Peroneal Groove Deepening for Subluxation of the Peroneal Tendons plus Brostrom-Gould Ankle Ligament Repair

Steven M. Raikin, MD and Levon N. Nazarian, MD

Many patients with symptoms and mechanisms consistent with subluxation of the peroneal tendons do not have reproducible clinical signs or objective studies to confirm the diagnosis. Most radiographic studies, such as MRI or CT scans, are static and do not facilitate the diagnosis of a motility disorder of the tendons. In this video supplement, Dr. Levon N. Nazarian of the Rothman Institute demonstrates the reliability and accuracy of dynamic testing of the peroneal tendons under ultrasound visualization and shows how the peroneal tendons remain within the intact peroneal retinaculum, but the brevis and longus tendons reverse their anatomic locations within the peroneal groove, causing reproducible painful symptoms. Dr. Steven M. Raikin, also of the Rothman Institute, then demonstrates the surgical technique for correction of the intrasheath subluxation with a peroneal groove-deeping and retinacular reefing procedure (combined with a tendon repair). The procedure is designed to restore the anatomic concavity of the retrofibular region in which the peroneal tendons run. The superior peroneal retinaculum is then repaired and reattached to the deep portion of the new groove through drill-holes in a reefed configuration.

Material Covered

  • Ultrasound Diagnosis
  • Retrofibular Sheath Osteotomy
  • Retinacular Repair
  • Brostrøm-Gould Ligament Repair
  • Pitfalls and Pearls
  • Postoperative Protocol
Click on any of the images below for a larger view:

See the Corresponding JBJS Article:
Steven M. Raikin, Ilan Elias, and Levon N. Nazarian
Intrasheath Subluxation of the Peroneal Tendons
J. Bone Joint Surg. Am., May 2008; 90: 992 – 999. [Article]
Steven M. Raikin
Intrasheath Subluxation of the Peroneal Tendons. Surgical Technique
J. Bone Joint Surg. Am., Mar 2009; 91: 146 – 155. [Article]
  • Total Run Time: 36:08 minutes
  • Catalog Number: 1030
  • VJO Publication Date: March, 2009