Preliminary results of calcaneofibular ligament transfer for recurrent peroneal subluxation in children and adolescents.

BACKGROUND

Subluxation of the peroneal tendons over the lateral malleolus is an uncommon condition in both pediatric and adult populations. The primary dislocation is thought to occur with rupture of the superior peroneal retinaculum and may be associated with marginal fractures of the lateral malleolus or a preexisting shallow groove inferiorly. Various operative techniques have been reported earlier, but little data exists regarding surgical management and outcome in a pediatric and adolescent population with open physes.

METHODS

A retrospective review of patients presenting to our institution over a 5-year period yielded 9 cases of recurrent peroneal subluxation refractory to nonoperative management in 7 children or adolescents (mean age 12 y). Both traumatic and atraumatic etiologies were represented. All patients failed nonoperative treatment and were treated operatively with calcaneofibular ligament (CFL) transfer to reroute the peroneal tendons underneath the CFL. All patients were observed in follow-up and sent validated outcomes questionnaires, including the Foot and Ankle Ability Measure and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale.

RESULTS

Mean clinical follow-up was 20.9 months (range: 12 to 35 mo). At follow-up, all patients had returned to sports and activity and there were no instances of recurrence of subluxation. Complications included 1 postoperative infection and 1 patient requiring revision surgery for fibrosis. Six of 9 ankles (66.6%) returned the outcomes surveys. The average Foot and Ankle Ability Measure activities of daily living score was 90.8 (±4.4) and the sports subscale was 62.5 (±9.3). The mean American Orthopaedic Foot and Ankle Society score was 86 (±3.2).

CONCLUSIONS

Peroneal subluxation is an uncommon condition in pediatric and adolescent athletes. CFL transfer over the peroneal tendons should be considered as it provides excellent stability, a low rate of recurrent subluxation, and good functional outcomes without risk of injury to the distal fibular physis which can occur with distal fibular osteotomy or groove deepening procedures.

LEVEL OF EVIDENCE

IV (Case series).