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Extends from the anteroinferior border of the fibula to the neck of the talus
11%
104/938
Originates on the posterior border of the fibula and inserts on the posterolateral tubercle of the talus
16%
151/938
It is plantar to the peroneal tubercle of the calcaneus
30%
277/938
Originates on the anterior border of fibula and inserts on the calcaneus distal to the subtalar joint
10%
90/938
It is dorsal to the peroneal tubercle of the calcaneus
33%
306/938
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This patient is presenting with a chronic tear of the peroneus brevis tendon, as evident on MRI. At the level of the peroneal tubercle of the calcaneus, the peroneus brevis is dorsal and the peroneus longus is plantar. Peroneal tendon tears represent a spectrum of traumatic injuries to the lateral ankle that include tenosynovitis, tendinopathy, tendon tears and/or tendon instability. The peroneus brevis and longus have a defined anatomic relationship in the retromalleolar sulcus and at the peroneal tubercle. The peroneus brevis lies anterior to the longus in the retromalleolar space, directly posterior to the fibula at the level of the groove. Both the peroneus brevis and longus are covered by the superior peroneal retinaculum (SPR) at this level, which is the primary restraint of the peroneal tendons within the retromalleolar space. Of note, tears in the SPR can lead to subluxation of the tendons and can be a cause of tendinopathy. This patient, however, likely sustained an isolated tear in the peroneus brevis after suffering an inversion ankle injury. Continued activity likely propagated the injury and lead to degenerative tendinopathy of the peroneus brevis as evident on the MRI. At the level of the peroneal tubercle of the calcaneus, the peroneus longus is plantar and the peroneus brevis is dorsal. Hyer et al. examined 114 calcanei and measured peroneal tubercle length, height, depth, and structural description. A peroneal tubercle was identified in 103 calcanei. The tubercle was found to be flat in 44, prominent in 30, concave in 28, and a tunnel in 1. They concluded that understanding peroneal tubercle pathology may help understand peroneal tendon pathology. Philbin et al. reviewed peroneal tendon injuries. They discussed the pertinent anatomy, physical examination, and imaging. Additionally, the pathology, treatment, and post-operative care of peroneal tendon injuries including peroneus brevis and longus tears/subluxation and os peroneum were discussed. They concluded peroneal tendon injuries are often missed and having awareness will aid in improved diagnosis and treatment. Figure A is a T2-weighted axial MRI cut of a left ankle demonstrating a longitudinal split degenerative tear of the peroneus brevis, as evident by the c-shape or "boomerang" appearance. Illustration A is a diagram demonstrating the anatomic relationship of the peroneus brevis and longus. Illustration B demonstrates an MRI of the anterior talofibular ligament. Incorrect answers: Answer 1: This describes the anterior talofibular ligament. Answer 2: This describes the posterior talofibular ligament. Answer 3: This describes the peroneus longus tendon. Answer 4: This describes the calcaneofibular ligament.
1.8
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