Tendoscopic Advantages for Managing Peroneal Intrasheath Subluxations

Abstract

Aim: Peroneal intrasheath subluxations are recalcitrant to nonsurgical management. Surgical treatment can be either open or tendoscopic. This study aimed to explore the advantages of tendoscopic treatment for peroneal intrasheath subluxations. Materials and methods: Patients who underwent peroneal tendoscopy to treat the intrasheath subluxations in our department between January 2013 and December 2020 were included in the study. The procedures were performed in a standardized fashion, in a lateral decubitus position, with a 4.5-mm and 30-degree arthroscope, gravity irrigation system, and standard arthroscopic instruments. A thigh tourniquet was always set in place but was not inflated in all patients. The procedures were performed consistently through standard portals described by van Dijk and Kort. The performed procedures included removing low-lying peroneus brevis muscle belly (LLMB), removing peroneus quartus (PQ) muscle, or retrofibular groove deepening. Results: Eleven consecutive patients (5 males and 6 females) with a mean age of 20.0 (range 10–40) years were included in the study. Low-lying peroneus brevis muscle belly was identified in nine patients, while PQ muscle was identified in one case. A flat or convex retrofibular groove was noticed in three cases, one of them without any evident space-occupying lesions. No perioperative complications were reported. The mean American Orthopedic Foot and Ankle Society (AOFAS) score increased from 81 preoperatively to 99 postoperatively. Conclusion: Although some believe that peroneal tendoscopy is a highly technically demanding procedure with limited utility, its efficacy and safety were demonstrated in this study supported by published literature results. Therefore, we believe that it is the method of choice for treating intrasheath peroneal subluxations. Clinical significance: The results of this study suggest that peroneal tendoscopy could be effectively used for treatment of peroneal intrasheath subluxations, as it has been used for the treatment of various peroneal tendons’ pathology.

Keywords

• intrasheath subluxation
• peroneal tendons
• tendoscopy