Use of the Tendoscopic Modified Das De Procedure for Recurrent Peroneal Tendon Dislocation

Category: Sports Introduction/Purpose: Traumatic peroneal tendon dislocation is an uncommon lesion that mainly affects young adults. It occurs most frequently during sports activities and generally during an ankle sprain. Unfortunately, most cases lead to recurrent peroneal tendon dislocation (RPTD). Therefore, most cases need operative treatments. Many surgical techniques for the treatment of RPTD have been described. One of the most popular operative procedures is the modified Das De procedure, which is the superior peroneal retinaculum (SPR) repair. Since 2014, we have performed the procedure along with tendoscopy. The purpose of this study is a preliminary report on the tendoscopic modified Das De procedure. Methods: We performed surgery for RPTD in 5 consecutive patients (4 men and 1 woman, mean age 21.4 years). All the patients were injured during sports activities. This procedure was performed with the patient in the lateral decubitus position. Two portals were made. Three anchors were inserted in the fibula. An 18-gauge needle, into which a shuttle relay had been looped (2-0 Prolene), was used to thread through the SPR. Six passes were made (Image), and the sutures were tightened in order to reattach the SPR to the fibula. A knotless anchor was screwed into the lateral aspect of the fibula to allow for suturing by using the bridge technique. For postoperative care, a short-leg cast was applied for 3 weeks. The patients were allowed partial and full weight bearing at 2 and 3 weeks, respectively. Evaluation parameters included the operation time, complications, return to regular sports activities, and recurrence. Results: The mean operation time was 88.8 minutes (range: 69–125 minutes), which was relatively longer than that of our previous open modified Das de procedure (mean: 40.0 minutes). However, compared with the initial cases, recent cases tended to have shorter surgical times. No complications occurred. All the patients could return to regular sports activities within 4 months after surgery. No recurrence was observed during the follow-up period (mean: 11.4 months; range: 9–14 months). Conclusion: The tendoscopic modified Das De procedure for RPTD required a longer operation time compared to open surgeries. However, the operation time is expected to be shortened as the surgeon gains experience. In addition, this procedure was not associated with any early severe complications and allowed patients to return to sports activities within a short period. Long-term studies involving a large number of cases are needed. However, this procedure is an attractive option because it is less invasive and has achieved similar results as those in open procedures.