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.