Peroneal tendon subluxation in athletes: fibular groove deepening and retinacular reconstruction

BACKGROUND: The purpose of this study was to evaluate the results of operative treatment of recurrent peroneal tendon dislocations followed by accelerated rehabilitation incorporating early range of motion and intermittent immobilization. METHODS: Four female and nine male athletes with an average age of 24 years had objective clinical evidence of peroneal tendon dislocation (14 ankles). Operative treatment involved removing a bone flap from the distal posterior fibula, deepening the posterior fibular groove, and reattaching the bone flap within the deepened groove. The superior peroneal retinaculum also was reconstructed. Postoperatively, a removable boot was worn for approximately 4 weeks, when it was replaced with a stirrup brace. RESULTS: At an average followup of 35 months, no recurrent subluxation or dislocation of the peroneal tendons had occurred. All patients were able to return to sports by 3 months after surgery. Nine of the 14 ankles regained normal range of motion, and the remaining five were within 5 degrees of the opposite side. Four patients were completely pain free, and nine patients had mild occasional pain that did not limit their activities. Eight patients returned to preinjury sports participation, and five patients elected to participate in sports at a level lower than they had before surgery for reasons not related to their ankle injury. CONCLUSIONS: This procedure was reliable for preventing recurrent peroneal tendon instability. Range of motion was nearly normal, immobilization time was minimal, and all patients returned to daily activities and sports within 3 months of surgery.