The Role of Fibrocartilage Preservation in Retromalleolar Groove Deepening for Peroneal Tendon Instability

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Surgery is often indicated for peroneal tendon dislocation as conservative treatment carries a high recurrence rate. Numerous surgical approaches have been described to stabilize the peroneal tendons, including direct groove deepening, a technique that concomitantly also strips the fibrocartilage layer within the retromalleolar groove. The purpose of this study was to compare the clinical outcomes between patients who underwent direct groove deepening as compared to those who underwent more traditional fibrocartilage-preserving procedures for peroneal tendon pathology. We hypothesized that there would be no significant outcome differences between the two techniques. Methods: This retrospective cohort study included 54 patients (aged 18-90 years) who underwent retromalleolar groove deepening. Outcomes assessed included residual symptoms, recurrence of pain and/or dislocation, revision surgery, and return to preoperative activity level, with a minimum follow-up of 6 months. Results: Of the 54 patients, 21 underwent direct groove deepening and 33 underwent fibrocartilage preservation. No significant outcome differences were observed between the two groups with respect to rate of residual symptoms (52.4% vs. 63.6%), recurrent instability (4.6% vs. 6.1%), need for revision surgery (4.6% vs 3.0%), or return to preoperative activity level (40.0% vs. 44.4%). Conclusion: Direct retromalleolar groove deepening appears to provide clinical outcomes that are comparable to more traditional fibrocartilage preserving techniques in short term follow-up, while also simplifying the surgical approach and reducing operative time. The high rate of residual symptoms in both groups, however, suggests that factors beyond integrity of the fibrocartilage layer likely play an important role in patient outcomes. Retromalleolar Groove Deepening Data Tables Normality test, T-test, and Outcome Data comparison for preservation or no preservation of the retromalleolar groove.