Surgical Procedure
Releasing the peroneal tendon sheath and retinaculum with a punch
With a probe the tendons are dislocated and hooked behind the lateral malleolus.
Under direct vision, an additional portal is created approximately 4 cm proximal to the posterolateral portal
A shaver is introduced in the third portal and directed inferiorly
Anatomical dissection of groove deepening procedure, with a probe in the posterolateral portal, the arthroscope in the posteromedial portal, and the bonecutter shaver in the proximal posterior portal.
With the shaver, the peroneal groove is deepened under direct vision
Result of the groove deepening
The probe is released to reposition the tendons
End-result
Pearls & Pitfalls
General
For general pearls & pitfalls in hindfoot endoscopy, click here, or go to 'Standard 2-Portal Hindfoot Approach'.
Pitfall
Be cautious while deepening the fibular groove with respect to the ligamentous structures. Medially from the groove, the posterior syndesmotic ligaments and the posterior talofibular ligament are located. Follow the contour of the groove from proximal to distal. The calcaneofibular ligament inserts more anterior in the most distal part of the lateral malleolus. When shaving the groove distally and anteriorly, aim the shaver medial from the calcaneofibular ligament insertion