title: Functional and ultrasonographic outcomes after surgical fibular tendon stabilisation by isolated re-tensioning of the superior fibular retinaculum.
abstract: Fibular tendon dislocation is a rare and usually sports-related injury. We report the functional and ultrasonographic outcomes of a simple technique for re-tensioning the superior fibular retinaculum.
  
  
  
  Our retinaculum re-tensioning technique is not followed by recurrent fibular tendon dislocation, as demonstrated by ultrasonography.
  
  
  
  This single-centre single-surgeon retrospective study included 17 patients who underwent surgery to treat fibular tendon dislocation between January 2008 and December 2013. The functional outcome at last follow-up was assessed based on the AOFAS score. Subjective patient satisfaction and return to sports were recorded. Dynamic comparative ultrasonography was performed at last follow-up and the results used to separate the patients into four categories: normal, recurrent dislocation, subluxation, and residual tendinopathy.
  
  
  
  The 17 patients had a mean age of 32.6±9.7 years (range, 18-52 years) and a mean pre-operative AOFAS score of 59.9±11.3 (range, 34-71). Mean follow-up was 36.9±16.9 months (range, 12-60 months). The mean AOFAS score at last follow-up was 89±9.0 (range, 68-100). Of the 17 patients, 7 (41%) returned to the same level of sports. The remaining 10 patients returned to a lower level or did not return to sports, usually (70%) for personal or work-related reasons. Follow-up ultrasonography was normal in 12 (71%) patients. Of the remaining 5 patients, 2 had clinically silent recurrent dislocation and 3 had residual tendinopathy, including 1 who was only moderately satisfied due to persistent pain. Of the 4 patients who reported pain due to the knots in the non-absorbable sutures used to tighten the retinaculum, 1 required removal of the sutures. No other complications were recorded. Finally, 16 (94%) patients were satisfied or very satisfied.
  
  
  
  Retinaculum re-tensioning is effective in stabilising the fibular tendons, with no true recurrences. Ultrasonography can detect clinically silent subluxation. This simple and reproducible technique is associated with a very low complication rate and with excellent functional and anatomical outcomes.
  
  
  
  Retrospective, level IV.
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, Paris, France. Electronic address: camchouf@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Choufani
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Rousseau
authors.affiliation: Service de radiologie ostéoarticulaire, Hôpital de la Pitié Salpêtrière, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Massein
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Pascal-Moussellard
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Khiami
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D001265:Athletic Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D017060:Patient Satisfaction; D012008:Recurrence; D012189:Retrospective Studies; D000068958:Return to Sport; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: Fibular tendon dislocation; Retinacular repair; Ultrasonography