TENDOSCOPY AND PERONEAL VINCULA: A CADAVERIC AND HISTOLOGICAL STUDY

Abstract

Aim of study is to verify feasibility of peroneal tendoscopy and to clarify the histological structure of peroneal vincula, so formulating a hypothesis regarding their functional role.

Peroneal tendons possess a vascular supply through mesotendineal structures (vincula), previously related to trophic role and healing response; aim of study is to verify feasibility of tendoscopy in evaluating peroneal tendon and vincula and to clarify histological structure of vincula and presence of nervous tissue, so formulating a hypothesis regarding their functional role.

Cadaver study was performed on 8 fresh-frozen ankles, verifying accessibility of endoscope to tendon and vincula; samples from cadaveric vincula were taken; 5 peroneal vincula biopsies were obtained from 5 patients affected by ankle instability, undergoing tendoscopy for chronic lateral ankle pain. Tendoscopy was performed for persistent pain at the posterior margin of lateral malleolus after at least 4 months of nonoperative treatment. Biopsies were taken from center of pathologic vincula.

Patients biopsies and cadaveric samples were analyzed with light microscopy and immunohistochemistry (anti-humanS100antibody)

Peroneal tendons are accessible by endoscope along whole common sheath; vincula were found in all cadaveric specimens; intraoperative finding of vincula lesion (thickening/scarring) was found in all patients biopsies. Histology and immunohistochemistry revealed presence of nervous fibers inside the intimate structure of peroneal vincula both in cadaveric specimens and in patients biopsies.

Tendoscopy as a useful tool in visualizing the entire length of peroneal tendons, allowing the surgeon to diagnose and treat different peroneal disorders.

Although literature provides no data about innervations of peroneal vincula, presence of free nervous fibers inside vincula structure is consistent with a proprioceptive role of the vinculum in peroneal tendon physiology.

Moreover, our findings in patients biopsies suggest lesion of peroneal vinculum is a nociceptive source and an important element leading, synergistically with other soft tissues (i.e. joint capsule, lateral ligaments) injuries, to proprioception impairment in clinical pictures of chronic ankle instability. So selective excision of degenerated areas of vincula can be justified as accessory procedure in treatment of chronic lateral pain in patients affected by chronic ankle instability.