Concomitant peroneal tendons intrasubstance tear

Case contributed by Dr Shervin Sharifkashani

Presentation

Soft tissue swelling and pain in lateral malleolus of the left with a history of ankle torsion.

Patient Data

Age: 70 years
Gender: Female

There are remarkable lateral malleolus soft tissue swelling, remarkable fluid within tendon sheath of peroneal longus and peroneal brevis tendons, foci of sheath tear, and intrasubstance tear, and relatively increased thickness of these tendons. A bruise in lateral malleolus bone and a partial tear in peroneal tendons musculotendinous junction is also evident.

Case Discussion

The case is a 70-year-old female with a history of left ankle torsion one month before but progressively soft tissue swelling of the ankle more prominent in lateral malleolus side. Based on the clinical findings left ankle MRI without gadolinium injection was requested and intrasubstance tear of both peroneal longus and peroneal brevis tendons with tenosynovial sheath tear and remarkable fluid in tendon sheath and also remarkable lateral malleolus soft tissue swelling and edema and bruise in lateral malleolus bone were found. 

The concomitant tear of the peroneal longus and peroneal brevis tendons is a rare event but can cause ankle instability and vice versa and also chronic pain in the lateral ankle joint. The imaging modality of choice for diagnosis and grading the tendons tear is performing MRI with ankle protocol and the best treatment in isolated or concomitant cases is surgical allograft repair.

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