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Anatomical variations and interconnections of the superior peroneal retinaculum to adjacent lateral ankle structures: a preliminary imaging anatomy study

Eleni E. Drakonaki
Eleni E. Drakonaki
, 
Khaldun Ghali Gataa
Khaldun Ghali Gataa
, 
Nektarios Solidakis
Nektarios Solidakis
 y 
Paweł Szaro
Paweł Szaro
   | 08 mar 2021
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Article Category: research-article
Publicado en línea: 08 mar 2021
Páginas: 12 - 21
Recibido: 16 oct 2020
Aceptado: 04 feb 2021
DOI: https://doi.org/10.15557/jou.2021.0003
Palabras clave
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

A 19-year-old patient with a clinical suspicion of rheumatoid arthritis. A. ultrasound, transverse section. B, C. proton density-weighted transverse sections. Fib – fibula. SPR – curved arrow. No connection with IER is present
A 19-year-old patient with a clinical suspicion of rheumatoid arthritis. A. ultrasound, transverse section. B, C. proton density-weighted transverse sections. Fib – fibula. SPR – curved arrow. No connection with IER is present

Fig. 2.

A 34-year-old patient with a suspicion of a ganglion. A, B. transverse section on ultrasound corresponding to section d. C, D, E. T2-weighted slightly oblique section. The interconnection (straight arrows) between the SPR (curved arrow) and ATFL (curved dashed arrow); fib – fibula
A 34-year-old patient with a suspicion of a ganglion. A, B. transverse section on ultrasound corresponding to section d. C, D, E. T2-weighted slightly oblique section. The interconnection (straight arrows) between the SPR (curved arrow) and ATFL (curved dashed arrow); fib – fibula

Fig. 3.

A 24-year-old patient with pain anterior to the lateral malleolus. A. transverse section on ultrasound, B, C. T2-weighted slightly oblique sections. The interconnection (arrows) between the SPR (curved arrow) and IER (dashed arrow); fib – fibula
A 24-year-old patient with pain anterior to the lateral malleolus. A. transverse section on ultrasound, B, C. T2-weighted slightly oblique sections. The interconnection (arrows) between the SPR (curved arrow) and IER (dashed arrow); fib – fibula

Fig. 4.

A 42-year-old patient presenting clinical suspicion of synovitis. A, B, C. transverse section on ultrasound, d-proton density-weighted oblique oriented section. The interconnection (arrows) between the SPR (curved arrow) and IER (dashed arrow); fib-fibula
A 42-year-old patient presenting clinical suspicion of synovitis. A, B, C. transverse section on ultrasound, d-proton density-weighted oblique oriented section. The interconnection (arrows) between the SPR (curved arrow) and IER (dashed arrow); fib-fibula

Fig. 5.

A 52-year-old patient presented with retromalleolar pain. A, B, C. transverse section on ultrasound. D. proton density-weighted transverse section. The interconnection (arrows) between the SPR (letter R) and IER (curved arrow) and ATFL. Fib – fibula
A 52-year-old patient presented with retromalleolar pain. A, B, C. transverse section on ultrasound. D. proton density-weighted transverse section. The interconnection (arrows) between the SPR (letter R) and IER (curved arrow) and ATFL. Fib – fibula

Fig. 6.

A 28-year-old patient with a clinical suspicion of an intraarticular free body in the ankle joint. A. transverse section at the level of the lateral malleolus (fib – fibula), SPR – curved arrow, connection to the PTS (straight arrow). B. oblique section along the calcaneofibular ligament (asterisk). C. coronal section at the level of the peroneal tubercle (t), PTS – dashed arrow, calcaneus – cal. D, E, F. MRI proton density-weighted axial sections
A 28-year-old patient with a clinical suspicion of an intraarticular free body in the ankle joint. A. transverse section at the level of the lateral malleolus (fib – fibula), SPR – curved arrow, connection to the PTS (straight arrow). B. oblique section along the calcaneofibular ligament (asterisk). C. coronal section at the level of the peroneal tubercle (t), PTS – dashed arrow, calcaneus – cal. D, E, F. MRI proton density-weighted axial sections

Fig. 7.

Anatomical variations of the peroneal tubercle, three different patients. A, B, C. coronal sections, ultrasound, A. no explicit peroneal tubercle was noted (X), B, C. the peroneal tubercle (t) was present. The peroneus brevis (curved arrow) and the peroneus longus (dashes curved arrow)
Anatomical variations of the peroneal tubercle, three different patients. A, B, C. coronal sections, ultrasound, A. no explicit peroneal tubercle was noted (X), B, C. the peroneal tubercle (t) was present. The peroneus brevis (curved arrow) and the peroneus longus (dashes curved arrow)

Fig. 8.

The most common variant of the retromalleolar fibular groove, convex (straight arrow). A 39-year-old patient with a suspicion of rheumatoid arthritis. A, B. cone-beam computed tomography ( A. 3D posterior medial view, B. transverse section), C. transverse ultrasound section. SPR (curved arrow) was connected (dashed curved arrow) to IER (not shown). Fib – the lateral malleolus
The most common variant of the retromalleolar fibular groove, convex (straight arrow). A 39-year-old patient with a suspicion of rheumatoid arthritis. A, B. cone-beam computed tomography ( A. 3D posterior medial view, B. transverse section), C. transverse ultrasound section. SPR (curved arrow) was connected (dashed curved arrow) to IER (not shown). Fib – the lateral malleolus

Prevalence of variants of the retro-malleolar fibular groove, peroneal tubercle, and os peroneum. N = 63. P-values indicated as * p <0.05

Retromalleolar fibular groove shape Presence of peroneal tubercle Presence of os peroneum
concave flat convex
US n 39 14 10 41 3
% 61.9% 22.2% 15.9% 65.1% 4.8%
CT n 45 12 6 40 6
% 71.4% 19.0% 9.5% 63.5% 9.5%
Difference % 9.5%* 3.2%* 6.3% 1.6%* 1.6%

Interconnections between the SPR, ATFL, IER, and PTS revealed on ultrasound and MRI, N = 63. P-values indicated as * p <0.05 and ** p <0.001

ATFL – SPR at the level of lateral malleolus ATFL – SPR inferior to lateral malleolus ATFL – SPR at the level and inferior to the lateral malleolus SPR - IER SPR - PTS
US 37 25 17 18 16
58.7% 39.7% 27.0% 28.6% 25.4%
MRI 28 31 23 30 14
44.4% 49.2% 36.5% 47.6% 22.2%
Difference 14.3%* 9.5%* 9.5%* 19.0%** 3.2%

Differences in the presence of interconnections between different variants of retromalleolar fibular groove on US and MRI, p-value

Modality Variant of retromalleolar fibular groove ATFL-SPR at the level of lateral malleolus ATFL-SPR inferior to lateral malleolus ATFL-SPR at the level and inferior to lateral malleolus SPR-IER SPR-PTS
US convex 0.80 0.42 0.55 0.38 0.59
concave 0.26 0.31 0.36 0.82 0.79
flat 0.69 0.95 0.70 0.43 0.81
CT convex 0.23 0.14 0.11 0.45 0.66
concave <0.05 <0.05 <0.05 0.53 0.26
flat 0.20 0.09 0.18 0.54 0.31
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