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A 22-year-old collegiate football player presents with persistent left lateral ankle pain 6 months after sustaining an ankle sprain during a game. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. A current radiograph and an MRI of his ankle are shown in Figures A and B, respectively. What structure labeled in Figure C is most likely injured?
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A 55-year-old recreational tennis player presents to clinic after initial rehabilitation complaining primarily about pain and swelling along the posterior fibula. He states he sprained his ankle six months ago, and was treated with bracing and proprioceptive training. He notes multiple sprains in the past, but the pain from prior sprains was different and always resolved. After an MRI demonstrated a peroneus brevis tear he is taken to the operating room. During surgery you identify multiple longitudinal tears in the peroneus brevis tendon, and a 3 cm portion of the tendon with significant tendinosis in over 70% of the cross-sectional area. What is the appropriate surgical procedure?
Core repair and tubularization of the peroneus brevis tendon
Peroneal groove deepening
Excision of the diseased tendon without transfer
Excision of the diseased tendon with proximal and distal transfer to the peroneus longus
Arthroscopic debridement of the peroneus brevis
Which of the following physical examination findings would suggest injury to the superior peroneal retinaculum?
Positive ankle anterior drawer test
Positive external rotation stress test
Crepitus over the anterolateral ankle joint
Palpable tendon snapping over the fibula during ankle dorsiflexion
Tenderness at the base of 5th metatarsal with ankle eversion.
A 26-year-old active woman is seen for persistent right lateral ankle pain. She has tried a course of treatment with NSAIDs, physical therapy and bracing. Plain films are unremarkable, and her MRI image is shown in Figures A and B. What is the distal insertion point of the injured structure?
Navicular and medial cuneiform
Base of distal phalanx of big toe
First metatarsal base and medial cuneiform
Fifth metatarsal base
Base of distal phalanx of digits 2-5
A 60-year-old with a history of diet controlled diabetes presents with ongoing 6-8 months history of lateral sided ankle pain. On physical exam, he is painful to resisted eversion, resisted plantar flexion of the 1st metatarsal and has a positive Coleman block test. A representative coronal MRI sequence at the level of the cuboid is shown in Figure A. Intra-operatively, the peroneal tendon located directly posterior to the fibula is found to be normal. The second peroneal tendon is found to have limited excursion, with multiple tears and fibrous tissue. Which of the following treatment options is ideal for this patient?
Debridement and attempted repair of peroneal brevis
Debridement and attempted repair of peroneal longus
Reconstruction of peroneal brevis with allograft
Debridement of peroneal brevis and tenodesis of peroneal brevis to longus
Debridement of peroneal longus and tenodesis of peroneal longus to brevis
What is the most appropriate management of the injury shown in Figures A and B?
Achilles tendon repair
Repair of superior peroneal retinaculum and deepening of the fibular groove
Posterior tibial tendon reconstruction with flexor hallucs longus transfer
Peroneus longus repair
Peroneus brevis repair
A 35-year-old man injured his ankle while playing soccer two years ago. Ever since he has had persistent right ankle pain that has failed to improve with nonoperative modalities including physical therapy. A video of his right ankle is found below. Radiographs are shown in Figures A through C. What is the most appropriate next step in management?
Physical therapy directed at proprioception and strengthening
Fibular shortening osteotomy
Surgical repair of the anterior talofibular ligament (ATFL)
Surgical repair of the calcaneofibular ligament (CFL)
Fibular groove deepening and superior peroneal retinaculum repair
A 24-year-old female sprains her ankle playing tennis. After 3 months of bracing, physical therapy, and NSAID treatment, she continues to complain of pain and a popping sensation over the lateral ankle. Physical exam is notable for tenderness over the lateral malleolus. Figure A shows the ankle at rest, while figure B shows the ankle during active eversion. Which of the following structures has been injured?
Inferior peroneal retinaculum
Superior peroneal retinaculum
Anterior talofibular ligament
Lateral process of the talus
In the retromalleolar groove, as shown in Figure A, what is the relationship of the peroneus brevis tendon to the peroneus longus tendon?
The peroneus longus tendon is not in the groove
The peroneus brevis tendon is not in the groove
A 20-year-old male sustained an ankle sprain 4 weeks ago while skiing. He now complains of persistent painful snapping and popping posterior to the lateral malleolus. On exam, snapping is felt over the lateral fibula when the patient moves against resistance in dorsiflexion and eversion. What was the most likely mechanism of his injury?
Forced dorsiflexion and inversion
Forced dorsiflexion and eversion
Forced plantarflexion and eversion
Forced plantarflexion and inversion
Direct trauma to the fibula
Which of the following mechanisms of injury to the ankle is most likely to result in disruption of the superior peroneal retinaculum with subsequent peroneal tendon instability?
Plantarflexion and eversion
Neutral ankle position
Neutral ankle flexion and inversion
Dorsiflexion and inversion
Plantarflexion and inversion