Peroneal tendoscopy

Objective: Peroneal tendon pathology should be within the differential diagnoses of patients who are admitted to the hospital with posterolateral ankle pain. Aim of this study is to discuss the role of tendoscopy within the diagnosis and the treatment of peroneal tendon pathologies and the association of TOL with peroneal tendon pathologies. Method: From 2006 to 2012, 20 ankles of 18 patients with retrofibular pain are included in this study. This study had been planned retrospectively. For the patients who had been pre-diagnosed as "peroneal tendinopathy" with physical examination, X-ray and MRI findings, "peroneal tendoscopy" had been performed diagnostically. After diagnostic peroneal tendoscopy, patients were definitively treated either with tendoscopy or with open surgery. Findings: We have included 18 patients with retrofibular pain, 13 were female and 5 were male. In 8 patients right ankle, in 8 patients left ankle and in 2 patients bilateral peroneal pathology had been detected. The mean age was 46.8 (29-71). Peroneal pathology had been detected in 14 of 20 ankles with MRI scans before the procedure, and MRI scans of 6 patients were normal regarding peroneal pathology, tendoscopy had been performed according to physical examinations and the findings for those patients. 13 of 20 ankles (65%) had accompanying ankle pathologies with peroneal pathology while the other 7 ankles had no concomitant pathology. The most common concomitant pathology was talar osteochondral lesion which had been detected in 8 of 20 ankles (40%). The other concomitant pathologies were; anterolateral sinovitis in one ankle, os trigonum in one ankle, sinchondrosis at talocalcaneal joint in one ankle, tarsal tunnel syndrome in one ankle had been detected. In the last patient, tibiotalar arthrosis and loose body at the ankle had been detected. Anatomic variations like peroneus quartus muscle or the distal insertion of peroneus brevis muscle fibers which may cause 'crowding phenomenon' had been detected in 9 ankles during tendoscopyand resected. We have seen anatomic variations in 6 out of 8 ankles with TOL. Additionally; we have detected peroneal tenosinovitis in 13 patients, peroneal tendon tear in 7 patients and vinkula thickening in one patient and treated accordingly. Results: Peroneal tendoscopy has a important role in the diagnosis and to treatment of peroneal pathologies. According to our theory, patients could have a sensation of fullness within their ankle joints with the presence of accessory muscle and distal insertion of peroneus brevis tendon within the superior peroneal retinaculum and may put their ankle in slight inversion position. This positional change within the ankle may disturb the ankle biomechanics and may be one of the causes of osteochondral lesions of the talus