Imaging-based prevalence of the peroneus quartus muscle and its association with peroneal tendon pathology: a systematic review and meta-analysis.
Luiza Borba de Almeida Madruga, Pandora Eloa Oliveira Fonseca, Giovanna Macanhã Scremin et al.
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In 30 seconds
This systematic review and meta-analysis assessed imaging-based prevalence of the peroneus quartus muscle and its relationship to peroneal tendon pathology. Across 17 studies and 3,725 ankle imaging examinations, pooled prevalence was 11% (95% CI: 8-15%), with substantial heterogeneity. In three studies comparing ankles with and without the variant, its presence was associated with higher odds of peroneal tendon tears (pooled odds ratio 3.40, 95% CI: 2.03-5.68; I² = 0%; p < 0.001). The authors note that this association does not establish causation.
Key findings
- The peroneus quartus prevalence was 11% (95% CI: 8-15%) across 3,725 ankle imaging examinations.
- Peroneal tendon pathology was present in 51.4% (95% CI: 41.9-60.8%) of positive ankles across six studies.
- Presence of the peroneus quartus was associated with higher odds of tendon tears: pooled odds ratio 3.40, 95% CI: 2.03-5.68; I² = 0%; p < 0.001.
Why it matters
The findings indicate that this anatomical variant is not uncommon on ankle imaging and may coexist with peroneal tendon disease. Recognising the association can inform interpretation of imaging and consideration of local tendon anatomy, while the evidence does not show that the variant causes tears.
What to keep in mind
Prevalence estimates showed substantial heterogeneity (I² = 80.5%). The tear association was based on only three studies, and the observational evidence cannot establish causality.