Abstract
Recurrent dislocation of peroneal tendons is an uncommon presentation following ankle injuries. It usually follows an inversion injury to the ankle, most commonly seen in skiing, however it has also been described in many other sporting activities. X rays appear normal, and patients usually get treated as ankle sprain. The diagnosis, usually delayed is a clinical one, patients usually describe ankle instability and sudden painful snapping or popping of the subluxating peroneal tendons. This makes it difficult for them to participate in any sporting activities and is a source of continous discomfort while walking. Examination may show tender peroneal tendons and demonstration of subluxing tendons is facilitated by eversion against resistance or manually by thumb pressure. The common pathology is tear of the peroneal retinaculum and striping of periosteum from the anterior attachment to the lateral maleolus.
We describe 11 cases of recurrent dislocation of peroneal tendons from February 1999 to October 2004. They all suffered trauma related dislocation of peroneal tendons, causing recurrent peroneal tendon dislocation. All procedures were performed by a single consultant. Procedure involves soft tissue anatomic reconstruction of the peroneal retinaculum. There were 9 males and 2 females, mean age was 30.1 years (range 15 to 58 years). All patients were treated initially with rest followed by period of physiotherapy to no benefit. All complained of ankle instability with pain associated with tendon dislocation even while walking. The mean duration from time of injury to surgery was 10 months (range 2 to 45 months). We performed clinical assessment, ankle scoring, SF 36 version2 scoring and assessed patient satisfaction with the procedure.
At the latest follow up of 6 months to 6 years all patients were extremely satisfied with the procedure. There was no recurrence of dislocation. All patients were back to their normal daily activities and sports within 6 months of surgery. One patient complained of occasional mild pain over the tendon. One patient reported mild paraesthesiae in distribution of sural nerve, which recovered over 3 months. On clinical assessment the tendon was stable in all patients with full ROM and strength in the affected ankle when compared to normal side. The mean ankle score increased from 62 pre-op (range 22 to 89) to 96 post-operative (range 90 to 100). Mean SF 36 scores increased from PCS of 41 and MCS of 53 pre-op to a PCS of 57 and MCS of 60 post-op.
In the past procedures have been described for treatment of recurrent dislocation of peroneal tendons. We report the results of a procedure previously described and published by the senior author ( ‘The Foot’: 2003 ). This is an anatomic procedure for repair of torn peroneal retinaculum and double breasting of redundant periosteum. Our latest follow up of 6 months to 6 years shows excellent results with no recurrence and no limitation of ankle movement or sporting activities.
The abstracts were prepared by Emer Agnew, Secretary to the IOA. Correspondence should be addressed to him at Irish Orthopaedic Association Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
