A false-pouch closure technique with an intact superior peroneal retinaculum for recurrent dislocation of the peroneal tendon

Abstract

Purpose To evaluate the usefulness of the false-pouch closure technique with an intact superior peroneal retinaculum (SPR). Methods From 2016 to 2020, 30 patients with recurrent dislocation of the peroneal tendon were treated with the current procedure. Clinical outcomes, including the time to resume running, the rate and time to return to sports, and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind Foot score, were evaluated preoperatively and at the last follow-up. Results The rate of return to the pre-injury level of sports activity was 93.3%, and the mean duration to return to running and sports was 8.0 ± 2.8 weeks (range: 3–12 weeks) and 14.4 ± 3.2 weeks (range: 10–24 weeks), respectively. The mean preoperative AOFAS score was 79.7 ± 9.6 points (range: 41–90), which improved significantly to 98.9 ± 3.2 (87–100) postoperatively (p < 0.01). Conclusion The false-pouch closure technique with suture tape and anchors had a reliable clinical outcome and can enable the early return of patients to their sports activities. Level of evidence IV, Case series

Autologous Chondrocyte Implantation With Collagen Membrane Using a Knotless Suture Bridge Technique

“…Consequently, we focused on the knotless suture bridge technique, frequently used in rotator cuff repair surgery [ 7 ], and the false-pouch closure technique [ 8 ] in peroneal tendon dislocation. This necessitated a fixation approach with a broader contact area, leading us to the knotless suture bridge technique.…”

Fibular morphology is not associated with incidence of peroneal tendon dislocation

“…Adachi et al classified the bone morphology of the first centimetre proximal to the tip of the fibula into three categories (convex, flat, and concave), and compared 39 ankles with and without peroneal tendon dislocation; however, there was no significant difference in shape distribution between the two groups [2]. Nishimura and colleagues also compared the fibular morphology in 30 patients with dislocation with that in 30 controls using the same three categories and found no difference between the two groups [14]. Combined with the results of this study, these previous studies highlight the difficulty of identifying predisposing bone morphology using a classification based on the subjective qualification of distal fibular shape as convex, concave or flat.…”

“…Furthermore, the relationship between bone morphology and postoperative redislocation rate was investigated. A study by Kumai et al using 10 cadaver healthy ankles reported that the SPR played a major role in stabilizing the peroneal tendon [14]. In a recent systematic review of 14 studies, the postoperative dislocation rate was 1.1% (one in 90 patients) in the SPR repair group and 1.5% (two in 135 patients) in the combined groove deepening group, with low rates of redislocation using both techniques; however, no statistical analysis was conducted [25].…”

“…The recurrent dislocation rate after conservative treatment has been reported as 56%-74% [3,9,20,29]; thus, surgical treatment is considered even after primary dislocation [6,26]. The predisposition to peroneal tendon dislocation has been reported to include the presence of a low-lying muscle belly of the peroneus brevis (PB) [10,14,24] and an accessory peroneal muscle (APM). These conditions cause 'overstuffing' of the peroneal tunnel, an important factor in peroneal tendon dislocation [20].…”

“…While some previous studies on the morphology of the fibula have reported that hypoplasia of the retromalleolar groove is associated with recurrent dislocation [12,24], others have reported that bone morphology is not relevant [1,14]. Therefore, the influence of fibular morphology on tendon dislocation remains controversial [13,26].…”