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Surgical treatment options for chronic instability of the peroneal tendons: a systematic review and proportional meta-analysis

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Several surgical techniques for chronic instability of the peroneal tendons have been reported. Yet, the most optimal technique has not been clarified. This study aims to perform a systematic review and meta-analysis of all existing evidence and compare all published surgical techniques in both the athletic as the nonathletic population.

Materials and methods

A systematic review and a proportional meta-analysis, with a random-effects model, were carried out according to the PRISMA guidelines, using the keywords “chronic luxation” OR “instability” AND “peroneal tendon” AND “treatment” OR “treatment protocol”. Four surgical techniques were compared in patients with chronic peroneal instability, comprising superior peroneal retinaculum (SPR) repair or replacement, groove deepening procedures (primarily with additional SPR operations), rerouting procedures, and bony procedures (respectively group S, G, R and B). Outcomes of interest include the pre- and postoperative American orthopedic foot and ankle society hindfoot score, return to sports, postoperative redislocation and complications. Pooled estimates of the last two outcomes were obtained.

Results

For the systematic review, 31 studies were eligible. Of these, 25 papers met the criteria for inclusion in the meta-analysis. All techniques demonstrated a clinical improvement postoperatively. Group B, however, demonstrated overall more unsatisfactory results, and higher complication rates were observed for both group R and group B. The latter was established by the proportional meta-analysis as well [95% confidence interval group S: (0.01–0.10); group G: (0.02–0.10); group R: (0.13–0.57); group B: (0.24–0.40)]. Concerning surgical efficacy (= no postoperative redislocation), no significant difference was statistically observed. Finally, considerable differences in study quality were identified.

Conclusion

Surgical treatment results in excellent clinical and functional outcomes in patients with chronic peroneal instability. More inferior results were demonstrated for rerouting and bony procedures. However, no high-quality studies are available and future randomized controlled trials are necessary to advocate for the most advantageous approach.

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Faculty of Medicine, KU Leuven-University of Leuven, Leuven, Belgium

    Joline Lootsma

  2. Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium

    Sander Wuite, Harm Hoekstra & Giovanni A. Matricali

  3. Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, Leuven, Belgium

    Sander Wuite & Giovanni A. Matricali

  4. Institute of Orthopaedic Research and Training, KU Leuven-University of Leuven, Leuven, Belgium

    Sander Wuite & Giovanni A. Matricali

  5. Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium

    Harm Hoekstra

  6. Center for Orthopedics, Trauma and Reconstructive Surgery, Rhein-Maas Klinikum, Würselen, Germany

    Joline Lootsma

  7. Boulevard du Midi 118, 1000, Brussels, Belgium

    Joline Lootsma

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Contributions

JL*: study design, data collection and analysis, manuscript´s writing and editing. HH: critical analysis, editing the paper. SW: critical analysis and editing the paper, GM: supervision of writing of the manuscript, conceptualization, editing the paper, and manuscript review. All authors contributed to the final manuscript.

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Correspondence to Joline Lootsma.

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Lootsma, J., Wuite, S., Hoekstra, H. et al. Surgical treatment options for chronic instability of the peroneal tendons: a systematic review and proportional meta-analysis. Arch Orthop Trauma Surg 143, 1903–1913 (2023). https://doi.org/10.1007/s00402-022-04395-4

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  • DOI: https://doi.org/10.1007/s00402-022-04395-4

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