Incidence of reoperation and wound dehiscence in patients treated for peroneal tendon dislocations: comparison between osteotomy versus soft tissue procedures

  • Youichi Yasui
  • Khushdeep S. Vig
  • Ichiro Tonogai
  • Chun Wai Hung
  • Christopher D. Murawski
  • Masato Takao
  • Hirotaka Kawano
  • John G. KennedyEmail author



There is a lack of substantial clinical evidence endorsing the clinical outcomes of osteotomy for peroneal tendon dislocations. The aim of this study was to compare the post-operative reoperation rates following osteotomy techniques and soft tissues procedures using large database in order to investigate the efficacy of bony techniques.


Patients who underwent osteotomy and soft tissue procedures for peroneal tendon dislocations were identified and subsequently analysed using the United Healthcare Orthopedic and the Medicare datasets (PearlDiver Patient Record Database, PearlDiver Technologies Inc., Fort Wayne, IN). The investigated period was from 2005 to 2012. The annual incidence, gender distribution, and incidences of reoperation and wound dehiscence following primary operative procedures were determined in these cohorts.


Of 6122 patients who received operative treatment for peroneal tendon dislocations, 1416 patients (23.1%) received the osteotomy technique, while 4706 (76.9%) were treated with the soft tissue techniques. The incidence of these operative procedures did not change significantly over the time periods of each database. In both databases, reoperation rates were 2.8% (40/1416) for osteotomy patients and 3.4% (158/4706) for soft tissue repair patients, with no statistical difference (2.8 vs. 3.4%. odds ratio 0.8, 95% confidence interval [CI] 0.6–1.2, [n.s.]) between them. Based on both databases, wound dehiscence occurred in 2.6% (37/1416) of the osteotomy patients and 2.3% (110/4706) of soft tissue repair patients with no statistical difference (2.6 vs. 2.3%, odds ratio 1.1, 95% CI 0.8–1.6, [n.s.]) between the groups.


The results of this study show that osteotomy techniques were frequently performed for patients with peroneal tendon dislocations. Nevertheless, osteotomy techniques for peroneal tendon dislocations are not associated with a lower risk of reoperation. In conclusion, soft tissue procedures offer a satisfactory method of treating peroneal tendon dislocations without any additional risk of reoperation when compared to osteotomy techniques that have potentially greater complication rates.

Level of evidence



Peroneal tendon dislocation Osteotomy Comparative study Reoperation Complications 


Compliance with ethical standards

Conflict of interest

Kennedy JG is a consultant for Arteriocyte, Inc.; has received research support from the Ohnell Family Foundation, Mr. and Mrs. Michael J Levitt, and Arteriocyte Inc.; is a board member for the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy, International Society for Cartilage Repair of the Ankle, American Orthopaedic Foot and Ankle Society Awards and Scholarships Committee, International Cartilage Repair Society finance board.


No funding has been received for this study.

Ethical approval

Ethical approval was not obtained because this study was a large database study that consist of de-identified patients records that provides anonymous information.

Informed consent

Informed consent was not obtained because this study was a retrospective review without the use of private patient information.


  1. 1.
    Adachi N, Fukuhara K, Tanaka H, Nakasa T, Ochi M (2006) Superior retinaculoplasty for recurrent dislocation of peroneal tendons. Foot Ankle Int 27:1074–1078CrossRefPubMedGoogle Scholar
  2. 2.
    Beck E (1981) Operative treatment of recurrent dislocation of the peroneal tendons. Arch Orthop Trauma Surg 98:247–250CrossRefPubMedGoogle Scholar
  3. 3.
    Cho J, Kim JY, Song DG, Lee WC (2014) Comparison of outcome after retinaculum repair with and without fibular groove deepening for recurrent dislocation of the peroneal tendons. Foot Ankle Int 35:683–689CrossRefPubMedGoogle Scholar
  4. 4.
    De Das S, Balasubramaniam P (1985) A repair operation for recurrent dislocation of peroneal tendons. J Bone Joint Surg Br 67:585–587CrossRefGoogle Scholar
  5. 5.
    Eckert WR, Davis EA Jr (1976) Acute rupture of the peroneal retinaculum. J Bone Joint Surg Am 58:670–672CrossRefPubMedGoogle Scholar
  6. 6.
    Escalas F, Figueras JM, Merino JA (1980) Dislocation of the peroneal tendons. Long-term results of surgical treatment. J Bone Joint Surg Am 62:451–453CrossRefPubMedGoogle Scholar
  7. 7.
    Ferran NA, Oliva F, Maffulli N (2006) Recurrent subluxation of the peroneal tendons. Sports Med 36:839–846CrossRefPubMedGoogle Scholar
  8. 8.
    Jones EB (1931) Operative treatment of chronic dislocation of the peroneal tendons. J Bone Joint Surg 14:574Google Scholar
  9. 9.
    Karlsson J, Eriksson BI, Sward L (1996) Recurrent dislocation of the peroneal tendons. Scand J Med Sci Sports 6:242–246CrossRefPubMedGoogle Scholar
  10. 10.
    Kelly RE (1920) An operation for chronic dislocation of the peroneal tendons. Br J Surg 7:502–504CrossRefGoogle Scholar
  11. 11.
    Kennedy JG, van Dijk PA, Murawski CD, Duke G, Newman H, DiGiovanni CW, Yasui Y (2016) Functional outcomes after peroneal tendoscopy in the treatment of peroneal tendon disorders. Knee Surg Sports Traumatol Arthrosc 24(4):1148–1154CrossRefPubMedGoogle Scholar
  12. 12.
    Kollias SL, Ferkel RD (1997) Fibular grooving for recurrent peroneal tendon subluxation. Am J Sports Med 25:329–335CrossRefPubMedGoogle Scholar
  13. 13.
    Larsen E, Flink-Olsen M, Seerup K (1984) Surgery for recurrent dislocation of the peroneal tendons. Acta Orthop Scand 55:554–555CrossRefPubMedGoogle Scholar
  14. 14.
    Lui TH (2006) Endoscopic peroneal retinaculum reconstruction. Knee Surg Sports Traumatol Arthrosc 14:478–481CrossRefPubMedGoogle Scholar
  15. 15.
    Maqdes A, Steltzlen C, Pujol N (2016) Endoscopic fibular groove deepening for stabilisation of recurrent peroneal tendons instability in a patient with open physes. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-016-4210-2 Google Scholar
  16. 16.
    Martens MA, Noyez JF, Mulier JC (1986) Recurrent dislocation of the peroneal tendons. Results of rerouting the tendons under the calcaneofibular ligament. Am J Sports Med 14:148–150CrossRefPubMedGoogle Scholar
  17. 17.
    Mason RB, Henderson JP (1996) Traumatic peroneal tendon instability. Am J Sports Med 24:652–658CrossRefPubMedGoogle Scholar
  18. 18.
    Ogawa BK, Thordarson DB (2007) Current concepts review: peroneal tendon subluxation and dislocation. Foot Ankle Int 28:1034–1040CrossRefPubMedGoogle Scholar
  19. 19.
    Porter D, McCarroll J, Knapp E, Torma J (2005) Peroneal tendon subluxation in athletes: fibular groove deepening and retinacular reconstruction. Foot Ankle Int 26:436–441CrossRefPubMedGoogle Scholar
  20. 20.
    Raikin SM (2009) Intrasheath subluxation of the peroneal tendons. Surgical technique. J Bone Joint Surg Am 91(Suppl 2 Pt 1):146–155CrossRefPubMedGoogle Scholar
  21. 21.
    Sarmiento A, Wolf M (1975) Subluxation of peroneal tendons. Case treated by rerouting tendons under calcaneofibular ligament. J Bone Joint Surg Am 57:115–116CrossRefPubMedGoogle Scholar
  22. 22.
    Saxena A, Ewen B (2010) Peroneal subluxation: surgical results in 31 athletic patients. J Foot Ankle Surg 49:238–241CrossRefPubMedGoogle Scholar
  23. 23.
    Selmani E, Gjata V, Gjika E (2006) Current concepts review: peroneal tendon disorders. Foot Ankle Int 27:221–228CrossRefPubMedGoogle Scholar
  24. 24.
    Stein RE (1987) Reconstruction of the superior peroneal retinaculum using a portion of the peroneus brevis tendon. A case report. J Bone Joint Surg Am 69:298–299CrossRefPubMedGoogle Scholar
  25. 25.
    Steinbock G, Pinsger M (1994) Treatment of peroneal tendon dislocation by transposition under the calcaneofibular ligament. Foot Ankle Int 15:107–111CrossRefPubMedGoogle Scholar
  26. 26.
    Tomihara T, Shimada N, Yoshida G, Kaneda K, Matsuura T, Satake S (2010) Comparison of modified Das De procedure with Du Vries procedure for traumatic peroneal tendon dislocation. Arch Orthop Trauma Surg 130:1059–1063CrossRefPubMedGoogle Scholar
  27. 27.
    van Dijk PA, Gianakos AL, Kerkhoffs GM, Kennedy JG (2016) Return to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc 24(4):1155–1164CrossRefPubMedGoogle Scholar
  28. 28.
    van Dijk PA, Lubberts B, Verheul C, DiGiovanni CW, Kerkhoffs GM (2016) Rehabilitation after surgical treatment of peroneal tendon tears and ruptures. Knee Surg Sports Traumatol Arthrosc 24(4):1165–1174CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    van Dijk PA, Madirolas FX, Carrera A, Kerkhoffs GM, Reina F (2016) Peroneal tendons well vascularized: results from a cadaveric study. Knee Surg Sports Traumatol Arthrosc 24(4):1140–1147CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Walther M, Morrison R, Mayer B (2009) Retromalleolar groove impaction for the treatment of unstable peroneal tendons. Am J Sports Med 37:191–194CrossRefPubMedGoogle Scholar
  31. 31.
    Zoellner G, Clancy W Jr (1979) Recurrent dislocation of the peroneal tendon. J Bone Joint Surg Am 61:292–294CrossRefPubMedGoogle Scholar
  32. 32.
    Zhenbo Z, Jin W, Haifeng G, Huanting L, Feng C, Ming L (2014) Sliding fibular graft repair for the treatment of recurrent peroneal subluxation. Foot Ankle Int 35:496–503CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Youichi Yasui
    • 1
    • 2
  • Khushdeep S. Vig
    • 1
    • 3
  • Ichiro Tonogai
    • 1
    • 4
  • Chun Wai Hung
    • 1
    • 5
  • Christopher D. Murawski
    • 1
    • 6
  • Masato Takao
    • 2
  • Hirotaka Kawano
    • 2
  • John G. Kennedy
    • 1
    Email author
  1. 1.Department of Foot and Ankle SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Orthopaedic SurgeryTeikyo UniversityTokyoJapan
  3. 3.Royal College of Surgeons in IrelandDublinIreland
  4. 4.Department of Orthopedic SurgeryTokushima UniversityTokushimaJapan
  5. 5.New York Medical CollegeValhallaUSA
  6. 6.University of Pittsburgh School of MedicinePittsburghUSA

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