A False-Pouch Closure Technique with an Intact Superior Peroneal Retinaculum for Recurrent Dislocation of the Peroneal Tendon

SLR - May 2021 - Sriya Babu

Reference: Matsui T, Kumai T, Shinohara Y, Kanzaki N, Noguchi K, Tanaka H, Sugimoto T, Yabiku H, Higashiyama I. A False-Pouch Closure Technique with an Intact Superior Peroneal Retinaculum for Recurrent Dislocation of the Peroneal Tendon. J Exp Orthop. 2021 Mar 18;8(1):22. doi: 10.1186/s40634-021-00343-0. PMID: 33738604.

Level of Evidence: Level IV, Retrospective Case Series 

Scientific Literature Review 

Reviewed By: Sriya Babu, DPM
Residency Program: Long Island Jewish Forest Hills Northwell Health – Queens, NY 

Podiatric Relevance: Dislocation of the peroneal tendon as a result of injury to the superior peroneal retinaculum (SPR) is a sports-related injury that podiatric surgeons commonly treat. Conservative treatment options have a significant failure rate of 50 percent and has a high chance of recurrent dislocation which inevitably results in surgical intervention. Studies show that ineffective repair of the SPR may play a role in recurrent peroneal dislocations with false pouches. The purpose of this study was to report the surgical technique and outcomes of a false-pouch closure with suture tape and anchors. The authors hypothesized improving initial strength by fixing the SPR will allow accelerated postoperative treatment resulting in early return to sports activity. 

Methods: This was a retrospective study of 30 patients who were treated with this procedure from 2016 to 2020. The mean follow-up duration was 10.8 ± 6.2 months. All patients were diagnosed with recurrent peroneal dislocations from sports related injuries. The indication of this procedure was type one of Oden’s classification where the SPR is still attached to the periosteum of the lateral malleolus along with periosteal elevation creating a false-pouch. Patients were excluded from the procedure if the SPR had a mid-substance tear, was avulsed from its insertion or there was an avulsion fracture which was confirmed through various imaging studies. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind Foot score was evaluated and compared preoperatively and at the last follow-up using a paired student t test. In addition, outcomes such as time to return to running and sports, rates of postoperative failure and complications were recorded. Operative technique was discussed in detail with intraoperative pictures.

Results: Twenty-eight out of 30 patients (93.3 percent) were able to return to their original level of sports activity without any major complications. The mean time to return to running was 8.0?±?2.8 weeks and sports was 14.4 ± 3.2 weeks. The mean AOFAS score was 79.7 ± 9.6 preoperatively and 98.9 ± 3.2 postoperatively which was a significant improvement (p<0.01). One patient had a postoperative recurrent dislocation at 8 weeks after returning to sports. One patient did not return to their original level of sports activity for unrelated reasons.

Conclusions: The authors concluded that the false-pouch closure technique with suture tape and anchors to reattach the SPR is an effective and viable surgical option for patients with recurrent dislocation of the peroneal tendon. While there are many different approaches in treating peroneal dislocations, this technique is less invasive thus preserving blood supply. In addition, the use of suture tape provides a greater contact area of fixation to the SPR which is biomechanically advantageous and enables early return to sports activities. While the short postoperative follow up period is a limitation, it is important for the podiatric surgeon to be aware of various methods of repairing peroneal dislocations such as this, so they can provide most appropriate surgical care to their patients and athletes.