Peroneal Tendon Dislocation

Peroneal tendon dislocation is one of the main causes of lateral ankle pain and instability. This injury is frequently misdiagnosed as a lateral ankle sprain usually in young and active patients. The most common mechanism of injury is a violent dorsiflexion with eversion or inversion in a dorsiflexed ankle. Patients may present with chronic instability, lateral sided ankle pain, ankle stiffness, and snapping. It often occurs among soccer, skiing, rugby, horse riding, and biking that results in ankle twisting. Proper history and clinical assessment such as Sobel Test are mandatory, but magnetic resonance imaging and dynamic ultrasound has been recognized to be the most accurate tool for diagnosing peroneal tendon dislocation. There are anatomical predisposing factors that lead to peroneal tendon dislocation such as the absence of SPR (Superior Peroneal Retinaculum), lateral ankle laxity, and shallow retro malleolar groove. Peroneal tendon dislocations occur mainly because of secondary disruption of the SPR from it’s insertion along the posterolateral margin of the fibula with or without it displacement of the associated fibrocartilaginous ridge. Treatment of this injury is cased of certain things like the timing of the injury and the activity level of the patient. No specific approach has been proven superior for peroneal tendon relocation surgical methods. Five different surgical methods are anatomic reattachment of the retinaculum, reinforcement of the SPR with local tissue transfers, rerouting the tendons behind the calcaneofibular ligament, bone block procedures, and groove deepening procedures. These procedures resulted in excellent outcomes, low recurrence rates, and a high rate of return to sports.