SLR - August 2010 - Gian Steinhauser
Reference:
Lamm, B., Myers, D., Dombek, M., Mendicino, R., Catanzariti, A., Saltrick, K. (2004). Magnetic Resonance Imaging and Surgical Correlation of Peroneus Brevis Tears. The Journal of Foot & Ankle Surgery, 43(1):30-36, 2004.
Scientific Literature Reviews
Reviewed by: Gian Steinhauser, DPM
Residency Program: Roxborough Memorial Hospital
Podiatric Relevance:
This study provides useful data for the correlation of peroneus brevis tendon tears with the MR advanced imaging modality, which is commonly used to diagnose patients with peroneal pathology. The purpose of the study was (1) to determine the sensitivity and specificity of the MRI diagnosis of peroneus brevis tendon tears as confirmed by surgical findings and (2) to define the prevalence of osseous and soft-tissue pathologies that coexist with peroneus brevis injuries.
Methods:
Thirty-two patients were analyzed with this retrospective study design. All had longstanding peroneus brevis tendon pathology with pain and underwent surgical treatment. All had preoperative magnetic resonance imaging, which was then compared to intra-operative findings. MRIs and surgical reports of each patient were reviewed. One author independently reviewed all MRIs without knowledge of the patient’s clinical or surgical presentation or the previous MRI report. Any concomitant regional soft tissue and osseous pathology associated with the injuries was recorded, as well as tendon shape, presence of tear, tear location, size and synovitis. Statistical analysis was performed to objectively asses the sensitivity and specificity of MRI, as well as prevalence of other coexistent pathologies.
Results:
Twenty-two patients were identified with a peroneus brevis tear on MRI. Seventeen of the 32 patients (53%) also had increased signal intensity in the peroneus longus tendon. Surgical repair of the peroneal tendons was performed on 32 patients. A peroneus brevis tear was diagnosed with MRI in 22 patients and was repaired in 24 patients. The MRI diagnosis of a peroneus brevis tendon tear was correct in 26 patients, but 4 false negatives and 2 false positives were identified. Therefore, MRI diagnosis of a peroneus brevis tear proved to be 83% sensitive and 75% specific as confirmed by surgical inspection. In the review of patients’ MRIs, multiple other soft tissue and osseous pathologies were identified along with brevis tendon tears. Eight patients (25%) had a prominent peroneal tubercle, while sixteen patients (50%) had an associated ATFL tear.
Conclusions:
MRI proved to be 83% sensitive and 75% specific in predicting peroneus brevis tears. In conjunction with physical examination, this modality plays a valuable role in the preoperative assessment of peroneal tendons.