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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2016

Open Access 01-04-2016 | Ankle

Peroneal tendons well vascularized: results from a cadaveric study

Authors: Pim A. D. van Dijk, F. Xavier Madirolas, Ana Carrera, Gino M. M. J. Kerkhoffs, Francisco Reina

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2016

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Abstract

Purpose

Peroneal tendon tears are relatively common injuries that seem to have a poor healing tendency. The discussion goes that peroneal tendons have avascular zones, contributing to the poor healing of those tears. The purpose of this study was to provide evidence on the vascularization pattern of the peroneal tendons.

Methods

Ten adult fresh-frozen cadavers were obtained from a university-affiliated body donation programme. The femoral artery was injected with natural coloured latex at the level of the knee. Macroscopic and microscopic dissections were performed to visualize the vascularization towards the peroneal tendons. To expose intratendinous vascularity, the tendons were cleared using a modified Spälteholz technique.

Results

In all specimens, blood was mainly supplied by the peroneal artery through a posterolateral vincula connecting both tendons. Branches were bifurcated every 3.9 ± 1.8 cm, starting 24 ± 5.3 cm proximal to the tip of the fibula. Eight out of 10 (80 %) specimens had poor vascularized zones in the peroneus longus tendon. No avascular zones were found in the peroneus brevis tendon.

Conclusion

The peroneal tendons are well vascularized by the peroneal artery, via vessels running through a common vincula for both tendons. In the peroneus brevis, no avascular zones were found. To keep the tendons well vascularized and therefore improve tendon healing, surgeons should be careful leaving the vincula intact during surgical procedures.
Literature
1.
go back to reference Ahmed IM, Lagopoulos M, McConnell P, Soames RW, Sefton GK (1998) Blood supply of the Achilles tendon. J Orthop Res 16:591–596CrossRefPubMed Ahmed IM, Lagopoulos M, McConnell P, Soames RW, Sefton GK (1998) Blood supply of the Achilles tendon. J Orthop Res 16:591–596CrossRefPubMed
2.
go back to reference Astrom M, Westlin N (1994) Blood flow in the human Achilles tendon assessed by laser Doppler flowmetry. J Orthop Res 12:246–252CrossRefPubMed Astrom M, Westlin N (1994) Blood flow in the human Achilles tendon assessed by laser Doppler flowmetry. J Orthop Res 12:246–252CrossRefPubMed
3.
go back to reference Bassett FH 3rd, Speer KP (1993) Longitudinal rupture of the peroneal tendons. Am J Sports Med 21:354–357CrossRefPubMed Bassett FH 3rd, Speer KP (1993) Longitudinal rupture of the peroneal tendons. Am J Sports Med 21:354–357CrossRefPubMed
4.
go back to reference Bonnin M, Tavernier T, Bouysset M (1997) Split lesions of the peroneus brevis tendon in chronic ankle laxity. Am J Sports Med 25:699–703CrossRefPubMed Bonnin M, Tavernier T, Bouysset M (1997) Split lesions of the peroneus brevis tendon in chronic ankle laxity. Am J Sports Med 25:699–703CrossRefPubMed
5.
go back to reference Clavert P, Kempf JF, Bonnomet F, Boutemy P, Marcelin L, Kahn JL (2001) Effects of freezing/thawing on the biomechanical properties of human tendons. Surg Radiol Anat 23:259–262CrossRefPubMed Clavert P, Kempf JF, Bonnomet F, Boutemy P, Marcelin L, Kahn JL (2001) Effects of freezing/thawing on the biomechanical properties of human tendons. Surg Radiol Anat 23:259–262CrossRefPubMed
6.
go back to reference Dauber W (2007) Pocket atlas of human anatomy. Thieme Medical Publishers Inc, New York Dauber W (2007) Pocket atlas of human anatomy. Thieme Medical Publishers Inc, New York
7.
go back to reference Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR (2003) Peroneal tendon tears: a retrospective review. J Foot Ankle Surg 42:250–258CrossRefPubMed Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR (2003) Peroneal tendon tears: a retrospective review. J Foot Ankle Surg 42:250–258CrossRefPubMed
8.
10.
go back to reference Gelberman RH, Khabie V, Cahill CJ (1991) The revascularization of healing flexor tendons in the digital sheath. A vascular injection study in dogs. J Bone Joint Surg Am 73:868–881PubMed Gelberman RH, Khabie V, Cahill CJ (1991) The revascularization of healing flexor tendons in the digital sheath. A vascular injection study in dogs. J Bone Joint Surg Am 73:868–881PubMed
11.
go back to reference Geller J, Lin S, Cordas D, Vieira P (2003) Relationship of a low-lying muscle belly to tears of the peroneus brevis tendon. Am J Orthop (Belle Mead NJ) 32:541–544 Geller J, Lin S, Cordas D, Vieira P (2003) Relationship of a low-lying muscle belly to tears of the peroneus brevis tendon. Am J Orthop (Belle Mead NJ) 32:541–544
12.
go back to reference Geppert MJ, Sobel M, Hannafin JA (1993) Microvasculature of the tibialis anterior tendon. Foot Ankle 14:261–264CrossRefPubMed Geppert MJ, Sobel M, Hannafin JA (1993) Microvasculature of the tibialis anterior tendon. Foot Ankle 14:261–264CrossRefPubMed
13.
go back to reference Gray H (1995) Gray’s anatomy. Churchill Livingstone, London Gray H (1995) Gray’s anatomy. Churchill Livingstone, London
14.
go back to reference Heckman DS, Reddy S, Pedowitz D, Wapner KL, Parekh SG (2008) Operative treatment for peroneal tendon disorders. J Bone Joint Surg Am 90:404–418CrossRefPubMed Heckman DS, Reddy S, Pedowitz D, Wapner KL, Parekh SG (2008) Operative treatment for peroneal tendon disorders. J Bone Joint Surg Am 90:404–418CrossRefPubMed
15.
go back to reference Karlsson J, Brandsson S, Kalebo P, Eriksson BI (1998) Surgical treatment of concomitant chronic ankle instability and longitudinal rupture of the peroneus brevis tendon. Scand J Med Sci Sports 8:42–49CrossRefPubMed Karlsson J, Brandsson S, Kalebo P, Eriksson BI (1998) Surgical treatment of concomitant chronic ankle instability and longitudinal rupture of the peroneus brevis tendon. Scand J Med Sci Sports 8:42–49CrossRefPubMed
16.
go back to reference Krause JO, Brodsky JW (1998) Peroneus brevis tendon tears: pathophysiology, surgical reconstruction, and clinical results. Foot Ankle Int 19:271–279CrossRefPubMed Krause JO, Brodsky JW (1998) Peroneus brevis tendon tears: pathophysiology, surgical reconstruction, and clinical results. Foot Ankle Int 19:271–279CrossRefPubMed
17.
go back to reference Langberg H, Bulow J, Kjaer M (1998) Blood flow in the peritendinous space of the human Achilles tendon during exercise. Acta Physiol Scand 163:149–153CrossRefPubMed Langberg H, Bulow J, Kjaer M (1998) Blood flow in the peritendinous space of the human Achilles tendon during exercise. Acta Physiol Scand 163:149–153CrossRefPubMed
18.
go back to reference Niculescu V, Matusz P (1988) The clinical importance of the calcaneal tendon vasculature (tendo calcaneus). Morphol Embryol (Bucur) 34:5–8 Niculescu V, Matusz P (1988) The clinical importance of the calcaneal tendon vasculature (tendo calcaneus). Morphol Embryol (Bucur) 34:5–8
19.
go back to reference Petersen W, Bobka T, Stein V, Tillmann B (2000) Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand 71:168–174CrossRefPubMed Petersen W, Bobka T, Stein V, Tillmann B (2000) Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand 71:168–174CrossRefPubMed
20.
go back to reference Romanes G (1972) Cunningham’s textbook of anatomy, 11th edn. Oxford University Press, London Romanes G (1972) Cunningham’s textbook of anatomy, 11th edn. Oxford University Press, London
21.
22.
go back to reference Saxena A, Pham B (1997) Longitudinal peroneal tendon tears. J Foot Ankle Surg 36:173–179 (discussion 255) CrossRefPubMed Saxena A, Pham B (1997) Longitudinal peroneal tendon tears. J Foot Ankle Surg 36:173–179 (discussion 255) CrossRefPubMed
23.
go back to reference Schmidt-Rohlfing B, Graf J, Schneider U, Niethard FU (1992) The blood supply of the Achilles tendon. Int Orthop 16:29–31PubMed Schmidt-Rohlfing B, Graf J, Schneider U, Niethard FU (1992) The blood supply of the Achilles tendon. Int Orthop 16:29–31PubMed
24.
25.
go back to reference Sobel M, Bohne WH, Levy ME (1990) Longitudinal attrition of the peroneus brevis tendon in the fibular groove: an anatomic study. Foot Ankle 11:124–128CrossRefPubMed Sobel M, Bohne WH, Levy ME (1990) Longitudinal attrition of the peroneus brevis tendon in the fibular groove: an anatomic study. Foot Ankle 11:124–128CrossRefPubMed
26.
go back to reference Sobel M, Geppert MJ, Hannafin JA, Bohne WH, Arnoczky SP (1992) Microvascular anatomy of the peroneal tendons. Foot Ankle 13:469–472CrossRefPubMed Sobel M, Geppert MJ, Hannafin JA, Bohne WH, Arnoczky SP (1992) Microvascular anatomy of the peroneal tendons. Foot Ankle 13:469–472CrossRefPubMed
27.
go back to reference Sobel M, Geppert MJ, Olson EJ, Bohne WH, Arnoczky SP (1992) The dynamics of peroneus brevis tendon splits: a proposed mechanism, technique of diagnosis, and classification of injury. Foot Ankle 13:413–422CrossRefPubMed Sobel M, Geppert MJ, Olson EJ, Bohne WH, Arnoczky SP (1992) The dynamics of peroneus brevis tendon splits: a proposed mechanism, technique of diagnosis, and classification of injury. Foot Ankle 13:413–422CrossRefPubMed
28.
go back to reference Sobel M, Geppert MJ, Warren RF (1993) Chronic ankle instability as a cause of peroneal tendon injury. Clin Orthop Relat Res 296:187–191PubMed Sobel M, Geppert MJ, Warren RF (1993) Chronic ankle instability as a cause of peroneal tendon injury. Clin Orthop Relat Res 296:187–191PubMed
29.
go back to reference Subotnick SI (1997) Achilles and peroneal tendon injuries in the athlete. An expert’s perspective. Clin Podiatr Med Surg 14:447–458PubMed Subotnick SI (1997) Achilles and peroneal tendon injuries in the athlete. An expert’s perspective. Clin Podiatr Med Surg 14:447–458PubMed
30.
go back to reference Title CI, Jung HG, Parks BG, Schon LC (2005) The peroneal groove deepening procedure: a biomechanical study of pressure reduction. Foot Ankle Int 26:442–448PubMed Title CI, Jung HG, Parks BG, Schon LC (2005) The peroneal groove deepening procedure: a biomechanical study of pressure reduction. Foot Ankle Int 26:442–448PubMed
31.
Metadata
Title
Peroneal tendons well vascularized: results from a cadaveric study
Authors
Pim A. D. van Dijk
F. Xavier Madirolas
Ana Carrera
Gino M. M. J. Kerkhoffs
Francisco Reina
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3946-4

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