Bonnin M, Tavernier T, Bouysset M
Clinique Charcot, Lyon, France.
Am J Sports Med. 1997 Sep-Oct;25(5):699-703. doi: 10.1177/036354659702500520.
Between 1993 and 1995, we operated on 18 patients for split lesions of the peroneal brevis tendon associated with chronic ankle instability. Five patients were competitive athletes, seven were recreational athletes, and six were persons. Symptoms developed in three phases: ankle sprain, chronic instability, and posterolateral pain. The mean delay between sprain and posterolateral pain was 6 years. At the time of surgery the main complaint was retromalleolar pain in nine patients, pain and instability in eight patients, and instability only in one patient. Diagnosis of tendinous lesions was based on clinical examination in three cases, preoperative magnetic resonance imaging in eight cases, preoperative tenography in one case, and surgical exploration in six cases. The lesion was localized at the tip of the lateral malleolus and was visible only after opening the peroneal retinaculum. In three cases an accessory peroneal muscle was present. A Chrisman-Snook procedure was performed in 13 cases and a simple tendinous repair in 5 cases. The split lesion of the peroneus brevis tendon may be the result of chronic ankle laxity. This lesion needs a specific surgical treatment and the peroneal tendon must be checked in case of surgical procedure for ankle laxity. After ligamentous repair, residual pain can be due to a neglected peroneus brevis tear.
1993年至1995年间，我们对18例因腓骨短肌腱分裂性损伤合并慢性踝关节不稳的患者进行了手术。其中5例为竞技运动员，7例为业余运动员，6例为普通人群。症状分三个阶段出现：踝关节扭伤、慢性不稳和后外侧疼痛。扭伤与后外侧疼痛之间的平均间隔时间为6年。手术时，主要主诉为9例患者的外踝后方疼痛，8例患者的疼痛和不稳，1例患者仅为不稳。肌腱损伤的诊断3例基于临床检查，8例基于术前磁共振成像，1例基于术前腱鞘造影，6例基于手术探查。病变位于外踝尖，仅在打开腓骨支持带后可见。3例存在副腓骨肌。13例行克里斯曼-斯诺克手术，5例行单纯肌腱修复。腓骨短肌腱分裂性损伤可能是慢性踝关节松弛的结果。该病变需要特定的手术治疗，在进行踝关节松弛手术时必须检查腓骨肌腱。韧带修复后，残留疼痛可能是由于腓骨短肌撕裂未得到重视。
