From the Guidelines
For a peroneal retinacular tear, MRI is the most appropriate diagnostic imaging modality due to its high sensitivity in detecting ankle tendon tears, including peroneal tendinopathy and tendon tears, with sensitivities and specificities of 83.9% and 74.5%, respectively, for tendinopathy and 54.5% and 88.7%, respectively, for tendon tears 1.
Diagnosis and Treatment
When diagnosing a peroneal retinacular tear, it is essential to consider the patient's clinical presentation and history. The use of MRI can help confirm the diagnosis, but it should be treated with caution as up to 34% of asymptomatic patients may have a tear of the peroneus brevis tendon 1.
Imaging Techniques
The following imaging techniques can be used to diagnose a peroneal retinacular tear:
- MRI: high sensitivity in detecting ankle tendon tears, including peroneal tendinopathy and tendon tears 1
- US: can detect intratendinous tophi in gout, enthesitis of the Achilles tendon or plantar fascia in spondyloarthritis, and tenosynovitis in spondyloarthritis and rheumatoid arthritis, but its sensitivity is lower than MRI for peroneal tendinopathy and tendon tears 1
- Image-Guided Anesthetic Injection: can be concurrently performed with US to diagnose and treat tendon abnormalities 1
Treatment Options
Treatment for a peroneal retinacular tear typically involves:
- Initial rest, ice, compression, and elevation (RICE protocol) for 48-72 hours to reduce swelling and pain
- Non-steroidal anti-inflammatory drugs like ibuprofen or naproxen to manage pain and inflammation
- Immobilization using a walking boot or ankle brace for 4-6 weeks, followed by physical therapy focusing on ankle strengthening and proprioception exercises for mild to moderate tears
- Surgical repair for severe tears, especially for athletes or individuals with persistent instability 1
From the Research
Peroneal Retinacular Tear
- A peroneal retinacular tear is an injury to the superior peroneal retinaculum, which can cause dislocation of the peroneal tendons and lead to pain and restricted movement in the ankle joint 2.
- The treatment for peroneal retinacular tears can include surgical repair, such as superior retinaculoplasty, which has been shown to be effective in treating symptomatic dislocation of the peroneal tendon 2.
- Rehabilitation after surgical treatment of peroneal tendon tears and ruptures is an important factor in the clinical success of the treatment, and may involve a period of immobilization followed by range of motion exercises 3.
- There are various surgical techniques for repairing peroneal retinacular tears, including knotless tendoscopic peroneal retinaculum repair and endoscopic superior peroneal retinaculum reconstruction, which have the advantages of minimally invasive surgery and less postoperative pain 4, 5.
- MRI can be a useful tool for detecting and grading superior peroneal retinacular injuries, and can provide important information for presurgical planning 6.
Surgical Techniques
- Superior retinaculoplasty involves anatomic reattachment of the detached superior peroneal retinaculum and periosteum of the fibula, and has been shown to be effective in treating symptomatic dislocation of the peroneal tendon 2.
- Knotless tendoscopic peroneal retinaculum repair is a complicated and expensive technique that incorporates a double-row suture bridge, but has the advantages of less postoperative pain and fewer complications 4.
- Endoscopic superior peroneal retinaculum reconstruction is a minimally invasive technique that allows for better assessment of retinaculum integrity and detection of coexisting pathology 5.
Rehabilitation
- The duration of immobilization after surgical treatment of peroneal tendon tears and ruptures can vary, but is typically around 6-8 weeks 3.
- Range of motion exercises are typically started within 4 weeks after surgery, and are an important part of the rehabilitation process 3.
- Appropriate directed rehabilitation appears to be an important factor in the clinical success of surgically treated peroneal tendon tears and ruptures, and should be adjusted to each individual patient 3.