Return to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic review.

PURPOSE: The aim of this study was to determine the outcome following different surgical treatment techniques in the treatment of peroneal tendon dislocation and to establish whether return to sports was achieved universally following the procedures. METHODS: A systematic review and best-evidence synthesis was performed. PubMed and EMBASE were searched for eligible studies. The last search was done in March 2015. Quality assessment of pooled data was performed using a modified Macleod scale and a best-evidence synthesis was performed. In total, 14 studies were included. RESULTS: Surgical treatment provides improvement in the post-operative AOFAS score (p < 0.0001) and high satisfaction rates. The redislocation rate is less than 1.5% at long-term follow-up. Patients treated with both groove deepening and SPR repair have higher rates of return to sports than patients treated with SPR repair alone (p = 0.022). CONCLUSIONS: Surgical treatment of peroneal tendon dislocation provides good outcomes, high satisfaction and a quick return to sports. Rates in return to sports are significantly higher in patients treated with both groove deepening and SPR repair. To optimize treatment, the surgical management should involve increasing the superior peroneal tunnel volume by groove deepening and stabilizing the tendons by SPR repair. LEVEL OF EVIDENCE: Level IV, systematic review of level IV studies.

Functional and ultrasonographic outcomes after surgical fibular tendon stabilisation by isolated re-tensioning of the superior fibular retinaculum.

BACKGROUND: Fibular tendon dislocation is a rare and usually sports-related injury. We report the functional and ultrasonographic outcomes of a simple technique for re-tensioning the superior fibular retinaculum. HYPOTHESIS: Our retinaculum re-tensioning technique is not followed by recurrent fibular tendon dislocation, as demonstrated by ultrasonography. MATERIAL AND METHOD: This single-centre single-surgeon retrospective study included 17 patients who underwent surgery to treat fibular tendon dislocation between January 2008 and December 2013. The functional outcome at last follow-up was assessed based on the AOFAS score. Subjective patient satisfaction and return to sports were recorded. Dynamic comparative ultrasonography was performed at last follow-up and the results used to separate the patients into four categories: normal, recurrent dislocation, subluxation, and residual tendinopathy. RESULTS: The 17 patients had a mean age of 32.6±9.7 years (range, 18-52 years) and a mean pre-operative AOFAS score of 59.9±11.3 (range, 34-71). Mean follow-up was 36.9±16.9 months (range, 12-60 months). The mean AOFAS score at last follow-up was 89±9.0 (range, 68-100). Of the 17 patients, 7 (41%) returned to the same level of sports. The remaining 10 patients returned to a lower level or did not return to sports, usually (70%) for personal or work-related reasons. Follow-up ultrasonography was normal in 12 (71%) patients. Of the remaining 5 patients, 2 had clinically silent recurrent dislocation and 3 had residual tendinopathy, including 1 who was only moderately satisfied due to persistent pain. Of the 4 patients who reported pain due to the knots in the non-absorbable sutures used to tighten the retinaculum, 1 required removal of the sutures. No other complications were recorded. Finally, 16 (94%) patients were satisfied or very satisfied. DISCUSSION: Retinaculum re-tensioning is effective in stabilising the fibular tendons, with no true recurrences. Ultrasonography can detect clinically silent subluxation. This simple and reproducible technique is associated with a very low complication rate and with excellent functional and anatomical outcomes. LEVEL OF EVIDENCE: Retrospective, level IV.

Lung metastases of diffuse giant cell tumour of the fibular tendon sheath at the ankle: A case report.

Diffuse giant cell tumours of the tendon sheaths are described in the literature as locally aggressive soft-tissue tumours. We report the case of a 56-year-old male with a history of multiple surgical procedures for a giant cell tumour of the fibular tendon sheath at the right ankle. The multiple recurrences prompted monitoring by positron-emission tomography, which showed lung tumours. Biopsies confirmed that the tumours were metastases from the giant cell tumour of the tendon sheath. In patients with recurrent and/or diffuse giant cell tumour, positron-emission tomography is an effective monitoring tool.