SLR - February 2017 - Ashley Finn
Incidence of Reoperation and Wound Dehiscence in Patients Treated for Peroneal Tendon Dislocations: Comparison Between Osteotomy versus Soft-Tissue Procedures
Reference: Yasui Y, Vig K, Tonogai I, Hung C, Murawski C, Takao M, Kawano H, Kennedy JG. Incidence of Reoperation and Wound Dehiscence in Patients Treated for Peroneal Tendon Dislocations: Comparison Between Osteotomy versus Soft-Tissue Procedures. Knee Surg Sports Tramatol Arthroc: 2016 Nov 30.
Scientific Literature Review
Reviewed By: Ashley Finn, DPM
Residency Program: Suburban Community Hospital
Podiatric Relevance: Conservative treatment for peroneal tendon dislocation is associated with high failure rates, making operative treatment necessary in patients with persistent symptoms. Currently, there is no established standard for the operative treatment of this pathology. While many procedures have been described, techniques can generally be divided into osteotomy techniques, soft-tissue repair and retromalleolar groove deepening procedures. Exceptional clinical outcomes following soft-tissue repair with and without retromalleolar deepening are present in the literature; however, data demonstrating the effectiveness of osteotomy techniques is scarce. Despite limited literature, the authors found osteotomy to be a prevalent treatment for peroneal tendon dislocation. The purpose of this study was to compare the postoperative reoperation rate following osteotomy techniques and soft-tissue procedures using a large data base in order to investigate the efficacy of bone techniques.
Methods: Patients who underwent operative treatment for peroneal tendon dislocation were identified using a CPT code search within the United Healthcare Orthopaedic and Medicare datasets between 2005 and 2012. CPT-27676 and CPT-27675 were used as a means of identifying the osteotomy and soft-tissue procedure groups, respectively. Annual incidence and gender distribution were investigated within the two cohorts as well as incidences of reoperation and wound dehiscence. Identification of the latter two was accomplished via the same CPT codes used to detect the original procedure, in addition to several ICD-9 codes relating to wound dehiscence. All obtained data was then analyzed via multiple statistical methods.
Results: A total of 6,122 patients who received peroneal tendon repair were included in the study. Of the involved patients, 1,416 patients received osteotomy while 4,706 were treated with soft-tissue techniques. Females in the UHO dataset were found to have significantly more soft-tissue procedures than their male counterparts, while females in the MD dataset had both procedures performed more frequently when compared to males. Reoperation rates were consistent in both data sets, measuring 2.8 percent for osteotomy patients versus 3.4 percent for soft-tissue procedures, with no statistical difference. The rate of wound dehiscence following osteotomy compared to soft-tissue repair was very similar, at 2.6 percent and 2.3 percent. Finally, the difference in complication rates between the two groups was not statistically significant.
Conclusions: The study results support the lack of a significant difference between reoperation and complication rates when comparing osteotomy and soft-tissue procedures for peroneal tendon dislocation. The authors believed the prevalence of osteotomy techniques, despite limited data on efficacy and risk of more significant complications, was related to the expectation of lower reoperation rates following a bony procedure compared to soft-tissue repair. This study was able to demonstrate that both reoperation and wound dehiscence rates were extremely similar for both techniques, allowing physicians to confidently choose soft-tissue repair as a viable and effective option for their patients.