Vol 79, No 3 (2020)
Original article
Published online: 2019-11-12

open access

Page views 1001
Article views/downloads 715
Get Citation

Connect on Social Media

Connect on Social Media

New aspect of morphometric study of the superior peroneal retinaculum: pertinent data for surgical repair and reconstruction

P. Dangintawat1, J. Apinun2, T. Huanmanop3, S. Agthong3, V. Chentanez3
Pubmed: 31724148
Folia Morphol 2020;79(3):594-603.


Background: This study was conducted to investigate characteristics, attachments and morphometric parameters of the superior peroneal retinaculum (SPR).

Materials and methods: Morphology and morphometric details including width, length, thickness and angle of alignment of SPR in 109 embalmed cadaveric legs were investigated. The occurrence of peroneal tendon tear was also noted.

Results: Most of SPR originated from the fibrocartilaginous ridge of the lateral malleolus. The SPR might be a single band or split into proximal and distal bands inserted on the posterior intermuscular septum and lateral wall of calcaneus, respectively. Based on the characteristics and insertion patterns, the SPR could be divided into three types: type I (double band with subtype Ia and Ib), type II (single band) and type III (single band) with the prevalence of 56.88% (12.84%, 44.04%), 1.83%, and 41.28%, respectively. The average coordinate (X, Y axis) of the midpoint of width at origin measured from the tip of fibula in all types was 7.26 ± 3.15 and 10.45 ± 4.52 mm. The average coordinate of the midpoint at insertion on the posterior intermuscular septum was 24.06 ± 4.94 and 13.35 ± 5.18, and those inserted on the lateral wall of calcaneus was 21.45 ± 7.88 and 13.59 ± 6.73 mm. Prevalence of peroneus brevis tendon tear was 12.84% (14 cases) and was associated with SPR type Ib with statistical significance.

Conclusions: Precise information of the characteristics, morphometric data and coordinates of attachment sites of SPR are essential for surgical procedures and reconstruction.

Article available in PDF format

View PDF Download PDF file


  1. Athavale SA, Gupta V, Kotgirwar S, et al. The peroneus quartus muscle: clinical correlation with evolutionary importance. Anat Sci Int. 2012; 87(2): 106–110.
  2. Athavale SA, Swathi , Vangara SV. Anatomy of the superior peroneal tunnel. J Bone Joint Surg Am. 2011; 93(6): 564–571.
  3. Cabral P, Paulino C, Takahashi R, et al. Correlation of morphologic and pathologic features of the various tendon groups around the ankle: MR imaging investigation. Skeletal Radiol. 2013; 42(10): 1393–1402.
  4. Cho J, Kim JY, Song DG, et al. Comparison of outcome after retinaculum repair with and without fibular groove deepening for recurrent dislocation of the peroneal tendons. Foot Ankle Int. 2014; 35(7): 683–689.
  5. Coughlin MJ, Saltzman C, Anderson RB. Part VI arthritis, ostural disorders, and tendon disorders. Mann's surgery of the foot and ankle. 9th ed. Elsevier, Philadelphia 2014: 1232–1275.
  6. Davis WH, Sobel M, Deland J, et al. The superior peroneal retinaculum: an anatomic study. Foot Ankle Int. 1994; 15(5): 271–275.
  7. Dombek M, Lamm B, Saltrick K, et al. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg. 2003; 42(5): 250–258.
  8. Eckert WR, Davis EA. Acute rupture of the peroneal retinaculum. J Bone Joint Surg. 1976; 58(5): 670–672.
  9. Hansen BH. Reconstruction of the peroneal retinaculum using the plantaris tendon: a case report. Scand J Med Sci Sports. 1996; 6(6): 355–358.
  10. Karlsson J, Wiger P. Longitudinal split of the peroneus brevis tendon and lateral ankle instability: treatment of concomitant lesions. J Aathl Train. 2002: 463–466.
  11. Ketz JP, Maceroli M, Shields E, et al. Peroneal tendon instability in intra-articular calcaneus fractures: a retrospective comparative study and a new surgical technique. J Orthop Trauma. 2016; 30(3): e82–e87.
  12. Kwaadu KY, Fleming JJ, Florek D. Superior peroneal retinacular injuries in calcaneal fractures. J Foot Ankle Surg. 2015; 54(3): 458–463.
  13. Maffulli N, Ferran NA, Oliva F, et al. Recurrent subluxation of the peroneal tendons. Am J Sports Med. 2006; 34(6): 986–992.
  14. Miyamoto W, Takao M, Komatu F, et al. Reconstruction of the superior peroneal retinaculum using an autologous gracilis tendon graft for chronic dislocation of the peroneal tendons accompanied by lateral instability of the ankle: technical note. Knee Surg Sports Traumatol Arthrosc. 2007; 15(4): 461–464.
  15. Moore KL, II AFD, Agur AMR. In: Taylor C, editor. Clinically oriented anatomy. 7th ed. Liincott Williams & Wilkins, a Wolters Kluwer business 2014 : 591–610.
  16. Numkarunarunrote N, Malik A, Aguiar RO, et al. Retinacula of the foot and ankle: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol. 2007; 188(4): W348–W354.
  17. Oliva F, Saxena A, Ferran NA, Maffulli N. Peroneal Tendinoathy. In: Sorts Medicine and Arthroscoic Surgery of the Foot and Ankle. Palo Alto: Springer Dordrecht Heidelberg, New York London 2013: 187–212.
  18. Roth JA, Taylor WC, Whalen J. Peroneal tendon subluxation: the other lateral ankle injury. Br J Sports Med. 2010; 44(14): 1047–1053.
  19. Saragas NP, Ferrao PN, Mayet Z, et al. Peroneal tendon dislocation/subluxation - Case series and review of the literature. Foot Ankle Surg. 2016; 22(2): 125–130.
  20. Schade VL, Harsha W, Rodman C, et al. Peroneal tendon reconstruction and coverage for treatment of septic peroneal tenosynovitis: a devastating complication of lateral ankle ligament reconstruction with a tendon allograft. J Foot Ankle Surg. 2016; 55(2): 406–413.
  21. Tubbs RS. Pelvic girdle and lower limb. In: Standring S (ed). Gray's Anatomy: the anatomical basis of clinical ractice. 41 ed. Elsevier, London 2014: 1400–1417.
  22. van Dijk PAD, Gianakos AL, Kerkhoffs GM, et al. Return to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016; 24(4): 1155–1164.
  23. Wang XT, Rosenberg ZS, Mechlin MB, et al. Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics. 2005; 25(3): 587–602.
  24. Zammit J, Singh D. The peroneus quartus muscle. Anatomy and clinical relevance. J Bone Joint Surg Br. 2003; 85(8): 1134–1137.
  25. Zhenbo Z, Jin W, Haifeng G, et al. Sliding fibular graft repair for the treatment of recurrent peroneal subluxation. Foot Ankle Int. 2014; 35(5): 496–503.