Clinical Outcomes and Complications of Peroneal Tendon Sheath Ultrasound-Guided Corticosteroid Injection.

BACKGROUND: The treatment of symptomatic peroneal tendinopathy and tears traditionally begins with nonsteroidal anti-inflammatory drugs, activity modification, physical therapy, and immobilization, with surgery typically reserved for those failing nonoperative treatment. Ultrasound-(US)-guided peroneal tendon sheath (PTS) corticosteroid injection is an additional nonoperative modality, but limited data exist on its safety and efficacy. The purpose of this study was to assess clinical outcomes following US-guided PTS corticosteroid injection for chronic tendinopathy or tears. METHODS: We retrospectively identified patients who had undergone US-guided PTS corticosteroid injection for pain due to peroneal tendinopathy, tears, or subluxation at our institution from 2012 to 2018. Underlying diagnosis was based on clinical examination, magnetic resonance imaging (MRI) results, and/or intraoperative findings, when available. Medical record data were supplemented by e-mail or telephone follow-up. Collected information included patient age, sex, body mass index (BMI), smoking status, workers' compensation status, prior surgeries about the foot and ankle, duration of symptoms prior to injection, perceived improvement in pain following injection and its duration, number of injections, progression to surgery, and any adverse outcomes of injection. We identified 96 patients (109 injections). Thirty-seven (38.5%) had previous foot and ankle surgery, with 17 (17.7%) having surgery specifically on the peroneal tendons. RESULTS: Twenty-four of 96 (25%) progressed to have surgery on their peroneal tendons following injection. Following injection, 38/87 (43.7%) of patients reported 0-1 weeks of pain relief, 11/87 (12.6%) 2-6 weeks, 6/87 (6.9%) 7-12 weeks, and 32/87 (36.8%) greater than 12 weeks. Preinjection duration of symptoms was associated with postinjection duration of pain relief (P=.036). There were 2 reported complications (1.8%): 1 case of self-limited sural nerve irritation and 1 of peroneus longus tear progression. CONCLUSION: Our study demonstrates US-guided PTS corticosteroid injection was safe and relatively effective in patients with symptomatic peroneal tendon tears or tendinopathy, including those who had undergone prior surgery, and may be considered in a comprehensive protocol of nonoperative management. LEVEL OF EVIDENCE: Level IV, case series.

Tenosynovial Bilateral Lipoma Arborescens of the Ankle in Adults / 대한족부족관절학회지

Lipoma arborescens or synovial lipomatosis is a rare disorder that is characterized by mature fat infiltration of the hypertrophic synovial villi, most frequently affecting the supra-patellar pouch of the knee. This paper presents a case of lipoma arborescens of the ankle joint bilaterally in an adult patient with involvement of both the intra-articular synovium and the synovial sheath of the tendons around the ankle.

Isolated peroneal tenosynovial lipoma arborescens: multimodality imaging features.

Synovial lipoma arborescens is a rare and benign fatty proliferative lesion of the synovium that is most commonly seen within the suprapatellar pouch of the knee, but increasingly reported to involve tendon sheaths, including those of the ankle. We present the third known case of tenosynovial lipoma arborescens isolated to the peroneal tendon sheath without ankle joint involvement. To our knowledge, this is the first to report this entity utilizing a unique combination of radiographic, sonographic, and MR imaging, along with intraoperative and histologic correlation. Knowledge of this case is important when interpreting radiographic or sonographic images of this condition to raise the possibility of the rare entity of lipoma arborescens involving the peroneal tendon sheath.

Endoscopic Versus Open Surgery for Calcaneal Bone Cysts: A Preliminary Report.

The purpose of the present study was to evaluate the advantages and disadvantages of an endoscopic procedure for patients with symptomatic calcaneal bone cyst compared with an open procedure. The cases of 16 consecutive patients with a calcaneal bone cyst were reviewed. Of the 16 patients, 8 had undergone the open procedure (O group) from October 2003 to August 2011, and 8 had undergone the endoscopic procedure (E group) from September 2011 to April 2013. The endoscopic procedure used a 2-portal technique in which skin incisions were made to avoid the peroneal tendon according to the preoperative ultrasonography. All surgeries (open or endoscopic) consisted of curettage of the inner wall of the bone cyst, followed by injection of calcium phosphate cement. The following factors were evaluated: radiographic assessment, operative time, postoperative adverse effects, and interval to the return to sports. No significant difference between the 2 groups was observed in the operative time (53.5 ± 6.5 minutes in the O group and 56.1 ± 13.8 minutes in the E group). The E group experienced no adverse effects; however, the O group had 1 temporary irritation in the sural nerve area and 1 calcium phosphate cement leakage along the peroneal tendon sheath. The interval to a return to sports was significantly shorter in the E group (14.5 ± 0.9 weeks in the O group and 6.5 ± 1.1 weeks in the E group; p < .01). In conclusion, endoscopic surgery is a useful approach for the treatment of calcaneal bone cysts, allowing early rehabilitation and an early return to sports without any adverse effects.