The Journal of Bone & Joint Surgery

Introduction

Epidemiology

Anatomy

Normal Biomechanics in the Gait Cycle and Mechanisms of Injury

Physical Examination and Diagnostic Tests

Imaging Studies

Peroneal Tendinitis, Peroneal Tendinopathy, and Painful Os Peroneum Syndrome

Peroneal Subluxation and Dislocation

Peroneal Tendon Tears

Overview

References

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Daniel S. Heckman, Sudheer Reddy, David Pedowitz, Keith L. Wapner, Selene G. Parekh; Operative Treatment for Peroneal Tendon Disorders. The Journal of Bone & Joint Surgery. 2008 Feb;90(2):404-418.

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JBJS Case Connector

Grade	Description
A	Good evidence (Level-I studies with consistent findings) for or against recommending intervention.
B	Fair evidence (Level-II or III studies with consistent findings) for or against recommending intervention.
C	Poor-quality evidence (Level-IV or V studies with consistent findings) for or against recommending intervention.
I	There is insufficient or conflicting evidence not allowing a recommendation for or against intervention.

Grade	Description
A	Good evidence (Level-I studies with consistent findings) for or against recommending intervention.
B	Fair evidence (Level-II or III studies with consistent findings) for or against recommending intervention.
C	Poor-quality evidence (Level-IV or V studies with consistent findings) for or against recommending intervention.
I	There is insufficient or conflicting evidence not allowing a recommendation for or against intervention.

Disorder	Treatment	Grade of Recommendation
Tenosynovitis	Immobilization or surgery	C
Painful os peroneum syndrome	Immobilization or surgery	C

Disorder	Treatment	Grade of Recommendation
Tenosynovitis	Immobilization or surgery	C
Painful os peroneum syndrome	Immobilization or surgery	C

Grade	Description
Eckert and Davis³⁸
I	Superior peroneal retinaculum elevated from fibula, peroneus longus dislocated anteriorly
II	Superior peroneal retinaculum + fibrocartilaginous rim avulsed from posterior aspect of fibula
III	Superior peroneal retinaculum + cortical fragment avulsed from fibula
Oden¹⁰²
IV	Superior peroneal retinaculum elevated from calcaneus

Abstract

Introduction

Epidemiology

Anatomy

Normal Biomechanics in the Gait Cycle and Mechanisms of Injury

Physical Examination and Diagnostic Tests

Imaging Studies

Peroneal Tendinitis, Peroneal Tendinopathy, and Painful Os Peroneum Syndrome

Peroneal Subluxation and Dislocation

Peroneal Tendon Tears

Overview

References

Topics

References

Grade	Description
Sobel et al.⁴⁰
I	Splaying of the tendon
II	Partial-thickness split <1 cm in diameter
III	Full-thickness split 1-2 cm in diameter
IV	Full-thickness split >2 cm in diameter
Krause and Brodsky⁴
I	<50% tendon involvement
II	>50% tendon involvement

Redfern and Myerson¹² Type	Pathological Findings	Treatment
I	Both tendons are grossly intact	Excision of the longitudinal tear and tubularization of the remaining tendon
II	One tendon is torn and irreparable and the other tendon is functional (has sufficient excursion)	Tenodesis performed proximally between the peroneus longus and peroneus brevis
III	Both tendons are nonfunctional
	No excursion of the proximal muscle	Tendon transfer
	Excursion of the proximal muscle and no tissue bed scarring	One-stage tendon graft
	Excursion of the proximal muscle with tissue bed scarring	Staged tendon graft

Type of Tear	Treatment	Grade of Recommendation
Peroneus brevis	Immobilization or surgery (repair/tubularization or tenodesis)	C
Peroneus longus	Immobilization or surgery (repair/tubularization or tenodesis)	C
Peroneus brevis and peroneus longus	Immobilization or surgery (repair/tubularization, tenodesis, tendon allograft, or tendon transfer)	C