneus longus tendon associated with hypertrophied peroneal tubercle in a junior soccer player: a case report, Surgical treatment of peroneal tendon tears, Ultrasound diagnosis of peroneal tendon tears: a surgical correlation, Magnetic resonance imaging and surgical correlation of peroneus brevis tears, Fracture and posterior dislocation of the os peroneum associated with rupture of the peroneus longus tendon, Radiography and US of os peroneum fractures and associated peroneal tendon injuries: initial experience, Cuboid oedema due to peroneus longus tendinopathy: a report of four cases, Peroneal tendon subluxation: the other lateral ankle injury, High-resolution US of non-traumatic recurrent dislocation of the peroneal tendons: a case report, Subluxing peroneals: a review of the literature and case report, Tendon injuries about the ankle resulting from skiing, Intrasheath subluxation of the peroneal tendons: surgical technique, Intrasheath subluxation of the peroneal tendons, Bilateral congenital peroneal tendon subluxation, MRI of the foot and ankle: prevalence and distribution of occult and palpable ganglia, MRI of an intratendinous ganglion cyst of the peroneus brevis tendon, Operative treatment for peroneal tendon disorders, Allograft reconstruction of peroneal tendons: operative technique and clinical outcomes, Staged reconstruction for chronic rupture of both peroneal tendons using Hunter rod and flexor hallucis longus tendon transfer: a long-term follow-up study, The management of concomitant tears of the peroneus longus and brevis tendons, Reconstruction of the peroneal retinaculum using the peroneus quartus: a case report, Recurrent subluxation of the peroneal tendons, Operative treatment for ganglion cysts of the foot and ankle, To read the full-text, please use one of the options below to sign in or purchase access, Purchase this article as pay-per-view (unlimited access for 24 hours), CT and MR Imaging of the Postoperative Ankle and Foot, High-Resolution US and MR Imaging of Peroneal Tendon InjuriesErratum. Nine operative reports described prior peroneal surgery on the affected side. Peroneal tendon disorders are common causes of lateral and retromalleolar ankle pain. Epidemiology Small published case series include patients ranging from 13 to 65 years of age 2,4. PMC 2, 2022 Radiological Society of North America, MRI features of chronic injuries of the superior peroneal retinaculum. Our intended use of the cleft sign is to be applied in conjunction with an interpreters own read. This muscle is important for walking, running, and standing on your toes, among other activities. This method allows the most detailed assessment of the peroneal tendons and further structures around the tendons. The interobserver reliability for MRI assessment of peroneus brevis muscle belly quality was almost perfect (0.89). PLT= Peroneus longus tendon, PBT= Peroneus brevis tendon, FHLT= Flexor hallucis longus tendon, FDLT= Flexor digitorum . Acute, limited tears of a single peroneal tendon may be debrided and repaired. MRI showed longitudinal tear of peroneus brevis tendon and the patient underwent surgical treatment. A Peroneal tendon tear is a tear of one of the tendons of the Peroneus muscles. No history of trauma. Peroneus Brevis - Physiopedia Non-steroidal anti-inammatory medication Rest Activity modication Orthoses with lateral forefoot posting in mild cases For persistent cases, immobilization in a short-leg cast or controlled ankle movement walker for six weeks may be helpful. [15] However, a limitation of their study was the lack of surgical confirmation of tendon status. The aim of the case report is to aid other surgeons in surgical treatment and post-operative care. These cookies will be stored in your browser only with your consent. Patients whose MRI studies did not include the peroneus brevis muscle belly in the field of view were excluded for this portion of the analysis. There is a longitudinal split resulting in two components of the Peroneus Brevis tendon (Pink arrows). 217, No. One hundred and five consecutive patients who had undergone peroneal tendon surgery between January 1, 2004, and December 31, 2019, were identified from a surgical database. The diagnostic performances of MRI for peroneal tendon tears with and without application of the cleft sign were analyzed. NewRunner13. Atrophy was determined based on analysis of the entirety of the muscle belly visualized within the field of view. fibula instead leads to longitudinal tears (2). Although we controlled for age, we did not account for disuse or denervation in the affected extremity. Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. The examination showed a transmural tear of the peroneus brevis tendon Full size image Magnetic Resonance Imaging Magnetic resonance imaging (MRI) is probably still today's diagnostic modality of choice. Although it was not in the area they were looking at, the report stated that there was a "small longitudinal split tear of the peroneus brevis tendon." My doctor at the time commented that . Ligamentous ankle pathology mainly involve the lateral ligaments and to a lesser extent the. Prior lateral ankle surgical intervention was recorded as either directly involving the peroneal tendons (peroneal tendon repair, debridement, and rerouting for lateral ligament reconstruction) or not (Open reduction and internal fixation [ORIF], fibular groove deepening, etc.). What to Expect After Peroneal Tendon Repair Surgery [9] ), University of Arizona Health Network, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; Department of Radiology, Southern Arizona VA Health Care Service, Tucson, Ariz (J.N.A. Score: 4.3/5 (52 votes) . To date, there have been no established criteria for peroneal tendon tears on MRI. 61, No. ). 3, American Journal of Roentgenology, Vol. Proton density weighted axial magnetic resonance image showing the flattened, MeSH Case 1. Peroneal Artery: the peroneal artery arises from the tibioperoneal trunk and supplies the muscles of the lateral compartment of the lower leg (peroneus brevis, and peroneus longus). The Peroneus Brevis Muscle is also known by the name of Fibularis Brevis Muscle. Patients who had incomplete MRI examinations and those with a time interval of >1 year between MRI and surgery were excluded from the study, yielding 38 subjects with complete pre-operative MRIs available for review. The dates of the pre-operative MRI and surgery were recorded. 2, World Journal of Orthopedics, Vol. 36, No. 16, Journal of Ultrasound in Medicine, Vol. [2] Even with a comprehensive history and physical examination, MRI in the current era is invaluable in distinguishing between various causes of ankle symptoms, such as ligamentous injury, tendinous pathology, osteochondral lesions, and synovitis. Intrasubstance signal on its own can be seen with tendinosis/intrasubstance tearing, but cannot be confirmed on surgery without a surfacing component, a concept well-established with the knee menisci and shoulder rotator cuff. Peroneus brevis tendon split tear at the level of the lateral malleolus. Left ankle pain after dropping heavy object on it. The details of the MRI are provided below. McNemars test with binomial distribution was used to test for significant differences in performance measures between traditional MRI reads and using the cleft sign. .switcher .option a.selected {background:#fff;} Skeletal Radiol doi:10.1007/s00256-009-0782-y, Retinacular disorders of the ankle and foot, The superior peroneal retinaculum: an anatomic study, Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles, Peroneus quartus muscle: MR imaging features, The peroneal tubercle: description, classification, and relevance to peroneus longus tendon pathology, Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle, Founders lecture of the ISS 2006: borderlands of normal and early pathological findings in MRI of the foot and ankle, MR imaging of the accessory muscles around the ankle, Congenital variations of the peroneus quartus muscle: an anatomic study, The dynamics of peroneus brevis tendon splits: a proposed mechanism, technique of diagnosis, and classification of injury, The peroneus quartus muscle: anatomy and clinical relevance, Sonographic appearance of the peroneus quartus muscle: correlation with MR imaging appearance in seven patients, The relationship between tears of the peroneus brevis tendon and the distal extent of its muscle belly: an MRI study, A radiologic and histologic study of the os peroneum: prevalence, morphology, and relationship to degenerative joint disease of the foot and ankle in a cadaveric sample, Os peroneum friction syndrome complicated by sesamoid fatigue fracture: a new radiological diagnosis? Novotel Suites Clermont Ferrand Polydome. [6] The normal flattening of the peroneus brevis tendon in the retromalleolar groove can also simulate a partial thickness tear. Surgical management of peroneal tendon tears includes debridement, repair/tubularization, tenodesis, tendon transfer, and autograft/allograft reconstruction.[4,5]. They commonly occur at the level of the retromalleolar groove. My dr said he will repair the tendon and also fix my plantar fasciitis. Longitudinal Split Tear Peroneus Brevis Tendon - YouTube 0:00 / 2:59 Longitudinal Split Tear Peroneus Brevis Tendon 4,017 views Nov 10, 2018 22 Dislike Share Save First Look MRI 9.61K. Tears of the peroneus brevis tendon are more frequent than reported in the literature. Ultrasound or MRI is useful in the diagnosis. We found that utilizing this sign could significantly increase a readers sensitivity and improved the accuracy of both readers to a non-significant degree when used in conjunction with their own reads. Second, we aim to examine the value of peroneus brevis muscle status on MRI in assessing tendon tears. Thirty-five patients (64 %) had combined PB and PL tendinosis. Most tears of the peroneal tendons are partial ruptures of the peroneus brevis tendon called longitudinal tears, tearing along the length of the tendon. Four surgical patients and one control patient were excluded from this part of the analysis as their MRI studies did not include the peroneus brevis muscle belly in the field of view. The minimally invasive ATFL reconstruction with partial peroneus brevis tendon has advantages of small trauma, good reconstruction a nd excellent clinical outcomes, thus, is a safe and effective method for the treatment of chronic lateral ankle instability. The second case was a 46-year-old woman with persistent pain on the lateral aspect of the ankle with a history of a road traffic accident two years ago. 69, No. [10,12] Similar MRI findings of peroneus longus tendon tears to peroneus brevis tears have been described. The doctor finally ordered an MRI. MRI diagnostic performance for peroneus longus tears. .switcher .option::-webkit-scrollbar-thumb {border-radius:5px;-webkit-box-shadow: inset 0 0 3px rgba(0,0,0,.3);background-color:#888;}. Only one patient had an isolated tear of peroneus longus. Sagittal T1-weighted spin echo; TR 400 ms, TE 9 ms, slice thickness 4.0 mm, and FOV 16 16 cm. The MRI shows a split tear in the peroneus brevis tendon. 2015;37:617627. The performance of the cleft sign for diagnosing peroneal tendon tears in isolation and in conjunction with traditional MRI assessment was compared to that of traditional MRI assessment alone regarding the surgical data. Mild peroneus longus and brevis tendinosis without tearing [29,30] The criteria for signal to be present on two contiguous slices improves specificity of the finding by decreasing the effect of partial volume averaging. 37, No. Splitting of of peroneus brevis tendon is more common than full thickness tear including that of the tears of the long peronius tendon. Immediate management involves prevention of secondary injury and man-agement of potential complications associated with spinal injury: C-spine immobilization and careful handling of the patient can limit the damage if the spine has sustained an unstable injury. Careers. 6, The British Journal of Radiology, Vol. 10, Canadian Association of Radiologists Journal, Vol. This article will discuss manifestations of ankle injury on MRI as well as associated findings that should be addressed. per night. While complete tears are less of a diagnostic dilemma, partial thickness tears can have a variable appearance. Chauhan B, Panchal P, Szabo E, Wilkins T. J Am Board Fam Med. Additional findings included fluid in the tendon sheath (n = 6), marrow edema of the lateral calcaneal wall (n = 3), enlarged peroneal tubercle (n = 3), and tear of the peroneus brevis tendon (n = 2). In addition to tendon status, the degree of muscle atrophy is affected by various other factors, including disuse, denervation, and age. [15] Based on shoulder rotator cuff literature, it has been hypothesized that the degree of muscle fatty degeneration correlates with tendon pathology and is a predictor of outcome after surgical tendon repair. LESSON 6, TOPIC 18. Venous Anatomy. 10 Peroneus Longus SplitAxial STIR images show a cleft of increased STIR signal in the posterior aspect of the longus consistent with a small longitudinal tear. [2] Anatomical variations such as the presence of peroneus quartus and peroneal tubercle hypertrophy may also be contributory. .switcher {font-family:Arial;font-size:10pt;text-align:left;cursor:pointer;overflow:hidden;width:163px;line-height:17px;} Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. There is no specific diagnostic and treatment algorithm. -, Klos K., Knobe M., Randt T., Simons P., Mckley T. Injuries of the peroneal tendons: often overlooked. Leppilahti J, Flinkkil T, Hyvnen P, Hmlinen M. Zhang W, Bai RJ, Qian ZH, Wang SM, Zhan HL, Li YX. In our study, the sensitivities and specificities for the two readers in diagnosing peroneus brevis tears in patients without prior peroneal surgery were 60%/89% and 80%/78%, respectively, comparable with that in literature. Orthop. [1,8-14] These previous studies have been limited by small sample sizes and heterogeneous study designs, most notably with inconsistent imaging criteria of tendon tears. 54, No. For irreparable tears of the tendon, a salvage procedure is indicated with segmental resection followed by reconstruction with tenodesis, tendon transfer, or bridging the defect using allograft or autograft. In patients with prior peroneal surgery, the use of the cleft sign led to overall decreased performance. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Giyab O, Peroneus brevis tear. PERONEUS BREVIS TENDON TEAR MRI DISCUSSION: WHAT'S THE dX Peroneus Brevis Tendon Tear: MRI demonstrates a peroneus brevis tendon tear. This can lead to partial volume averaging effects and difficulties in delineating tendon borders. Operative treatments include repair of the tendon, resection of the tear, debridement of the tendon, or tenodesis of the peroneus. Injuries of the peroneal tendon complex are common and should be considered in every patient who presents with chronic lateral ankle pain. These cookies do not store any personal information. Common diseases include tenosynovitis, rupture, and dislocation of the peroneal tendons as well as injuries to the SPR. .switcher .selected {background:#fff linear-gradient(180deg, #efefef 0%, #fff 70%);position:relative;z-index:9999;} Foot Ankle. Results MRI revealed peroneal tendinosis in 55 patients (95 % of the total study population). In cases when symptoms persist, surgical exploration is indicated. MRI diagnostic performance for peroneus brevis tears. [26] Finally, as expected, we found the cleft sign to be highly unreliable in peroneal tendons that have undergone prior surgery [Figure 5]. Peroneus brevis tendon tears are acute or chronic, and may be asymptomatic or associated with lateral ankle pain and/or instability. Even though MRI is the most effective diagnostic tool in depicting peroneal tendon injuries, there are false positive findings. [Magnetic resonance imaging of normal anatomy and injury of the peroneal tendon]. The mean peroneus brevis muscle grades in patients with peroneus brevis tendon tears were 0.68 for Reader 1 and 0.50 for Reader 2. Fluid signal intensity is seen between the torn parts of the peroneus brevis tendon. High-resolution US and MR imaging provide crucial information for evaluation of peroneal tendon injuries and disorders, including tendinosis and tenosynovitis, partial- and full-thickness tears, retinacular injuries, and ankle instability, and imaging findings can assist orthopedic surgeons in determining the appropriate treatment. The use of the cleft sign in these patients decreased specificity and accuracy for peroneus brevis tears to a non-significant degree. The cleft sign is reproducible and practical, quickly detected on routine axial T2-weighted sequences, and can be used in situations where oblique-plane imaging sequences may not be readily available. Check for errors and try again. The ankle ligaments and remaining tendons are normal. [20-22] Split tears of the peroneus brevis tendon have been described as two distinct bundles as well as a C or boomerang-shaped tendon surrounding the peroneus longus tendon with central thinning. Low-lying peroneus brevis tendon muscle belly has been speculated to be an associated factor with symptomatic peroneal tendon pathology. Enter your email address below and we will send you the reset instructions. [16,17] The authors found that patients with peroneus brevis tendon tears on MRI demonstrated significantly higher grades of fatty atrophy compared with controls. The mean peroneus brevis muscle grades in patients without peroneus brevis tendon tears were 0.33 for Reader 1 and 0.40 for Reader 2. Clinical findings can be vague and the result from MRI at times are not accurate, as suggested from our case of an . We describe a set of novel, objective MRI criteria, named the cleft sign, that could improve the diagnostic performance of readers for peroneal tendon tears. 2009;17(5):306317. Selected foot muscles were scanned using an ultrasound device and the scanned images were processed to measure the thickness and cross-sectional area of the muscles. The operative reports of the 38 surgical patients documented 26 patients with peroneal tendon tears and 12 patients without tears [Table 2]. Prevalence and Role of a Low-Lying Peroneus Brevis Muscle Belly in Patients With Peroneal Tendon Pathologic Features: A Potential Source of Tendon Subluxation. Peroneus brevis muscle quality (Goutallier grade). ); and Department of Radiology, Southern Illinois University School of Medicine, Springfield, Ill (J.D.R. American journal of roentgenology. 19, No. Control patients had a variety of clinical symptoms but were excluded if the indication suggested lateral ankle pain or clinically suspected peroneal pathology. 38, No. In: Lippincott Williams & Wilkins Atlas of Anatomy. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gilcrease-Garcia B, Peroneus brevis split tendon tear. Seven of these involved the peroneus brevis (five repairs/tendon transfers, one debridement, and one Evans procedure) and five involved the peroneus longus (four repairs/tendon transfers and one debridement). Our study is limited by its small sample size and retrospective design, comparable to other similar studies.

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