Karlsson J, Brandsson S, Kälebo P, Eriksson B I
Department of Orthopaedics, Ostra University Hospital, Göteborg, Sweden.
Scand J Med Sci Sports. 1998 Feb;8(1):42-9. doi: 10.1111/j.1600-0838.1998.tb00227.x.
Chronic lateral ankle instability can be associated with a longitudinal rupture of the peroneus brevis tendon. Patients with these problems have atypical posterolateral or retromalleolar pain, as well as clinical signs of ligamentous instability. This injury is frequently concomitant with lateral ligament injuries and the injury mechanism is similar; however, the tendon rupture is often missed. Laxity or insufficiency of the superior peroneal retinaculum allows the anterior part of the peroneus brevis tendon to ride upon the sharp posterior fibular edge, resulting in a longitudinal rupture of the tendon. We report on the results after surgical treatment in nine patients (10 ankles) with combined instability of the lateral ankle ligaments and longitudinal rupture of the peroneus brevis tendon. All these patients underwent surgical repair of the peroneus tendon, reconstruction of the superior peroneal retinaculum, removal of the sharp posterior edge of the fibula and correction of the ligamentous instability of the anterior talofibular and calcaneofibular ligaments. One constant finding at surgery was a longitudinal intratendineal rupture of the peroneus brevis tendon combined with insufficiency of the superior peroneal retinaculum and insufficiency of the lateral ligaments. At follow-up 3 (2-5) years post-operatively, the functional results were excellent or good in nine ankles and fair in one. All the patients with excellent or good results had resumed their preinjury activity level. We conclude that this lesion should be suspected in patients with lateral ligamentous instability, combined with retromalleolar pain. In these cases, it is important to address both the tendon rupture and the ligamentous insufficiency.
慢性外侧踝关节不稳可能与腓骨短肌腱纵向断裂有关。有这些问题的患者会出现非典型的后外侧或踝后疼痛，以及韧带不稳的临床体征。这种损伤常与外侧韧带损伤同时存在，损伤机制相似；然而，肌腱断裂常被漏诊。腓骨上支持带松弛或功能不全，使腓骨短肌腱前部骑跨于腓骨后缘锐利处，导致肌腱纵向断裂。我们报告了9例（10个踝关节）外侧踝关节韧带联合不稳及腓骨短肌腱纵向断裂患者的手术治疗结果。所有这些患者均接受了腓骨肌腱手术修复、腓骨上支持带重建、去除腓骨后缘锐利部分以及矫正距腓前韧带和跟腓韧带的韧带不稳。手术中一个常见发现是腓骨短肌腱纵向腱内断裂，合并腓骨上支持带功能不全和外侧韧带功能不全。术后随访3（2 - 5）年，9个踝关节功能结果为优或良，1个为可。所有功能结果为优或良的患者均恢复到伤前活动水平。我们得出结论，对于伴有外侧韧带不稳及踝后疼痛的患者，应怀疑存在这种损伤。在这些病例中，处理肌腱断裂和韧带功能不全都很重要。
