Fibularis brevis tendon variants: a classification-based surgical and radiological approach

Area of Science:

• Anatomy
• Radiology
• Orthopedic Surgery

Background:

• Fibularis brevis tendon (FBT) variants are often overlooked.
• These variants can complicate imaging interpretation and surgical approaches.
• A standardized classification is needed to address these challenges.

Purpose of the Study:

• To review and synthesize existing literature on distal FBT variants.
• To organize this evidence using a classification-based approach.
• To improve understanding of FBT morphology for clinical application.

Main Methods:

• A narrative review of anatomical, radiological, and surgical publications.
• Utilized the Olewnik classification as an organizational framework.
• Focused on distal FBT morphology and its clinical implications.

Main Results:

• Identified two main distal FBT attachment types (Type I and Type II with subtypes IIa-IIc).
• Highlighted the recognition of accessory slips, fused components, and differentiation from tears.
• Noted that atypical insertions impact operative exposure, with strong anatomical and imaging evidence but limited treatment validation.

Conclusions:

• The Olewnik classification is a valuable tool for radiological reporting and preoperative planning.
• Currently, the classification is considered clinically promising but not fully validated.
• A structured, variant-aware approach enhances communication and surgical preparation for lateral ankle conditions.