Peroneal Tendoscopy Technique

Background: Peroneal tendoscopy is indicated for patients with persistent posterolateral ankle pain in which other intraarticular or extraarticular etiologies have been excluded. Physical examination findings and magnetic resonance imaging (MRI) evaluation are often equivocal, making direct visualization critical in characterizing the injury. Peroneal tendoscopy is a minimally invasive technique that is used to achieve this with little disruption to surrounding anatomy and minimal complications. Indications: We present a 57-year-old woman with 3 months of left posterolateral ankle pain and subluxation after a hyper-inversion injury despite conservative management. Magnetic resonance imaging showed irregularities of the peroneal tendons. Physical examination demonstrated swelling of the posterolateral ankle with tenderness to palpation and crepitus over the peroneal tendons and weakness with eversion. With inconclusive MRI findings and physical examination findings concerning for peroneal pathology, peroneal tendoscopy is indicated to evaluate the injury and indication for accompanying procedures. Technique Description: The patient is placed in a semi-lateral decubitus position using a bean bag. External anatomic landmarks are identified for a 2-portal approach with the “nick and spread” technique used to form the openings and avoid neurovascular structures and minimize retinacular disruption. The scope and a probe are used to manipulate the tendons for circumferential visualization and evaluation for tears, adhesions, tenosynovitis, and other pathologies. Dynamic testing of peroneal tendon tracking is completed. The decision is made to convert to a targeted open procedure based on the extent of peroneal pathology. Results: Clinical studies of patients undergoing peroneal tendoscopy have shown excellent results, with most patients reporting excellent outcomes and no recurrent subluxation events. Patients return to athletic activities as early as 3 to 4 months from surgery. Rare minor complications have been reported, including iatrogenic tendon damage and peroneal sheath rupture. Discussion/Conclusion: Posterolateral ankle pain may be difficult to diagnose and manage as it is often missed on MRI evaluation. Peroneal tendoscopy is a safe and efficacious procedure to evaluate and treat refractory posterolateral ankle pain secondary to peroneal pathology. Due to its minimally invasive technique, few complications have been reported, and most patients report good or excellent results. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.