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Scientific Articles   |    
Anatomy of the Superior Peroneal Tunnel
Sunita Arvind Athavale, MD1; Swathi, MBBS2; S.V. Vangara, BSc3
1 Department of Anatomy, Peoples College of Medical Sciences and Research Centre, Bhanpur Bhopal, Madhya Pradesh 462010, India. E-mail address: arvindat@rediffmail.com
2 Department of Anatomy, K.V.G. Medical College, Kurunjibhag, Sullia, DK District 574327, India
3 Department of Anatomy, Kasturba Medical College Manipal, Udupi District 576104, India
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at K.V.G. Medical College, Sullia, India

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Mar 16;93(6):564-571. doi: 10.2106/JBJS.J.00662
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Abstract

Background: 

Standard texts of anatomy provide cursory and varied descriptions of the superior peroneal retinaculum and the contents of the tunnel formed by it. The available clinical literature suggests that the boundaries and contents of the superior peroneal tunnel have a direct bearing on the causation of peroneal tendinopathies. Knowledge of the anatomy of this region is essential for successful diagnosis and treatment.

Methods: 

Fifty-eight embalmed lower limbs were dissected and the boundaries and contents of the superior peroneal tunnel were ascertained. Sixty dry fibulas were also studied to observe the contour of the retromalleolar groove.

Results: 

The tunnel was spacious, with the superior peroneal retinaculum forming its roof. The floor of the tunnel has an osseous and a nonosseous component. The osseous component is formed by the retromalleolar groove of the fibula, and the nonosseous component is formed by the lower part of the posterior intermuscular septum of the leg. Muscle fibers of the peroneus brevis muscle were the most frequent additional contents followed by an aberrant muscle, termed the peroneus quartus. A split peroneus brevis tendon, a double peroneus longus tendon, and an accessory peroneal nerve were some of the variants observed. In the study of the dry fibulas, it was observed that the contour of the retromalleolar groove was constantly concave.

Conclusions: 

The study suggests that frequent additional structures can normally exist within the spacious superior peroneal tunnel. The retromalleolar groove has a concave contour and forms only a part of the floor of the tunnel and so is an unlikely cause of tendinopathies. The findings may facilitate radiographic evaluation of the tunnel and lead to improvements in the treatment of peroneal tendinopathies.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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