SLR - January 2011 - George E. Gopoian
Reference: Saxena, A., Ewen, B. (2010) Peroneal subluxation: Surgical results in 31 athletic patients. The Journal of Foot and Ankle Surgery, 49 (3), 238-241
Scientific Literature Reviews
Reviewed by: George E. Gopoian, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
This study was performed to evaluate if athletic patients could return to activity following surgical repair of subluxating peroneal tendons treated surgically with groove deepening and retinaculum repair. It also evaluated how long return to athletic activity would take and assessed any post operative complications.
Methods:
Thirty-one patients participated in a prospective study conducted from January 2000 through December 2005. Inclusion criteria required patients to be engaged in athletic activity with confirmed symptomatic subluxation of the peroneal tendons. The diagnosis was made both clinically and surgically. Plain films and MRI were used to rule out any other pathology and to evaluate the patient's condition. All surgery was performed by the same surgeon, the senior author. Patient's age, sex, return to activity time frame (RTA), pre and post operative AOFAS ankle and hind foot scores, and Roles and Maudsley (RM) scores were obtained and statistally analyzed for a minimum of 2 years following surgery.
Results:
Of the 31 patients in this study, 16 had isolated subluxation repairs, nine underwent concomitant peroneus brevis repair, and 6 others had ankle stablization procedures performed at the time of surgery. Patients who required tendon repair were signifcantly older than those requiring ankle stabilization or retinaculum repair alone. Average RTA for the entire group was 3.2 months, preoperative AOFAS score was 58.3 and postoperative was 97.0. RM postoperative score was 1.3. RTA for those patients with tears averaged 3.6 months and those requiring ankle stabilization averaged 3.3 months. The only statistically significant finding between RTA, AOFAS scores, and RM was that the RTA for patients with tendon tears was slower than those with retinaculum repair alone. All patients were able to return to their previous athletic activities. Complications included one re-subluxation, one nerve entrapment, one decreased activity level, and one grade III frostbite injury resulting from improper use of a cryotherapy unit.
Conclusions:
On the basis of these findings, the authors feel that the treatment of peroneal subluxation in athletic patients is best treated with surgical intervention including groove deepening , muscle debulking, and repair of the reinaculum. Also noted is that repair of concomitant pathology does not significantly reduce the ability of a patient to return to athletic activity.