Surgical Outcomes after Superior Peroneal Retinaculum Repair without Bony Procedures for Chronic Peroneal Tendon Instability: A Consecutive Case Series.

Abstract

Although bony procedures tailored to retromalleolar groove morphology have been advocated to reduce recurrence in chronic peroneal tendon instability, concerns remain regarding tendon adhesion and procedure-related morbidity. Consequently, it remains unclear whether isolated superior peroneal retinaculum repair alone is sufficient across different fibular morphologies, providing the rationale for the present study. This study evaluated whether isolated superior peroneal retinaculum repair, without adjunctive bony procedures, can restore stability and function in chronic peroneal tendon instability while avoiding tendon adhesion risk. Level IV, retrospective cohort study METHODS: From September 2014 to December 2024, all patients with chronic peroneal tendon instability were treated with isolated superior peroneal retinaculum repair. Recurrence of instability, surgery-related complications, and functional outcomes were assessed by the Karlsson-Peterson score and the AOFAS Ankle-Hindfoot Scale. A total of 38 patients underwent superior peroneal retinaculum repair; 22 patients (23 ankles) had a minimum 12-month follow-up. The average follow-up duration was 20.7 months (range, 12.4-36.3 months). No patient experienced recurrent instability or postoperative complications, including nerve injury or wound problems. The mean Karlsson-Peterson score improved from 57.5 ± 20.4 preoperatively to 86.0 ± 10.0 postoperatively, and the mean AOFAS Ankle-Hindfoot Scale improved from 61.9 ± 19.1 to 88.9 ± 7.9. Superior peroneal retinaculum repair without bony procedures provided stable tendon reduction, significant functional improvement, and a low complication rate in chronic peroneal tendon instability, regardless of retromalleolar groove morphology. Level IV, retrospective cohort study.