Title: A rare case of peroneus brevis tendon tear repair in 30 years old female

Biography:

Ajay Trivedi is a third year orthopedic resident in NHL Municipal Medical College and Shree Vadilal Sarabhai General Hospital, Ellisbridge, Ahmedabad, Gujarat, India. He is from Ahmedabad and went to Nutan Vidhyavihar Higher secondary school. He has completed my graduation MBBS (medicine and surgery bachelor) from B J Medical College, Civil Hospital, Ahmedabad under Gujarat University in the year 2016 and took admission in the aforementioned institute (NHL MMC) for postgraduate degree course of master of surgeon in orthopedics and traumatology. He will be completing my masters by May-2019.

Abstract

Peroneus brevis tendon tears are frequently overlooked or misdiagnosed. Longitudinal tears, often associated with ankle sprains are mostly situated the level of distal fibula. The most reliable diagnostic sign is persistent swelling & tenderness along the peroneal tendon sheath.. The pathophysiological mechanism is subluxation of tendon over the posterolateral edge of fibula, which produces multiple longitudinal splits. Treatment is primarily surgical & must address both split tendon & the subluxation that caused it. Debridement & repair are recommended for grade I tears, which have damage less than 50% of the cross sectional area. Excision of the damaged segment & tenodesis  to peroneus longus are recommended for grade II tears, which have destruction of more than50% of the cross sectional area. Both the methods must be augmented by stabilization of etiological subluxation. We here present a case of 38 years old female with gradual onset, poorly localized pain behind left ankle which was radiologically suggestive of split Peroneus brevis tendon in  retromalleolar groove & was confirmed intraoperatively, leading to release of inflammed tendon sheath, ethibond repair of tendon split & removal of a soft tissue mass attached to the tendon sheath beneath the retromalleolar groove, which was found out histopathologically to be fibrocollagenous & hyalinised tendon tissue with adipose tissue, with possibility of lipoma arborescence couldn’t be ruled out. On follow up after 2 months, patient did not have pain & full range of movements.