0:00

So we're up high, lower leg, syndesmotic level,

0:05

some of the myotendinous unit coming off the

0:07

fibula, and we're looking at the peroneus complex.

0:12

Who's who, what's what?

0:15

The peroneus brevis, higher up, sits

0:17

a little bit behind the peroneus

0:19

longus, and they switch positions.

0:21

So this is brevis, brevis, brevis, longus,

0:27

with some signal inside, retinaculum, and

0:30

perhaps some stringy little tissue over here.

0:33

That is yet to be defined.

0:36

Let's start scrolling down.

0:38

And as soon as we get a little bit

0:39

further down, our brevis looks horrible.

0:43

It's irregular.

0:44

It's straggly.

0:46

It's ragged.

0:46

And there's another piece of tendon here.

0:48

With a massively distended retinaculum.

0:52

And there's our longus in the

0:53

front with some signal inside.

0:55

Let's keep going, shall we?

0:57

Look at our longus.

0:58

Abnormal.

0:59

Look at our brevis.

1:01

Brevis.

1:02

Brevis.

1:03

Splitting into two.

1:05

Because what has happened is down

1:07

low, the brevis split into two.

1:10

Let me draw it.

1:11

Down low, the brevis split into two.

1:15

The longest was in the middle.

1:18

And as we went up higher, the two torn

1:22

components of the brevis, as we went up,

1:25

slid backwards and sat behind the longest.

1:31

As we go down, you're going to see

1:33

them assume a more anterior position.

1:36

And they are.

1:38

They're more anterior.

1:39

They're starting to come around.

1:40

Here's one limb.

1:42

Here's the other limb.

1:43

They're going to wrap right

1:44

around and go in front.

1:45

Here they, they're going in front.

1:47

They have gone in front.

1:48

There they are together.

1:50

That is the peroneus brevis back together again.

1:53

Now let's go back up.

1:54

Watch it split.

1:55

It's going to drape right around.

1:57

It's draping around the longus,

1:58

which, by the way, is abnormal.

2:00

It's now draped around the back.

2:02

It's going to stay behind

2:03

the longus as we go higher.

2:06

There's the torn brevis.

2:09

Now let's go back down.

2:10

Still, torn brevis, two pieces,

2:13

wrapping around, wrapping around.

2:15

Now it's in the front.

2:16

And there's our sick peroneus longus, which I'm

2:18

going to magnify and make a little bigger so you

2:21

can see the tear in the longus, too, right there.

2:24

And now the longus, in its weak area, where

2:27

it goes into the cuboidal tunnel, has some

2:29

tendinosis affecting it, and it gets quite a

2:32

bit grayer as it goes into the plantar arch.

2:35

And there's one other interesting caveat in

2:36

this case, and that is that the two arms,

2:41

the two torn leaves of the peroneus brevis,

2:45

this one right here, it itself is torn.

2:49

So we have a medial bundle that's torn,

2:51

a lateral bundle that's torn of the P.

2:53

brevis, and within the medial bundle All

2:55

these little gray areas, those are tears.

2:59

So there's a tear in a tear.

3:02

What else can we say about this monstrous case?

3:05

We can say that the retinaculum is stripped

3:07

off the fibula and distended and elastic,

3:11

no longer holding these structures in place.

3:13

Let's check out the groove.

3:15

It's convex backward about 10 or 11

3:18

percent of patients that predisposes

3:21

to peroneus longus and brevis tears.

3:24

So in summary, you're seeing the GOAT.

3:27

The greatest of all time, peroneus brevis tear.

3:30

A tear within a tear.

3:31

The relationship of the brevis to the longus.

3:34

A tear of the longus.

3:35

An injury, a stretch injury and stripping of

3:40

the lateral retinaculum all in one felt swoop.