Groove Deepening Procedures and Approaches to Treatment of Peroneal Tendon Dislocations

  • David A. PorterEmail author
  • Joseph E. Jacobson


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.


Groove deepening Fibular osteotomy Peroneal tendon dislocation Athlete Surgery 


  1. 1.
    Adachi N, Fukuhara K, Kobayashi T, Nakasa T, Ochi M. Morphologic variations of the fibular malleolar groove with recurrent dislocation of the peroneal tendons. Foot Ankle Int. 2009;30(6):540–4.CrossRefGoogle Scholar
  2. 2.
    Adachi N, Fukuhara K, Tanaka H, Nakasa T, Ochi M. Superior retinaculoplasty for recurrent dislocation of peroneal tendons. Foot Ankle Int. 2006;27(12):1074–8.CrossRefGoogle Scholar
  3. 3.
    Cho J, Kim J, Song D, Lee W. Comparison of outcome after retinaculum repair with and without fibular groove deepening for recurrent dislocation of the peroneal tendons. Foot Ankle Int. 2014;35(7):683–9. Scholar
  4. 4.
    Dijk PA, Gianakos AL, Kerkhoffs GM, Kennedy JG. Return to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1155–64. Scholar
  5. 5.
    Dijk PA, Vopat BG, Guss D, Younger A, Digiovanni CW. Retromalleolar groove deepening in recurrent peroneal tendon dislocation: technique tip. Orthop J Sports Med. 2017;5(5):232596711770667. Scholar
  6. 6.
    Edwards M. The relations of the peroneal tendons to the fibula, calcaneus, and cuboideum. Am J Anat. 1928;42:213–53.CrossRefGoogle Scholar
  7. 7.
    Ferran NA, Oliva F, Maffulli N. Recurrent subluxation of the peroneal tendons. Sports Med. 2006;36(10):839–46. Scholar
  8. 8.
    Ferran NA, Maffulli N, Oliva F. Management of recurrent subluxation of the peroneal tendons. Foot Ankle Clin. 2006;11(3):465–74. Scholar
  9. 9.
    Guelfi M, Vega J, Malagelada F, Baduell A, Dalmau-Pastor M. Tendoscopic treatment of peroneal intrasheath subluxation: a new subgroup with superior peroneal retinaculum injury. Foot Ankle Int. 2018;39(5):542–50. Scholar
  10. 10.
    Heckman DS, Reddy S, Pedowitz D, Wapner KL, Parekh SG. Operative treatment for peroneal tendon disorders. J Bone Joint Surg. 2008;90(2):404–18. Scholar
  11. 11.
    Hu M, Xu X. Treatment of chronic subluxation of the peroneal tendons using a modified posteromedial peroneal tendon groove deepening technique. J Foot Ankle Surg. 2018;57(5):884–9. Scholar
  12. 12.
    Kelly RE. An operation for the chronic dislocation of the peroneal tendons. Br J Surg. 1920;7:502–4.CrossRefGoogle Scholar
  13. 13.
    Kollias SL, Ferkel RD. Fibular grooving for recurrent peroneal tendon subluxation. Am J Sports Med. 1997;25(3):329–35.CrossRefGoogle Scholar
  14. 14.
    Kumai T, Benjamin M. The histological structure of the malleolar groove of the fibula in man: its direct bearing on the displacement of peroneal tendons and their surgical repair. J Anat. 2003;203(2):257–62. Scholar
  15. 15.
    Maffulli N, Ferran NA, Oliva F, Testa V. Recurrent subluxation of the peroneal tendons. Am J Sports Med. 2006;34:986–92.CrossRefGoogle Scholar
  16. 16.
    Martens MA, Noyez JF, Mulier JC. Recurrent dislocation of the peroneal tendons. Results of rerouting the tendons under the calcaneofibular ligament. Am J Sports Med. 1986;14(2):148–50.CrossRefGoogle Scholar
  17. 17.
    Marti R. Dislocation of the peroneal tendons. Am J Sports Med. 1977;5:19–22.CrossRefGoogle Scholar
  18. 18.
    Maqdes A, Steltzlen C, Pujol N. Endoscopic fibular groove deepening for stabilisation of recurrent peroneal tendons instability in a patient with open physes. Knee Surg Sports Traumatol Arthrosc. 2017;25(6):1925–8. Scholar
  19. 19.
    McLennan JG. Treatment of acute and chronic luxations of the peroneal tendons. Am J Sports Med. 1980;8:432–6.CrossRefGoogle Scholar
  20. 20.
    Oden RR. Tendon injuries about the ankle resulting from skiing. Clin Orthop Relat Res. 1987;216:63–9.Google Scholar
  21. 21.
    Ogawa BK, Thordarson DB, Zalavras C. Peroneal tendon subluxation repair with an indirect fibular groove deepening technique. Foot Ankle Int. 2007;28(11):1194–7. Scholar
  22. 22.
    Oliva F, Ferran N, Maffulli N. Peroneal retinaculoplasty with anchors for peroneal tendon subluxation. Bull Hosp Joint Dis. 2006;63(3–4):113–6.Google Scholar
  23. 23.
    Poll R, Duijfres F. The treatment of recurrent dislocation of the peroneal tendons. J Bone Joint Surg. 1984;66-B:98–100.CrossRefGoogle Scholar
  24. 24.
    Porter D, McCarroll J, Knapp E, Torma J. Peroneal tendon subluxation in athletes: fibular groove deepening and retinacular reconstruction. Foot Ankle Int. 2005;26:436–41.CrossRefGoogle Scholar
  25. 25.
    Pozo JL, Jackson AM. A rerouting operation for dislocation of peroneal tendons: operative technique and case report. Foot Ankle. 1984;5(1):42–4.CrossRefGoogle Scholar
  26. 26.
    Raikin SM. Intrasheath subluxation of the peroneal tendons. Surgical technique. J Bone Joint Surg. 2009;91:146–55. Scholar
  27. 27.
    Raikin SM, Elias I, Nazarian LN. Intrasheath subluxation of the peroneal tendons. J Bone Joint Surg Am. 2008;90(5):992–9.CrossRefGoogle Scholar
  28. 28.
    Saxena A, Ewen B. Peroneal subluxation: surgical results in 31 athletic patients. J Foot Ankle Surg. 2010;49(3):238–41.CrossRefGoogle Scholar
  29. 29.
    Shawen SB, Anderson RB. Indirect groove deepening in the management of chronic peroneal tendon dislocation. Tech Foot Ankle Surg. 2004;3:118–25.CrossRefGoogle Scholar
  30. 30.
    Slätis P, Santavirta S, Sandelin J. Surgical treatment of chronic dislocation of the peroneal tendons. Br J Sports Med. 1988;22:16–8.CrossRefGoogle Scholar
  31. 31.
    Stenquist DS, Gonzalez TA, Tepolt FA, Kramer DE, Kocher MS. Calcaneofibular ligament transfer for recurrent peroneal tendon subluxation in pediatric and young adult patients. J Pediatr Orthop. 2018;38(1):44–8. Scholar
  32. 32.
    Steinbock G, Pinsger M. Treatment of peroneal tendon dislocation by transposition under the calcaneofibular ligament. Foot Ankle Int. 1994;15:107–11.CrossRefGoogle Scholar
  33. 33.
    Stover C, Bryan D. Traumatic dislocation of the peroneal tendons. J Bone Joint Surg. 1962;61-A:292–4.Google Scholar
  34. 34.
    Suh JW, Lee JW, Park JY, Choi WJ, Han SH. Posterior fibular groove deepening procedure with low-profile screw fixation of fibrocartilaginous flap for chronic peroneal tendon dislocation. J Foot Ankle Surg. 2018;57(3):478–83. Scholar
  35. 35.
    Taljanovic MS, Alcala JN, Gimber LH, Rieke JD, Chilvers MM, Latt LD. High-resolution US and MR imaging of peroneal tendon injuries. Radiographics. 2015;35(1):179–99. Scholar
  36. 36.
    Tan V, Lin SS, Okereke E. Superior peroneal retinaculoplasty: a surgical technique for peroneal subluxation. Clin Orthop Relat Res. 2003;410:320–5. Scholar
  37. 37.
    Thomas JL, Lopez-Ben R, Maddox J. A preliminary report on intra-sheath peroneal tendon subluxation: a prospective review of seven patients with ultrasound verification. J Bone Joint Surg Am. 1989;71:293–5.CrossRefGoogle Scholar
  38. 38.
    Title CI, Jung H, Parks BG, Schon LC. The peroneal groove deepening procedure: a biomechanical study of pressure reduction. Foot Ankle Int. 2005;26(6):442–8. Scholar
  39. 39.
    Tomihara T, Shimada N, Yoshida G, Kaneda K. Comparison of modified Das De procedure with Du Vries procedure for traumatic peroneal tendon dislocation. Arch Orthop Trauma Surg. 2010;130(8):1059–63.CrossRefGoogle Scholar
  40. 40.
    Vega J, Batista JP, Golanó P, Dalmau A, Viladot R. Tendoscopic groove deepening for chronic subluxation of the peroneal tendons. Foot Ankle Int. 2013;34(6):832–40. Scholar
  41. 41.
    Walther M, Morrison R, Mayer B. Retromalleolar groove impaction for the treatment of unstable peroneal tendons. Am J Sports Med. 2009;37(1):191–4. Scholar
  42. 42.
    Zhenbo Z, Jin W, Haifeng G, Huanting L, Feng C, Ming L. Sliding fibular graft repair for the treatment of recurrent peroneal subluxation. Foot Ankle Int. 2014;35(5):496–503. Scholar
  43. 43.
    Zoellner G, Clancy W Jr. Recurrent dislocation of the peroneal tendon. J Bone Joint Surg Am. 1979;61(2):292–4.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Methodist Sports MedicineIndianapolisUSA
  2. 2.Department of OrthopedicsIndiana UniversityIndianapolisUSA

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