Review Question - QID 4635

The images demonstrate a peroneus longus tear and the most appropriate treatment is peroneus longus repair of the options provided.

Peroneus longus tears occur less frequently than peroneus brevis tears and are related to direct trauma or sports injuries. The peroneus brevis sits anterior to the peroneus longus. Hypertrophy of the peroneal tubercle is commonly thought to be a contributing factor to peroneus longus tenosynovitis, tears, and rupture.

Squires et al. present a Level 5 review of peroneal tendon tear surgical management. Peroneus brevis tendon tears are often longitudinal split tears and are thought to occur secondary to compression over the edge of the fibula. Debridement and repair are recommended for grade 1 tendons, which have damage to less than 50% of the cross-sectional area. Excision of the damaged segment and tenodesis to the peroneus longus are recommended for grade 2 tendons, which have destruction of greater than 50% of the cross-sectional area.

Figures A and B demonstrate a transverse peroneus longus tear. The fibula and peroneus brevis are visualized in the images to help give orientation to the pathology. Illustration A demonstrates a dislocation of the peroneus longus which can be surgically treated with repair of the superior peroneal retinaculum and deepening of the fibular groove. Illustration B is the axial MRI showing the relationship of the peroneus brevis and longus.

Incorrect Answers:
Answer 1,3,&5: The achilles,posterior tibial tendons, and peroneus brevis tendons are not ruptures.
Answer 2: The peroneus longus tendon is ruptured. If the tendon was intact and dislocated then repair of the superior peroneal retinaculum and deepening of the fibular groove would be appropriate.