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Peroneal and Achilles tendon problems with surgical management. Peroneal tendon stabilisation. Anatomy. Peroneal tendons course behind the distal fibula The peroneus brevis may have degenerative changes if the injury is not identified in a timely fashion. What happens and what you see. - PowerPoint PPT Presentation
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Peroneal and Achilles tendon problems with surgical management
Peroneal tendon stabilisation
Anatomy
Peroneal tendons course behind the distal fibula
The peroneus brevis may have degenerative changes if the injury is not identified in a timely fashion
What happens and what you see
The peroneal retinaculum may be avulsed from the fibula or calcaneus or lifted up enough to allow tendon dislocation
Forceful contraction of peronealsduring sudden dorsiflexion andinversion
Classification
Figure 26-65 Classification of pathology in peroneal tendon dislocations. A, Normal. B, Grade I: superior peroneal retinaculum stripped off fibula. C, Grade II: fibrous rim avulsed from the posterolateral aspect
of the fibula along with the superior peroneal retinaculum. D, Grade III: bony avulsion of the posterolateral part of the fibula by the superior peroneal retinaculum. (Modified from Eckert WR, Davis
EA Jr: J Bone Joint Surg Am 58:670-673, 1976.)
Management 1 Direct repair
• If acute repair correctly
• Anchors useful to aid stabilisation of retinaculum
Management 2 Groove deepening repair
Like trochleoplasty of the knee allowing a deeper grove for the tendons to sit in, minimising further dislocation
Split the fibula distally leaving a posterior hinge intact, by curetting out some of the cancellous bone and replacing the hinge the groove will be deepened
Management 3 DuVries Bone block lateral fibula osteotomy procedure
Creates new groove for tendons to sit in, posterior to the fibula
Modification of Kelly procedure
Insertional Achilles tendinopathy
Approach to Achilles/Haglunds
• Can approach medially or laterally– If lateral find and protect the sural nerve
• Try and avoid central/splitting incision
Haglunds decompression I
• Try to remove degenerative tissue and decrease impingement
• Can take away more than you think
Haglunds decompression II
Can resect/decompress with osteotome or burr. If involving greater than 50% of achilles stabilsie with anchors
FHL transfer
• Severe unremitting insertional tendinopathy
• Excessive calcific insertional tendinopathy
• Failed anchors resulting in pullout
Principles of FHL transfer2 incisions: Medial over Achilles and Medial over knot of Henry
Deliver FHL into Achilles wound and secure to OS Calsis with biotenodesis screw at appropriate tension
NB don’t forget to tenodese distal FHL with FDL to enable flexion at big toe
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