Peroneal Tendon Dislocation Treated with Arthroscopic Approach: A Case Report

Abstract

Peroneal tendon dislocation is usually manifested as ankle instability and pain. Peroneal tendon dislocation is caused by ruptured of superior peroneal retinaculum (SPR) due to anatomical abnormality. SPR can be damaged due to excessive contraction force of dorsiflexion of the foot. The epidemiology of this pathology is also uncertain, because peroneal tendon dislocation is often mistaken for lateral ankle ligament sprain. The treatment should include conservative treatment and surgical treatment if it fails. A 20-year-old Indonesian Male attended orthopedic consultation with pain and snapping of the lateral side of left foot from 2 years ago after twisting his ankle during a recreational sport. Snapping was felt when doing sport exercise and in certain position. The tendon dislocation can be seen after that. On examination, he felt pain on palpation and snapping on lateral side of the ankle. The left ankle was snapped in a dorsiflexion and plantarflexion positions and can return into normal position. After conservative therapy, the condition did not improve. Then surgical intervention was suggested. Patient was operated on June 21st 2022 on a operating room with lateral decubitus position under subarachnoid anesthesia. The surgery was done with arthroscopic approach. During operation we found a SPR disruption, peroneus longus tendon longitudinal tear, low lying peroneus brevis muscle belly and shallow retromaleolar groove. These finding may increase the risk of dislocation. We performed a peroneus longus debridement, peroneal brevis muscle excision, retromaleolar groove deepening, and SPR repair are our best choice of treatment. Short leg splint and physiotherapy exercise were applied after surgery. Presented case of peroneal dislocation is very low. Usually for this case is best treated with surgical intervention. By using arthroscopy, we can detect abnormality and treat them at once. SPR repair and groove deepening with arthroscopic approach can offers a satisfactory outcome.