[Pathological rupture of the distal peroneal retinaculum with dislocation of the peroneus longus tendon in a high jump champion : A 15-year case study].

BACKGROUND

Hypertrophy of the peroneal tubercle and/or a local cortisone injection promoted a pathological rupture of the distal peroneal retinaculum with dislocation of the peroneus longus tendon.

OBJECTIVE

Presentation of a distal peroneal retinaculum replacement using a periosteal flap after remodelling of the hypertrophied peroneal tubercle by creating the natural sulcus below it, which enable safe and permanent guidance of the peroneus longus tendon.

MATERIAL AND METHOD

A 21-year-old high jump athlete suffered a painful crack on the outer left foot while running a right hand curve without any trauma. Clinically, there was a painful, palpable reproducible dislocation of the peroneus longus tendon probably due to an extremely oversized peroneal tubercle. A local cortisone injection had been given 5 months previously because of local pain. The X‑ray, computed tomography (CT) and magnetic resonance imaging (MRI) examinations showed substantial hypertrophy of the left peroneal tubercle with a riding dislocation of the peroneus longus tendon on it. As conservative therapy was known to be insufficient, surgery was indicated.

RESULT

There was no recurrence over the course of 15 years. In the year following the operation, the patient became German champion in the high jump discipline and another 5 years later, German champion in the triple jump.

DISCUSSION

If hypertrophy of the peroneal tubercle and/or the local cortisone injection alone caused the pathological rupture of the distal retinaculum with dislocation of the tendon remained unclear. A secure and longstanding tendon guidance with restoration of full jumping strength can only be surgically achieved.