Department of Orthopaedics and Traumatology, Dr Sadi Konuk Research and Training Hospital, Tevfik Saglam Cad. No: 11, Zuhuratbaba, 34147, Istanbul, Turkey,
Arch Orthop Trauma Surg. 2014 Apr;134(4):481-7. doi: 10.1007/s00402-014-1937-4. Epub 2014 Feb 14.
The most common variant muscle of the ankle, peroneus quartus muscle, is located in the lateral leg compartment. In literature there is ambiguous nomenclature of this muscle because of its different origin and insertion sides. It is related to many pathologic conditions in the lateral ankle compartment but also it can be used as a tendon graft for reconstructive procedures.
We dissected 115 cadaver legs and investigated prevalence of peroneus quartus. We also present 2 year result of a patient who had torn superior peroneal retinaculum reconstructed with peroneus quartus tendon.
The peroneus quartus muscle, with a number of different attachments, was present in 5.2 % (6/115) of the legs. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneus. Associated pathologies are longitudinal degeneration and tear in the tendon of peroneus brevis. There is no any association between the prevalence of peroneus quartus and the height of retrotrochlear eminence or presence of peroneal tubercule (p > 0.05). But there is strong relationship between peroneus brevis degeneration and peroneus quartus existence (p: 0.03). We also defined a new type of peroneus quartus with a bifurcated insertion around the peroneus brevis. In literature our case report is unique because we present a patient who has torn superior peroneal retinaculum which is reconstructed with peroneus quartus tendon with 2 year follow up.
Peroneus quartus may lead to some pathologic conditions (pain, snapping, tear, synovitis, etc.) in the lateral ankle compartment but it may be used to reconstruct some pathologic conditions. Orthopaedics, anatomists and radiologists should be aware of this accessory tendon structure because of its clinical importance.
最常见的踝关节变异肌——第四腓骨肌，位于小腿外侧肌间隔。由于其起源和插入部位不同，文献中对该肌肉的命名存在一定的模糊性。它与外侧踝关节间隙的许多病理状况有关，但也可作为重建手术的肌腱移植物。
我们解剖了 115 具尸体标本，研究了第四腓骨肌的发生率。我们还介绍了一位患有上腓侧支持带撕裂患者的 2 年随访结果，该患者的撕裂采用第四腓骨肌肌腱重建。
第四腓骨肌（附着方式多样）存在于 5.2%（115 具标本中的 6 具）的标本中。它最常见的起源于腓骨短肌，并插入跟骨的滑车切迹后缘。相关的病理改变为腓骨短肌腱的纵向退变和撕裂。第四腓骨肌的发生率与滑车切迹后缘的高度或腓骨粗隆的存在无关（p＞0.05）。但第四腓骨肌与腓骨短肌退变之间存在很强的关系（p：0.03）。我们还定义了一种新的第四腓骨肌类型，其插入方式为围绕腓骨短肌的分叉。在文献中，我们的病例报告是独特的，因为我们介绍了一位患有上腓侧支持带撕裂的患者，该患者的撕裂采用第四腓骨肌肌腱重建，并进行了 2 年的随访。
第四腓骨肌可能导致外侧踝关节间隙出现一些病理状况（疼痛、弹响、撕裂、滑膜炎等），但也可用于重建一些病理状况。骨科医生、解剖学家和放射科医生应该意识到这种辅助肌腱结构的临床重要性。
