J Korean Foot Ankle Soc.  2020 Dec;24(4):168-172. 10.14193/jkfas.2020.24.4.168.

Distal Fibular Rotational Plasty for Chronic Peroneal Tendon Recurrent Dislocation: A Technical Report

• Suh JW
• Park HW

• KMID: 2509540
• DOI: http://doi.org/10.14193/jkfas.2020.24.4.168

Abstract

Chronic recurrent peroneal dislocation often responds poorly to conservative treatment. Surgical treatment has been reported to be more effective than conservative treatment, and various surgical treatment methods are available: superior peroneal retinaculum repair or reattachment, peroneal groove deepening procedures, rerouting procedures, or bone block procedures. Although various treatment options have been reported, there is no consensus regarding which treatment is better. This paper proposes a distal fibular rotational plasty that can prevent recurrent peroneal dislocations and recover its function well by securing a stable peroneal tendon excursion space.

Keyword

Ankle; Tendon; Dislocation; Autografts

Figure

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  Fig. 1 Operative technique. (A) After the longitudinal incision posterolateral to the distal fibular, the peroneal tendon sheath and superior peroneal retinaculum (SPR) were incised leaving a 3-mm cuff at the posterior border of the fibula and then, the dislocated peroneal tendon was observed. Black arrow heads indicate dislocated peroneus longus. (B) After dislocating the peroneal brevis and longus tendon laterally (asterisk [*] indicates fibrocartilaginous ridge), (C) the osteotomy with sagittal saw was done 3 cm proximally to the distal tip of the fibula from posterolateral margin of the peroneal groove with 5 mm in depth to the half width of the distal fibular. In this process, the fibrocartilaginous surface of peroneal groove was preserved as much as possible by including the fibrocartilaginous ridge and cutting at just posterolateral margin of the peroneal groove. (D) The bone block was temporary fixed with two K-wires after rotating 15~20 degrees counterclockwise and making 5 mm roof to preventing tendon dislocation at posterolateral aspect of distal tip of fibula. The C-arm fluoroscopy image showed the direction of K-wires. The proximal K-wire was inserted vertically, and the distal one was inserted with oblique direction from posterolateral bone block to anteromedial distal fibula. (E) The bone block was fixed with two 4.0 mm cancellous screws along the direction of the K-wires. (F) The peroneal brevis and longus tendon were relocated and the stability of tendon was confirmed with a stress test. The firm screw fixation and no penetration of screws to the joint were confirmed with the C-arm fluoroscopy. (G) The SPR was repaired to the posterolateral margin of the fibula without damage to a fibrocartilaginous ridge and the fascia was closed. And the stability of tendon was confirmed again with a stress test and the skin repaired layer by layer (asterisk [*] indicates fibrocartilaginous ridge).

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  Fig. 2 The illustration shows distal fibular rotational plasty in the lateral view of the ankle. The black arrow shows a fibrocartilaginous ridge.

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  Fig. 3 The illustration of the operative technique shows a posterior view of the ankle. It shows the osteotomy line at just the posterolateral margin of the peroneal groove, and the bone block, including the fibrocartilaginous ridge, is made in 5 mm-depth.

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  Fig. 4 The axial image of magnetic resonance imaging (MRI) with the illustration shows the concept of distal fibular rotational plasty. With 5 mm depth bone block (A), the roof is made to prevent tendon dislocation and to restore enough volume of the peroneal tendon excursion space (B). *Peroneus brevis. †Peroneus longus.

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  Fig. 5 The illustration of the operative technique shows a posterolateral view of the ankle. It shows a 5 mm-width roof to prevent tendon dislocation at the posterolateral aspect of the distal fibular tip.

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  Fig. 6 Postoperative anteroposterior (A), mortise (B), and lateral (C) ankle radiographs of a 29-year-old male patient who had chronic recurrent peroneal dislocation and medial ankle instability at 10 weeks after surgery. These show successful bone union without any penetration of the two cancellous screws to the ankle joint. (C) The white dotted line shows a rotated bone block roof.

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