Tendoscopy of the peroneal tendons.

Abstract

An anatomic cadaver study was performed. Subsequently, in a prospective study, diagnostic and therapeutic tendoscopy (tendon sheath endoscopy) was performed in nine consecutive patients with a history of persistent posterolateral ankle pain for at least 6 months. All patients had pain on palpation over the peroneal tendons, a positive peroneal tendon resistance test, and most often local swelling. In two patients, a peroneal click was found without symptoms of dislocation of the tendons over the fibula. The indications for arthroscopy were diagnostic procedure postsurgery (3), diagnostic procedure postfracture (2), snapping sensation (2), removal of exostosis (1), and partial tendon rupture (1). Inspection and surgery of both tendons and tendon sheath could be performed well by a standard two-portal technique. A new finding is the vincula that was consistently present in all our autopsy specimens, as well as in all our patients. The vincula attaches both tendons to each other and to the tendon sheath. At a mean follow-up of 19 months, three of the four patients in which adhesions were found and resected were symptom free. In one patient, a symptomatic prominent peroneal tubercle was successfully removed. One patient had a longitudinal rupture of the peroneus brevis tendon that was successfully sutured. There were no complications.