What Is the Rate of Recurrence of Peroneal Groove Deepening for Subluxation/Dislocation

Abstract

Category: Sports Introduction/Purpose: Peroneal tendon subluxation is an uncommon, yet well-known, condition that can occur after injury to the lateral ankle. The diagnosis can be difficult and is often missed or delayed. This may lead to recurrent or chronic subluxation or dislocation. Surgical management is often recommended, both in the acute and subacute setting. Multiple different surgical procedures have been described ranging from soft tissue repair to fibular groove deepening procedures. Soft tissue procedures alone may be inadequate to treat this pathology, especially in the case of shallow peroneal grooves. Multiple fibular groove deepening techniques have been described, although the population size in each study has been low. This investigation will evaluate the largest cohort of patients undergoing fibular groove deepening for peroneal subluxation or dislocation. Methods: Forty-four patients (Age 39.3 +/- 15.6, BMI 27.9 +/- 5.9) who underwent fibular groove deepening without concomitant bony procedures were able to return to clinic with a minimum two year follow-up. Demographic and operative data was collected via chart review. A standing CT scan, physical examination and functional outcome data was collected at the time of the office visit. The primary outcome was revision surgery. Secondary outcomes included radiographic findings(depth of groove), physical examination data (subluxation/dislocation, strength, ROM) and functional scores(FAAM). Results: 44 patients who underwent isolated peroneal groove deepening were enrolled. Rate of revision surgery was 3/44. CT scan showed an average depth on the operative side of (4.4 mm +/- 2.6) compared to (0.6 mm +/- 1.9) on the contralateral side. On physical exam 5% had objective subluxation, 2% dislocation, 84% had full strength to eversion. The median dorsiflexion and plantarflexion range of motion was 14 (0,100) and 40 (15,155) degrees, respectively. FAAM scores for ADL and Sports were (88.6% +/- 16.4% and 71.7% +/- 20.5%, respectively). 84% of patients would undergo the operation again. Conclusion: Our results show that peroneal groove deepening has a low recurrence rate but results in decreased strength and modest decreases in plantar flexion. The majority of patients were satisfied and would have the operation again. There was low incidence revision surgery (7%), and postoperative dislocation (2%). This is the first study to our knowledge that looked at postoperative CT scans. We showed that deepening is preserved and in our study increased peroneal groove depth by 3.8 mm on average.