title: Calcaneofibular Ligament Transfer for Recurrent Peroneal Tendon Subluxation in Pediatric and Young Adult Patients.
abstract: BACKGROUND
  Peroneal tendon subluxation is an uncommon cause of lateral ankle pain and instability but can be disabling for some young patients. Surgical management may be required to restore function for patients who fail nonoperative management. The purpose of this study was to determine the functional outcomes after surgical management of peroneal tendon subluxation in pediatric and adolescent patients.
  
  
  METHODS
  A retrospective review of patients presenting to our institution over a 10-year period yielded 18 cases of recurrent subluxation refractory to nonoperative management in 14 children or young adults (mean age 15.0 y). All patients failed nonoperative management and were treated operatively with isolated calcaneofibular ligament transfer to construct a new soft tissue restraint for the peroneal tendons. Patients were evaluated clinically and sent validated questionnaires, including the Foot and Ankle Ability Measure (FAAM) and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale.
  
  
  RESULTS
  All 18 ankles of 14 patients had minimum 2-year follow-up. Ten of 18 ankles (55.6%) returned the outcome surveys at an average of 5.7 years after the index procedure (range, 2. 0 to 9.7 y). The average FAAM activities of daily living score was 93.5 (±2.9) and the sports subscale was 77.8 (±6.1). The mean AOFAS subjective scaled score was 84.3 (±4.5). All patients returned to sports and recreational activity. Complications included 1 case of recurrent subluxation (1/18, 5.5%) treated with revision to a Chrisman-Snook procedure and 4 ankles (4/18, 22.2%) with stiffness or arthrofibrosis treated with a secondary procedure of peroneal tendon release or lysis of adhesions.
  
  
  CONCLUSIONS
  Surgical management with rerouting of the peroneal tendons under the calcaneofibular ligament appears to be safe and effective for young patients with chronic peroneal tendon subluxation. It provides a low rate of recurrent subluxation, excellent stability, and good long-term functional outcomes. However, the potential for postoperative stiffness appears to be a limitation to the procedure and necessitates aggressive physical therapy to maintain ankle motion.
  
  
  METHODS
  Level IV- retrospective case series.
authors: Harvard Medical School.
authors: Derek S
authors: DS
authors: Stenquist
authors: Harvard Combined Orthopaedic Residency Program.
authors: Tyler A
authors: TA
authors: Gonzalez
authors: Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Boston, MA.
authors: Frances A
authors: FA
authors: Tepolt
authors: Harvard Medical School.|Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Boston, MA.
authors: Dennis E
authors: DE
authors: Kramer
authors: Harvard Medical School.|Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Boston, MA.
authors: Mininder S
authors: MS
authors: Kocher
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013708:Tendon Injuries / Q000150:complications / Q000601:surgery*; D055815:Young Adult