Peroneal Deepening Procedure with Low Profile Screws in Chronic Peroneal Tendon Dislocation

Transcription

1 2015 AOFAS e-poster Peroneal Deepening Procedure with Low Profile Screws in Chronic Peroneal Tendon Dislocation Jae Wan Suh, MD, Seung Hwan Han, MD, PhD, Jin Woo Lee, MD, PhD Kwang Hwan Park, MD, PhD, Woo Jin Choi, MD, PhD Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea

2 YUMC Foot & Ankle Service NO CONFLICT TO DISCLOSE < Peroneal Deepening Procedure with Low Profile Screws in Chronic Peroneal Tendon Dislocation> < Jae Wan Suh, MD> My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Introduction Peroneal Tendon Dislocation Relatively uncommon disorder, often misdiagnosed to ankle sprain Mechanism Dorsi-flexion of the foot with powerful contraction of the peroneus tendon Inversion injury with the foot in plantar flexion (stretch or avulse the Superficial peroneal retinaculum(spr)) Convex or flat posterior fibular space Chronic irritation or tear of peroneal tendon Fibro-osseous tunnel Anterior wall Fibula Lateral wall Superior Peroneal Retinaculum (primary restraint to instability)

4 Treatment Conservative treatment Surgical Treatment Introduction Rerouting of tendon Soft tissue reconstruction(spr reattachment/reconstruction) Bony Procedure Bone block procedure Groove deepening procedure - Anatomical restoration of fibular - Intratendinous stress diminishing - Low recurrence - Promising clinical results has been gaining popularity recently Lew C. Schon, FAI, 2005

5 Spin Screw Introduction 2 mm diameter Small screw head Thickness 1 mm Diameter 4 mm Embeding Head Snap off screw Self tapping Commonly used for Weil Osteotomy We propose a novel way to perform peroneal groove deepening using 2 snap-off Spin Screws to securely fix the fibrocartilaginous flap which prevents reduction loss.

6 Materials and Methods Chronic Peroneal Tendon Dislocation Consecutive 21 patients (Level III study) M:F = 17:4 Mean Age = 31.4 year (18-66) Mean follow up period = 1.5 years Patient Evaluation AOFAS score Patient Satisfaction <Dorsiflexion-Eversion> Diagnosis - Provocation Test (Dorsiflexion-Eversion) - MRI Evaluating the status of peroneal tendon Other adjacent soft tissue evaluation

7 Materials and Methods Operative procedure After observing the posterior peroneal groove, a window-shaped flap was designed at 3cm proximal to the distal tip of the peroneous. The corticocancellous flap with cartilage was raised using small osteotome. After removing 5mm of underlying cancellous bone with a burr, the flap was fixed with two snap-off Spin screws Tendon stability was confirmed with an ankle dorsiflexion-eversion test, and the SPR was repaired. Postoperative Care Short leg cast or boot brace : 4 weeks Muscle Strengthening Exercise : 4 weeks Low level exercise : allowing after 8 weeks High level exercise : allowing after 12 weeks

8 Operative Procedure 5 mm

9 Results AOFAS Score Preop. : 72 (52-90) Postop. : 96 (78-100) (p<0.05) Combined operation Peroneal tendon tubalization : 4 cases Hardware removal : 1 case Excellent : 7 Good : 4 Fair : 2 Poor : 0 Patient Satisfaction 85%(11/13) Postop. Complication Spin screw removal d/t malposition : 1 case No recurrence until last follow up No peroneal irritation by screw

10 Discussion Brent KO et al. Simple compression of fibrocartilage flap No fixation method Unstable flap Lew LC et al. Transosseous suture fixation for fibrocartilage flap Technically hard method Unstable flap Markus W et al. Combined Method Technically simple Not secure the fibrocartilage flap stability Unstable flap

11 Conclusion Authors Consideration Previous methods Unstable(?) fibrocartilage flap Technically complicated method No proper radiographic assessment Designing new operative method using two spin screws internal fixation Peroneal deepening using two Spin screws may be simpler, more rigid fixation than other methods leads to a faster rehabilitation & resumption of athletic activities

12 Reference 1. Adachi, N; Fukuhara, K; Tanaka, H; Nakasa, T; Ochi, M: Superior retinaculoplasty for recurrent dislocation of peroneal tendons. Foot Ankle Int. 27(12): , Heckman, DS; Reddy, S; Pedowitz, D; Wapner, KL; Parekh, SG: Operative treatment for peroneal tendon disorders. J Bone Joint Surg Am. 90(2): , Ogawa, BK; Thordarson, DB: Current concepts review: peroneal tendon subluxation and dislocation. Foot Ankle Int. 28(9): , Ogawa, BK; Thordarson, DB; Zalavras, C: Peroneal tendon subluxation repair with an indirect fibular groove deepening technique. Foot Ankle Int. 28(11): , Porter, D; McCarroll, J; Knapp, E; Torma, J: Peroneal tendon subluxation in athletes: fibular groove deepening and retinacular reconstruction. Foot Ankle Int. 26(6): , Raikin, SM; Elias, I; Nazarian, LN: Intrasheath subluxation of the peroneal tendons. J Bone Joint Surg Am. 90(5): , Rosenfeld, P: Acute and chronic peroneal tendon dislocations. Foot Ankle Clin. 12(4): , vii, Title, CI; Jung, HG; Parks, BG; Schon, LC: The peroneal groove deepening procedure: a biomechanical study of pressure reduction. Foot Ankle Int. 26(6): , Walther, M; Morrison, R; Mayer, B: Retromalleolar groove impaction for the treatment of unstable peroneal tendons. Am J Sports Med. 37(1): , 2009.