The Role of Fibrocartilage Preservation in Retromalleolar Groove Deepening for Peroneal Tendon Instability

BackgroundSurgery is often indicated for peroneal tendon dislocation as conservative treatment carries a high recurrence rate. Direct retromalleolar groove deepening removes the fibrocartilage layer, whereas fibrocartilage-preserving techniques are more complex and their clinical benefit is uncertain. This study compared outcomes between these approaches for peroneal tendon instability.MethodsWe retrospectively reviewed 54 patients (21 direct, 33 fibrocartilage-preserving) who underwent retromalleolar groove deepening with ≥6 months follow-up. Outcomes were residual symptoms, recurrent instability, revision surgery, and return to activity. Analyses were descriptive, reporting effect sizes with 95% confidence intervals.ResultsNo statistically significant differences were detected between direct and fibrocartilage-preserving techniques in residual symptoms (52.4% vs 63.6%, P = .75), recurrent instability (4.8% vs 6.1%, P = .64), revision surgery (4.8% vs 3.0%, P = .55), or return to preoperative activity among those active pre-injury (40.0% vs 44.4%, P = 1.00).ConclusionIn this retrospective cohort, direct groove deepening achieved outcomes comparable to fibrocartilage-preserving techniques while offering a simpler procedure. High residual symptom rates in both groups suggest that factors beyond fibrocartilage integrity may be relevant for outcome.Level of Evidence:Level III.