1 Rothman Orthopaedic Institute, Philadelphia, PA, USA.
2 Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Foot Ankle Int. 2019 Aug;40(8):888-894. doi: 10.1177/1071100719847629. Epub 2019 May 8.
The treatment of symptomatic peroneal tendinopathy and tears traditionally begins with nonsteroidal anti-inflammatory drugs, activity modification, physical therapy, and immobilization, with surgery typically reserved for those failing nonoperative treatment. Ultrasound-(US)-guided peroneal tendon sheath (PTS) corticosteroid injection is an additional nonoperative modality, but limited data exist on its safety and efficacy. The purpose of this study was to assess clinical outcomes following US-guided PTS corticosteroid injection for chronic tendinopathy or tears.
We retrospectively identified patients who had undergone US-guided PTS corticosteroid injection for pain due to peroneal tendinopathy, tears, or subluxation at our institution from 2012 to 2018. Underlying diagnosis was based on clinical examination, magnetic resonance imaging (MRI) results, and/or intraoperative findings, when available. Medical record data were supplemented by e-mail or telephone follow-up. Collected information included patient age, sex, body mass index (BMI), smoking status, workers' compensation status, prior surgeries about the foot and ankle, duration of symptoms prior to injection, perceived improvement in pain following injection and its duration, number of injections, progression to surgery, and any adverse outcomes of injection. We identified 96 patients (109 injections). Thirty-seven (38.5%) had previous foot and ankle surgery, with 17 (17.7%) having surgery specifically on the peroneal tendons.
Twenty-four of 96 (25%) progressed to have surgery on their peroneal tendons following injection. Following injection, 38/87 (43.7%) of patients reported 0-1 weeks of pain relief, 11/87 (12.6%) 2-6 weeks, 6/87 (6.9%) 7-12 weeks, and 32/87 (36.8%) greater than 12 weeks. Preinjection duration of symptoms was associated with postinjection duration of pain relief (=.036). There were 2 reported complications (1.8%): 1 case of self-limited sural nerve irritation and 1 of peroneus longus tear progression.
Our study demonstrates US-guided PTS corticosteroid injection was safe and relatively effective in patients with symptomatic peroneal tendon tears or tendinopathy, including those who had undergone prior surgery, and may be considered in a comprehensive protocol of nonoperative management.
Level IV, case series.
传统上，对于症状性腓肠肌腱病和撕裂，治疗始于非甾体抗炎药、活动调整、物理治疗和固定，手术通常保留给非手术治疗失败的患者。超声（US）引导的腓肠肌腱鞘（PTS）皮质类固醇注射是另一种非手术方法，但关于其安全性和疗效的数据有限。本研究旨在评估 US 引导的 PTS 皮质类固醇注射治疗慢性肌腱病或撕裂的临床结果。
我们回顾性地确定了 2012 年至 2018 年期间在我们机构因腓肠肌腱病、撕裂或腓骨肌腱脱位导致疼痛而接受 US 引导的 PTS 皮质类固醇注射的患者。潜在诊断基于临床检查、磁共振成像（MRI）结果和/或术中发现（如有）。病历数据通过电子邮件或电话随访进行补充。收集的信息包括患者年龄、性别、体重指数（BMI）、吸烟状况、工人赔偿状况、足部和踝关节既往手术、注射前症状持续时间、注射后疼痛改善及其持续时间、注射次数、进展为手术以及注射的任何不良结果。我们确定了 96 名患者（109 次注射）。37 名（38.5%）有足部和踝关节手术史，其中 17 名（17.7%）有专门针对腓肠肌腱的手术。
96 名患者中有 24 名（25%）在注射后进展为接受腓肠肌腱手术。注射后，87 名患者中有 38 名（43.7%）报告疼痛缓解 0-1 周，11 名（12.6%）2-6 周，6 名（6.9%）7-12 周，32 名（36.8%）>12 周。注射前症状持续时间与注射后疼痛缓解持续时间呈正相关（=0.036）。有 2 例报告的并发症（1.8%）：1 例为自限性腓肠神经刺激，1 例为腓骨长肌撕裂进展。
我们的研究表明，US 引导的 PTS 皮质类固醇注射在有症状的腓肠肌腱撕裂或肌腱病患者中是安全且相对有效的，包括那些已经接受过手术的患者，并且可以在非手术治疗的综合方案中考虑。
IV 级，病例系列。
