Background: Recurrent peroneal tendon subluxation is uncommon. We report the results of a delayed anatomic repair using suture anchors. Using a case series we tested the null hypothesis that there are no differences between pre- and post-operative status following anatomical repair of the superior peroneal retinaculum.

Methods: In the period 1996 to 2001, we operated on 14 patients (all males; average age 25.3 ± 6.3 years, range 18–37) with traumatic recurrent unilateral peroneal tendon subluxation, with a followed up of 38 ± 3 (range 22 to 47) months.

Results: No patient experienced a further episode of peroneal tendon subluxation, and all had returned to their normal activities. Maximum calf circumference, functional ability, peak torque, total work and average power of plantar flexion were always lower in the operated leg, but the differences did not reach statistical significance. The AOFAS Ankle-Hindfoot Scale increased significantly from 54.3 ± 11.4 to 94.5 ± 6.4 (p = 0.03), with five patients reporting a fully normal ankle.

Conclusion: If an anatomic approach to treating the pathology is utilised, reattachment of the superior retinaculum is a most appropriate technique. It returns patients to a high level of physical activity, and gives high rate of satisfactory results both objectively and subjectively. Randomised control trials may be the way forward in determining the best surgical management method. However, the relative rarity of the condition and the large number of techniques make such a study difficult.