Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Patel M, Deng F, et al. Superior peroneal retinaculum injuries. Reference article, Radiopaedia.org (Accessed on 24 Apr 2024) https://doi.org/10.53347/rID-18302
Superior peroneal retinaculum injuries refer to a spectrum of acute and chronic injuries to the superior peroneal retinaculum in the ankle. They are one of the causes of lateral ankle pain and instability.
Classification
One method of grading is the Oden's classification 1,7 which classifying injuries into four types:
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type I
- elevation or stripping off of the periosteal attachment of the superior peroneal retinaculum to the lateral malleolus at the level of the fibular groove
- stripped-off periosteum and superior peroneal retinaculum form a pouchlike configuration lateral to the distal fibula into which the peroneal tendons can dislocate
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type II: tear of the superior peroneal retinaculum at its attachment to the distal fibula
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type III: distal fibular avulsion fracture at the attachment of the retinaculum to the lateral malleolus
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type IV: tear of the retinaculum at its posterior attachment
Plain radiograph
If a distal fibular avulsion fracture is present, a bony fleck is seen lateral to the lateral malleolus 8. The lateral malleolar fleck sign is pathognomonic for peroneal retinacular avulsion.
MRI
Axial images of the ankle are probably the best for assessment and allows direct visualization of any disruption 6. In a complete disruption the peroneal tendons may sublux.
Treatment and prognosis
Treatment of acute and chronic injuries varies. Plaster immobilization is initially attempted, particularly with acute dislocations while surgery is reserved for patients with painful, chronic, unstable dislocations and varies depending on the extent and classification.
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1. Rosenberg ZS, Bencardino J, Astion D et-al. MRI features of chronic injuries of the superior peroneal retinaculum. AJR Am J Roentgenol. 2003;181 (6): 1551-7. AJR Am J Roentgenol (citation) - Pubmed citation
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2. Geppert MJ, Sobel M, Bohne WH. Lateral ankle instability as a cause of superior peroneal retinacular laxity: an anatomic and biomechanical study of cadaveric feet. Foot Ankle. 14 (6): 330-4. - Pubmed citation
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3. Kirby AB, Beall DP, Murphy MP et-al. Magnetic resonance imaging findings of chronic lateral ankle instability. Curr Probl Diagn Radiol. 34 (5): 196-203. doi:10.1067/j.cpradiol.2005.06.003 - Pubmed citation
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4. Wang XT, Rosenberg ZS, Mechlin MB et-al. Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics. 25 (3): 587-602. doi:10.1148/rg.253045123 - Pubmed citation
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5. Chandnani VP, Harper MT, Ficke JR et-al. Chronic ankle instability: evaluation with MR arthrography, MR imaging, and stress radiography. Radiology. 1994;192 (1): 189-94. Radiology (citation) - Pubmed citation
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6. Pedowitz R, Chung CB, Resnick D. Magnetic Resonance Imaging in Orthopedic Sports Medicine. Springer Verlag. (2010) ISBN:1441923748. Read it at Google Books - Find it at Amazon
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7. Nyska M, Mann G. The unstable ankle. Human Kinetics Publishers. (2002) ISBN:0880118024. Read it at Google Books - Find it at Amazon
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8. Wong-Chung J, Tucker A, Lynch-Wong M, Gibson D, O'Longain DS. The lateral malleolar bony fleck classified by size and pathoanatomy: The IOFAS classification. (2018) Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons. 24 (4): 300-308. doi:10.1016/j.fas.2017.02.015 - Pubmed
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