Modified bone block procedure with periosteal augmentation for peroneal tendon dislocation: a retrospective case series

Peroneal tendon dislocation is an uncommon but functionally limiting condition frequently affecting physically active individuals. The standard surgical treatment consists of superior peroneal retinaculum (SPR) repair, with or without fibular groove deepening. However, surgical failure may occur in selected patients with severe SPR deficiency, in whom isolated soft-tissue reconstruction may not provide sufficient mechanical stability. In this context, we therefore developed a modified bone block procedure combined with periosteal augmentation.

A retrospective case series was conducted including patients with peroneal tendon dislocation who underwent surgical treatment between 2005 and 2025. The procedure consisted of posterior translation and fixation of a contoured fibular bone block based on a modified DuVries osteotomy, combined with reconstruction using an inverted periosteal flap. Clinical outcomes were assessed preoperatively and at final follow-up using the American Orthopaedic Foot and Ankle Society (AOFAS) score, Short Form-12 (SF-12), visual analogue scale (VAS), Manchester-Oxford Foot Questionnaire (MOXFQ), Tegner activity score, and return-to-activity and return-to-sport rates.

During the study period, 12 patients underwent surgical treatment for peroneal tendon dislocation. One patient was lost to follow-up, leaving 11 patients in the final cohort. Significant improvements were observed in AOFAS (74.4 ± 15.2 to 89.7 ± 12.7, p = .002), SF-12 (89.1 ± 17.6 to 105.8 ± 9.7, p = .004), VAS (4.1 ± 3.4 to 1.5 ± 2.7, p = .004), MOXFQ scores (35.5 ± 25.4 to 9.7 ± 13.9, p = .003) and Tegner score (1.2 ± 0.6 to 3.4 ± 1.5, p < .001) at a mean follow-up of 68.2 months. All patients returned to daily activities, and those who participated in sports preoperatively resumed sports. No recurrence occurred. One patient experienced transient sural nerve irritation that resolved without intervention.

The modified bone block procedure with periosteal augmentation was associated with generally favorable clinical and functional outcomes in this study. This technique may represent a potential surgical option for selected patients with peroneal tendon dislocation, particularly in cases with severe superior peroneal retinaculum insufficiency in which direct SPR repair is not feasible.