Groove Deepening Procedures and Approaches to Treatment of Peroneal Tendon Dislocations
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Treatment of the peroneal tendon often involves instability of the peroneal tendon itself. Dislocation or subluxation of the peroneal tendon is most often related to a traumatic event. Instability of the peroneal tendons often necessitates operative intervention to stabilize the peroneal tendons. Superior peroneal retinacular (SPR) reconstruction or repair is always involved with operative treatment. Often, the posterior retromalleolar fibular groove is smooth/flat or convex. It is thought this lack of depth in the groove can contribute to an instability episode and recurrence. Therefore, often some form of groove deepening procedure is required for successful stabilization of the peroneal tendons behind the fibula. We discuss both direct and indirect groove deepening procedures (both involving some form of a “fibular osteotomy”) to create a concave posterior surface of the fibula and support the stability of the peroneal tendons in addition to the SPR repair/reconstruction. There are numerous approaches to groove deepening procedures; we have tried to give our reader a good understanding of each, along with diagrams and rationale for each approach. The reader should have a good armamentarium for approaches to groove deepening for operative treatment of both acute and chronic peroneal tendon dislocations/subluxations. We also discuss intrasheath subluxation and present our preferred approach to groove deepening and postsurgical rehabilitation.
KeywordsGroove deepening Fibular osteotomy Peroneal tendon dislocation Athlete Surgery
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