Skeletal MRI Features Associated with Peroneal Tendon Split Tears – A Comparative Retrospective Cohort Study

Abstract

Background: Peroneal split tears are an underrated cause of ankle pain. While MRI (magnetic resonance imaging) evaluation is useful in diagnosis, the condition is among the most challenging to identify due to complex anatomy and artifacts. Several anatomical variants, soft tissue lesions and skeletal pathologies have been suspected to be associated with the condition. There is a lack of contemporary and comprehensive radiological research studying the relationship between peroneal split tears and other lesions seen on MRI. Objectives: Investigate whether skeletal anatomical variants and pathologies of the ankle are associated with peroneal tendon split tears. Methods: This retrospective cohort assessed existing MR images of the ankle in two groups: one with peroneus split tears (N=80) and one without (control group, N=115). Predetermined skeletal anatomical variants and pathologies were noted. The proportion of findings in each group were compared with Fishers exact test and analyzed with Pearson correlation. Results: Moderate joint effusion, concave malleolar groove, bone marrow edema in the posterior fibula and in the lateral talus were significantly (p<0.05, confidence interval not including 0) more common in the split tear group than in the control group. No joint effusion and history of trauma were significantly less common. Distinct correlations in the split tear group were primarily found between bone marrow edema in the medial talus and no joint effusion. Conclusion: Certain MRI features (i.e., moderate joint effusion, concave malleolar groove, bone marrow edema in the posterior fibula and in the lateral talus) were associated with peroneal split tears and these could potentially inform future research, guidelines and facilitate MRI evaluation.