Treatment of Peroneal Tendon Dislocation by Transposition Under the Calcaneofibular Ligament

Abstract

Of the many different surgical techniques to treat peroneal tendon dislocations, transposition of the peroneal tendons under the calcaneofibular ligament has been used at the Orthopadisches Spital of ViennaIAustria since 1975. The method was first described by Platzgummer in 1967. After dividing the calcaneofibular ligament and removing the fatty tissue in the space between this ligament, the posterior talofibular ligament, and the lateral capsule of the subtalar joint, the peroneal tendons are placed behind the lateral rnalleolus and under the calcaneofibular ligament, which is reconstructed by suture to create an efficient retainment.Of 17 feet operated on, 13 were available for follow-up in 12 patients. Dislocation was idiopathic in three and traumatic in 10 feet. Criteria for evaluation were patient's satisfaction, absence of pain and swelling, and stability of tendon retention and of ankle and subtalar joints. Of the 13 operated feet, 11 showed an excellent result and two showed a good result.In the results graded as "good," occasional pain and swelling occurred in both feet of a patient belonging to the idiopathic group.

Modified Rerouting Procedure for Failed Peroneal Tendon Dislocation Surgery

“…ROM of the hindfoot increased in all ankles in our study although three of our six patients showed a mild restriction of hindfoot mobility compared to the unaffected side (Tables 3, 4). In the literature, restriction of supination as well as of extension and flexion of the ankle were rarely found following a rerouting procedure (Table 5) [17,38,53,54,65,72]. While we expected that one tendon in a space intended for two tendons would lead to less limitation of hindfoot ROM in contrast to the classic rerouting operation, we could not confirm that expectation.…”

“…During the followup of 2 to 11 years, no recurrence of the peroneal tendon dislocation was found [53]. Steinböck and Pinsger treated 13 ankles of 12 patients with the same technique and reported no recurrences at a followup of 1.8 to 13.5 years [65]. In 1968, Leitz [36] performed an osteotomy of the fibular insertion of the FCL, transposed both peroneal tendons, and reattached the FCL insertion with Kirschner wires.…”

“…Pöll and Duijfjes reported lateral ankle stability increased in one and unchanged in nine of 10 patients [54]. Martens et al [38], Platzgummer [53], and Steinböck and Pinger [65] found no evidence for hindfoot instability following surgery. Instability of the ankle following transposition of one or both tendons behind the FCL has not yet been described (Table 5).…”

Peroneal tendon dislocation/subluxation – Case series and review of the literature

“…These are not currently recommended [21]. (5) Rerouting the peroneal tendons beneath the calcaneo fibular ligament [22,23]. (6) Sliding fibular graft [24].…”

The Singapore operation for recurrent dislocation of peroneal tendons

“…Zoellner and Clancy 14 advocated groove-deepening procedures, but we did not find the groove to be shallow in any of our patients. Other recent series [15][16][17] report only a few patients with a short follow-up. In our late-presenting patients, the periosteal flap and the superior peroneal retinaculum were thickened due to repeated trauma: this helped to provide firm tissue for repair.…”