Guelfi Matteo, Vega Jordi, Malagelada Francesc, Baduell Albert, Dalmau-Pastor Miki
1 Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Chieti, Italy.
2 Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain.
Foot Ankle Int. 2018 May;39(5):542-550. doi: 10.1177/1071100718764674. Epub 2018 Mar 29.
Snapping peroneal tendons is a rare cause of lateral ankle pain. Two subgroups have been described: chronic subluxation with superior peroneal retinaculum (SPR) injury and intrasheath subluxation with SPR intact. The aim of the study was to report the tendoscopic findings and results in patients affected by snapping peroneal tendons without evident dislocation.
Between 2010 and 2015, a total of 18 patients with a retromalleolar "click" sensation and no clinical signs of peroneal tendon dislocation underwent tendoscopy. Mean age was 29 years (range, 18-47). Mean follow-up was 45 months (range, 18-72).
Tendoscopic examination revealed an intact SPR in 12 patients. Of these 12, a space-occupying lesion was present in 7, a superficial tear of peroneus brevis in 4, and a shallow fibular groove in 7. An SPR injury without peroneal tendon dislocation was observed in the remaining 6 patients. All these 6 patients presented a shallow fibular groove. Although the SPR was injured, they had been diagnosed as intrasheath subluxation. Patients with intrasheath subluxation and intact SPR underwent debridement of a space-occupying lesion in 11 cases and fibular groove deepening in 5 cases. Patients with intrasheath subluxation and SPR injury underwent fibular groove deepening without addressing the SPR. At follow-up, the mean American Orthopaedic Foot & Ankle Society score increased from 76 (range, 69-85) preoperatively to 97 (range, 84-100). No recurrence or major complications were reported. Conclusion Intrasheath subluxation of peroneal tendons was successfully treated tendoscopically. A new subgroup of intrasheath subluxation with SPR injury but no clinically evident peroneal tendon dislocation is reported.
Level IV, case series.
腓骨肌腱弹响是外侧踝关节疼痛的罕见原因。已描述了两个亚组：伴有腓骨上支持带（SPR）损伤的慢性半脱位和SPR完整的鞘内半脱位。本研究的目的是报告在无明显脱位的腓骨肌腱弹响患者中的关节镜检查结果及治疗结果。
2010年至2015年期间，共有18例有踝后“咔嗒”感且无腓骨肌腱脱位临床体征的患者接受了关节镜检查。平均年龄为29岁（范围18 - 47岁）。平均随访时间为45个月（范围18 - 72个月）。
关节镜检查发现12例患者的SPR完整。在这12例患者中，7例存在占位性病变，4例腓骨短肌有表浅撕裂，7例有浅的腓骨沟。其余6例患者观察到有SPR损伤但无腓骨肌腱脱位。所有这6例患者均有浅的腓骨沟。尽管SPR受损，但他们被诊断为鞘内半脱位。鞘内半脱位且SPR完整的患者中，11例行占位性病变清创术，5例行腓骨沟加深术。鞘内半脱位且有SPR损伤的患者未处理SPR而行腓骨沟加深术。随访时，美国矫形足踝协会平均评分从术前的76分（范围69 - 85分）提高到97分（范围84 - 100分）。未报告复发或重大并发症。结论腓骨肌腱鞘内半脱位通过关节镜检查得到成功治疗。报告了一种新的鞘内半脱位亚组，伴有SPR损伤但临床上无明显的腓骨肌腱脱位。
IV级，病例系列。
