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Peroneal tendon irritation after arthroscopic modified Broström procedure: A case report
Young Koo Lee1, Hong Seop Lee2, Whi Je Cho1
1Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, Wonmi-gu, Bucheon.
Rationale:
With the development of ankle arthroscope techniques and procedures, the number of arthroscopic modified Broström procedures (MBPs) is increasing. All-inside arthroscopic MBP was developed recently, with good to excellent results. However, several complications have been reported in patients after arthroscopic MBP. This case report describes a rare complication of arthroscopic MBP.
Patient Concerns:
A 34-year-old woman presented with severe pain in her right ankle and underwent arthroscopic MBP for lateral ankle instability. About 6 months postoperatively, she presented with severe pain on the lateral aspect of the right ankle, especially while walking.
Diagnosis:
In physical examinations, there was marked swelling around the ankle and focal tenderness in the posterolateral malleolar area. Ankle ultrasonography showed a diffuse low-echoic mass-like lesion at the distal fibula between the fibular tip and peroneus tendon. T1-weighted sagittal magnetic resonance imaging images showed an irregularly shaped mass-like lesion with a heterogeneous signal near the distal fibula posteriorly where the anchor protruded.
Interventions:
The suture anchor in the posterior distal fibula area, which had irritated the peroneus tendon, was removed with debridement of the granulomatous lesion.
Outcomes:
At the 3-month follow-up, the patient was almost asymptomatic and had a nearly full range of motion. No complications or recurrent symptoms were noted at the 1-year follow-up.
Lessons:
Three-dimensional computed tomography studies of the appropriate fibular depth and position of suture anchors are needed to standardize the procedure and reduce complications.
Insights
A rare complication following arthroscopic modified Broström procedure (MBP) involved a suture anchor irritating the peroneus tendon. Surgical removal of the anchor and debridement resolved the issue, leading to a full recovery.
Area of Science:
- Orthopedic surgery
- Arthroscopic procedures
- Ankle instability management
Background:
- Arthroscopic modified Broström procedure (MBP) is increasingly performed for lateral ankle instability.
- While generally successful, complications can arise after arthroscopic MBP.
- This case highlights a rare complication associated with this technique.
Observation:
- A patient developed severe lateral ankle pain and swelling 6 months post-arthroscopic MBP.
- Imaging revealed a mass-like lesion near the distal fibula where a suture anchor protruded.
- The anchor was found to be irritating the peroneus tendon.
Findings:
- Surgical intervention involved removing the problematic suture anchor and debriding a granulomatous lesion.
- Post-intervention, the patient experienced significant symptom relief.
- Follow-up at 3 months and 1 year showed no recurrent symptoms or complications.
Implications:
- This case underscores the importance of precise suture anchor placement in arthroscopic MBP.
- 3D CT imaging may be beneficial for pre-operative planning to avoid such complications.
- Standardizing anchor positioning can improve patient outcomes and reduce revision rates.
