Endoscopic treatment of intrasheath subluxation of peroneal tendons in a thirteen-year-old boy

Abstract

Intrasheath subluxation of peroneal tendons is a new clinical entity which can nowadays be treated by performing tendoscopy of peroneal tendons. Patients with no history of previous ankle injury usually complain of palpable and visible clicking during active maximum eversion and dorsifl exion of the foot and ankle, with no clinical reproduction of the symptoms. Two types of subluxation have been described: type A in which the tendons snap over one another and switch their relative positions with the peroneus longus tendon subluxating in front and medially of the peroneus brevis tendon, while in type B the peroneus longus tendon subluxates through a longitudinal split tear within the peroneus brevis tendon, with typically intact superior peroneal retinaculum in both cases. Dynamic ultrasonography may be helpful in confi rming the diagnosis, while magnetic resonance imaging and computed tomography can sometimes help determine the cause of subluxation and in preoperative planning because nonoperative treatment has proven unsuccessful. We present a case of a 13-year-old boy with type A subluxation of the peroneal tendons, which we successfully treated by performing tendoscopy of the peroneal tendons. The advantages of this minimally invasive surgery are better cosmetic results, less postoperative pain, faster postoperative rehabilitation, and higher patient satisfaction. It also carries the advantage of being easily converted to an open technique, if required.