TENDOSCOPY OF THE PERONEAL TENDONS

An anatomic cadaver study was performed. Subsequently, in a prospectiv e study, diagnostic and therapeutic tendoscopy (tendon sheath endoscop y) was performed in nine consecutive patients with a history of persis tent posterolateral ankle pain for at least 6 months. All patients had pain on palpation over the peroneal tendons, a positive peroneal tend on resistance test, and most often local swelling. In two patients, a peroneal click was found without symptoms of dislocation of the tendon s over the fibula. The indications for arthroscopy were diagnostic pro cedure postsurgery (3), diagnostic procedure postfracture (2), snappin g sensation (2), removal of exostosis (1), and partial tendon rupture (1). Inspection and surgery of both tendons and tendon sheath could be performed well by a standard two-portal technique. A new finding is t he vincula that was consistently present in all our autopsy specimens, as well as in all our patients. The vincula attaches both tendons to each other and to the tendon sheath. At a mean follow-up of 19 months, three of the four patients in which adhesions were found and resected were symptom free. In one patient, a symptomatic prominent peroneal t ubercle was successfully removed. One patient had a longitudinal ruptu re of the peroneus brevis tendon that was successfully sutured. There were no complications.