Abstract
Purpose
Acute dislocation of the peroneal tendon is caused by massive combined flexion-torsion trauma supported by preexisting ligamentous laxity of the ankle joint.
This study aimed to investigate the clinical outcome of combined treatment of peroneal tendon dislocation and lateral and medial ligamentous laxity.
Methods
Between 2005 and 2007, forty-two patients with peroneal tendon dislocation and coexisting ligamentous laxity were treated. The superior extensor retinaculum was reconstructed using anchor technique and periosteal flap repair, whereas the preexisting ligamentous laxity with regard to the extensor inferior retinaculum was addressed using anchor reconstruction. All patients underwent arthroscopy prior to surgery. Thirty-eight of a total of 42 patients (aged 17–31) completed the 24-month follow-up. Clinical and arthroscopic examination was accomplished consistently by always the same two surgeons. Postoperative follow-up comprised clinical evaluation after 3, 6, 12 and 24 months.
Results
Clinical results showed a significant (P < 0.0001) increase in the AOFAS-Hindfoot Score as an often used but not validated outcome measure, as well as a significant decrease in the Visual Analogue Scale and in the internal and external rotation, after 3 months. The clinical outcome was confirmed at the 6-, 12- and 24-months measuring points. No dislocation of the peroneal tendon recurred within the 24-month follow-up. Subjective patient satisfaction was stated as high.
Conclusions
Combined treatment of peroneal tendon dislocation and coexisting lateral and medial ligamentous laxity in the ankle joint following arthroscopy results in good clinical outcome and high patient satisfaction.
Level of evidence
Case series, Level IV.
Similar content being viewed by others
References
Arrowsmith SR, Fleming LL, Allman FL (1983) Traumatic dislocations of the peroneal tendons. Am J Sports Med 11:142–146
Bonnin M, Tavernier T, Bouysset M (1997) Split lesions of the peroneus brevis tendon in chronic ankle laxity. Am J Sports Med 25:699–703
Buchhorn T, Ziai P (2009) Ventrales impingementsyndrom am oberen Sprunggelenk. Arthroskopie 22:109–115
Drewes LK, McKeon PO, Casey Kerrigan D, Hertel J (2009) Dorsiflexion deficit during jogging with chronic ankle instability. J Sci Med Sport 12:685–687
Ferran NA, Oliva F, Maffulli N (2006) Recurrent subluxation of the peroneal tendons. Sports Med 36:839–846
Geppert MJ, Sobel M, Bohne WH (1993) Lateral ankle instability as a cause of superior peroneal retinacular laxity: an anatomic and biomechanical study of cadaveric feet. Foot Ankle 14:330–334
Haight HJ, Dahm DL, Smith J, Krause DA (2005) Measuring standing hindfoot alignment: reliability of goniometric and visual measurements. Arch Phys Med Rehabil 86:571–575
Hughes T, Rochester P (2008) The effects of proprioceptive exercise and taping on proprioception in subjects with functional ankle instability: a review of the literature. Phys Ther Sport 9:136–147
Karlsson J, Eriksson BI, Sward L (1996) Recurrent dislocation of the peroneal tendons. Scand J Med Sci Sports 6:242–246
Kumai T, Benjamin M (2003) The histological structure of the malleolar groove of the fibula in man: its direct bearing on the displacement of peroneal tendons and their surgical repair. J Anat 203:257–262
Lee AJ, Lin WH (2008) Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability. Clin Biomech (Bristol, Avon) 23:1065–1072
Magerkurth O, Frigg A, Hintermann B, Dick W, Valderrabano V (2008) Frontal and lateral characteristics of the osseous configuration in chronic ankle instability. Br J Sports Med 44:568–572
Mason RB, Henderson JP (1996) Traumatic peroneal tendon instability. Am J Sports Med 24:652–658
Messer TM, Cummins CA, Ahn J, Kelikian AS (2000) Outcome of the modified Brostrom procedure for chronic lateral ankle instability using suture anchors. Foot Ankle Int 21:996–1003
Neustadter J, Raikin SM, Nazarian LN (2004) Dynamic sonographic evaluation of peroneal tendon subluxation. AJR Am J Roentgenol 183:985–988
Oliva F, Del Frate D, Ferran NA, Maffulli N (2009) Peroneal tendons subluxation. Sports Med Arthrosc 17:105–111
Safran MR, O’Malley D Jr, Fu FH (1999) Peroneal tendon subluxation in athletes: new exam technique, case reports, and review. Med Sci Sports Exerc 31:487–492
Schafer D, Hintermann B (1996) Arthroscopic assessment of the chronic unstable ankle joint. Knee Surg Sports Traumatol Arthrosc 4:48–52
Schafer D, Hintermann B (1996) Arthroscopic findings in the unstable upper ankle joint. Sportverletz Sportschaden 10:63–66
Shellock FG, Feske W, Frey C, Terk M (1997) Peroneal tendons: use of kinematic MR imaging of the ankle to determine subluxation. J Magn Reson Imaging 7:451–454
Tan V, Lin SS, Okereke E (2003) Superior peroneal retinaculoplasty: a surgical technique for peroneal subluxation. Clin Orthop Relat Res 410:320–325
Valderrabano V, Hintermann B (2005) Diagnostik und Therapie der medialen Sprunggelenkinstabilität. Arthroskopie 18:112–118
Walther M, Morrison R, Mayer B (2009) Retromalleolar groove impaction for the treatment of unstable peroneal tendons. Am J Sports Med 37:191–194
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ziai, P., Sabeti-Aschraf, M., Fehske, K. et al. Treatment of peroneal tendon dislocation and coexisting medial and lateral ligamentous laxity in the ankle joint. Knee Surg Sports Traumatol Arthrosc 19, 1004–1008 (2011). https://doi.org/10.1007/s00167-011-1471-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-011-1471-7