SLR - January 2023 - Leng Xiong, DPM
Title: Open Peroneal Tendon Stabilization With Fibular Groove Deepening SummaryReference: Hwang IM, Rayos Del Sol S, Jenkins SM, Bryant SA, Gardner BB, McGahan P, Chen J. Open Peroneal Tendon Stabilization With Fibular Groove Deepening. Arthrosc Tech. 2022 Feb 12;11(3):e347-e352.
Level of Evidence: Level VI
Scientific Literature Review
Reviewed By: Leng Xiong, DPM
Residency Program: LECOM Health/Millcreek Community Hospital, Erie, PA
Podiatric Relevance: One of the common causes of lateral ankle pain is from peroneal tendons dislocation. Podiatric surgeons usually encounter peroneal subluxation/dislocation from trauma or abnormal anatomy. Peroneal dislocation pathology has been under reported in the literature and are sometimes misdiagnosed as a lateral ankle sprains. However, there are not accepted standards within the Podiatric community about which surgical technique is the gold standard to deepen the fibular groove. This study focuses on a surgical technique for fibular groove deepening while preserving the fibrocartilage and repairing the superior peroneal retinaculum (SPR).
Methods: This is a surgical technique article that the surgeons used to treat peroneal tendon dislocations and identify an acceptable gold standard for fibular groove deepening along with preservation of the natural fibrocartilage and repair the SPR. The article discusses the technique with an indirect fibular groove deepening through a modified osteoperiosteal flap with a retinaculum repair. Patients that are included for this surgical technique go through a preoperative assessment that is consistent with peroneal tendon dislocation with instability. The technique is when the posterior cortex of the fibula is thinned by reaming the fibular from distal to fibular with an approximate diameter of 7-8 mm. Next, the two sagittal cuts are created to the posterior fibula and then the posterior cortex is collapsed with a tamp and mallet to deepen the fibular groove. Lastly, the SPR is recreated to make sure the peroneal tendons are secured and do not continue to dislocate.
Results: The results described by the surgeon, if carefully performed correctly, is that the fibrocartilage of the fibular groove deepening is kept intact to allow the peroneal tendons to glide smoothly. If the fibrocartilage is undamaged during the procedure, this would prevent irritation from shear and compressive forces created by the tendons. Advantages of this techniques include: minimal damage to the fibrocartilage, unintended fibular fracture with the tamp and mallet, undisturbed other structures and tendons in the ankle, and less technically demanding compared to other techniques of fibular groove deepening. However, disadvantages include risk of fibrocartilage injury with the sagittal cuts to the posterior fibula and tamping, risk of sharp fragment formation because the SPR must be incised, and risk of inadequate correction of the SPR.
Conclusions: The author concluded that the technique, if done correctly, would decrease the risk of fibular fracture and conserve the fibrocartilage at the malleolar groove. In addition, adequate reconstruction of the SPR would prevent future peroneal tendon dislocation. This peroneal groove deepening technique to protect the natural fibrocartilage at the posterior fibular and repair of the SPR could be an acceptable gold standard if surgeons correctly execute the procedure and technique. However, further studies are needed to compare the effectiveness of this techniques to others.