{"id":2094,"date":"2025-11-01T07:21:10","date_gmt":"2025-11-01T07:21:10","guid":{"rendered":"https:\/\/suzhouyoubest.com\/?p=2094"},"modified":"2025-11-01T07:21:10","modified_gmt":"2025-11-01T07:21:10","slug":"diagnosis-and-surgical-management-of-peroneal-tendon-subluxation-with-anterior-talofibular-ligament-atfl-injury","status":"publish","type":"post","link":"https:\/\/suzhouyoubest.com\/zh\/diagnosis-and-surgical-management-of-peroneal-tendon-subluxation-with-anterior-talofibular-ligament-atfl-injury\/","title":{"rendered":"Diagnosis and Surgical Management of Peroneal Tendon Subluxation with Anterior Talofibular Ligament (ATFL) Injury"},"content":{"rendered":"<p><strong>Meta Description:<\/strong><\/p>\n\n\n\n<p>This article explores the <strong>diagnosis and treatment of peroneal tendon subluxation with ATFL tear<\/strong>, including detailed surgical techniques such as <strong>peroneal groove deepening, SPR repair, and modified Brostr\u00f6m-Gould reconstruction<\/strong>, following the latest <strong>SCARE 2023 guidelines<\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"266\" src=\"https:\/\/suzhouyoubest.com\/wp-content\/uploads\/2025\/11\/7c6139f2-22ca-4c85-bc44-722b52e8b9c9-1024x266.png\" alt=\"\" class=\"wp-image-2097\" srcset=\"https:\/\/suzhouyoubest.com\/wp-content\/uploads\/2025\/11\/7c6139f2-22ca-4c85-bc44-722b52e8b9c9-1024x266.png 1024w, https:\/\/suzhouyoubest.com\/wp-content\/uploads\/2025\/11\/7c6139f2-22ca-4c85-bc44-722b52e8b9c9-300x78.png 300w, https:\/\/suzhouyoubest.com\/wp-content\/uploads\/2025\/11\/7c6139f2-22ca-4c85-bc44-722b52e8b9c9-768x200.png 768w, https:\/\/suzhouyoubest.com\/wp-content\/uploads\/2025\/11\/7c6139f2-22ca-4c85-bc44-722b52e8b9c9-1536x399.png 1536w, https:\/\/suzhouyoubest.com\/wp-content\/uploads\/2025\/11\/7c6139f2-22ca-4c85-bc44-722b52e8b9c9.png 1670w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Understanding the Pathophysiology<\/strong><\/h2>\n\n\n\n<p>Among the most frequent <strong>orthopedic emergencies<\/strong>, ankle injuries remain a diagnostic challenge. <strong>Peroneal tendon subluxation<\/strong>, often misdiagnosed as a simple ankle sprain, leads to persistent posterolateral pain and instability. Meanwhile, <strong>anterior talofibular ligament (ATFL) tears<\/strong> are the most common cause of chronic lateral ankle instability, accounting for nearly <strong>75% of lateral ankle injuries<\/strong>.<\/p>\n\n\n\n<p>In athletes and active adults, both lesions can coexist. <strong>Peroneal tendon instability<\/strong> results from <strong>superior peroneal retinaculum (SPR)<\/strong> rupture or avulsion, allowing the tendon to dislocate from its fibular groove during dorsiflexion and eversion. When left untreated, this condition progresses to chronic pain and functional impairment.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Clinical Presentation and Diagnostic Approach<\/strong><\/h2>\n\n\n\n<p>Patients typically present with:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Persistent <strong>lateral ankle swelling and tenderness<\/strong><\/li>\n\n\n\n<li>Pain aggravated by inversion or eversion<\/li>\n\n\n\n<li>Positive <strong>anterior drawer<\/strong> and <strong>peroneal subluxation<\/strong> tests<\/li>\n<\/ul>\n\n\n\n<p>MRI remains the <strong>gold standard<\/strong> for confirming:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ATFL rupture<\/li>\n\n\n\n<li>Peroneal tendinitis and subluxation<\/li>\n\n\n\n<li>Inflammatory changes or SPR tears<\/li>\n<\/ul>\n\n\n\n<p>Dynamic MRI or ultrasound during dorsiflexion and eversion enhances diagnostic precision by visualizing real-time tendon instability.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Surgical Technique Overview<\/strong><\/h2>\n\n\n\n<p>The case involves a 47-year-old female patient with <strong>peroneal tendon subluxation and ATFL tear<\/strong>, treated through <strong>open surgical repair<\/strong>. The operative sequence included:<\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li><strong>Debridement and Tubularization<\/strong> \u2013 Removal of degenerated tendon tissue, followed by tubular reshaping for mechanical stability.<\/li>\n\n\n\n<li><strong>Peroneal Groove Deepening<\/strong> \u2013 Using bone flap elevation and cancellous compression to create an 8 mm deepened groove for stable tendon seating.<\/li>\n\n\n\n<li><strong>SPR Reconstruction<\/strong> \u2013 Restoring retinacular continuity to prevent recurrent dislocation.<\/li>\n\n\n\n<li><strong>Modified Brostr\u00f6m-Gould Repair<\/strong> \u2013 Anatomical ATFL reconstruction with a 2.9 mm suture anchor, reinforced with the inferior extensor retinaculum.<\/li>\n<\/ol>\n\n\n\n<p>Postoperatively, pain management was achieved with ketorolac injections, followed by progressive <strong>rehabilitation emphasizing ROM, proprioception, and gait training<\/strong>.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Postoperative Rehabilitation and Functional Outcome<\/strong><\/h2>\n\n\n\n<p>A structured <strong>three-phase recovery protocol<\/strong> was implemented:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Weeks 0\u20132:<\/strong> Non-weight bearing; passive ankle motion within pain tolerance.<\/li>\n\n\n\n<li><strong>Weeks 3\u20136:<\/strong> Gradual weight-bearing and proprioceptive training.<\/li>\n\n\n\n<li><strong>Weeks 7+:<\/strong> Strengthening, agility drills, and single-leg hop testing.<\/li>\n<\/ul>\n\n\n\n<p>At the 7-week mark, the patient achieved a <strong>FADI score improvement from 54 to 101<\/strong>, demonstrating excellent functional recovery with no recurrence or instability.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Discussion: Brostr\u00f6m-Gould vs Arthroscopic Techniques<\/strong><\/h2>\n\n\n\n<p>The <strong>modified Brostr\u00f6m-Gould procedure<\/strong> remains the <strong>gold standard<\/strong> for ATFL reconstruction due to its simplicity and high success rate. However, recent studies suggest that <strong>arthroscopic Brostr\u00f6m-Gould repair<\/strong> offers similar outcomes with:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Minimal soft tissue trauma<\/li>\n\n\n\n<li>Faster ROM recovery<\/li>\n\n\n\n<li>Lower postoperative pain<\/li>\n<\/ul>\n\n\n\n<p>In this case, open repair was selected due to <strong>equipment limitations<\/strong>, yet the results affirm that <strong>open techniques remain effective<\/strong> when executed with precision and anatomical restoration.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Clinical Takeaways<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Up to <strong>77% of chronic lateral ankle instability<\/strong> cases involve concomitant <strong>peroneal tendon pathology<\/strong>.<\/li>\n\n\n\n<li><strong>MRI<\/strong> is essential for differentiating subluxation from ligamentous injury.<\/li>\n\n\n\n<li>Combining <strong>groove deepening, SPR repair, and ATFL reconstruction<\/strong> ensures durable stability.<\/li>\n\n\n\n<li>Postoperative rehabilitation is crucial for restoring proprioception and preventing recurrence.<\/li>\n<\/ul>\n\n\n\n<p>For further reading, refer to the <a href=\"https:\/\/www.aaos.org\/\"><strong>American Academy of Orthopaedic Surgeons (AAOS)<\/strong><\/a><strong><\/strong> guidelines on ankle instability management.<\/p>","protected":false},"excerpt":{"rendered":"<p>Meta Description: This article explores the diagnosis and treatment of peroneal tendon subluxation with ATFL tear, including detailed surgical techniques such as peroneal groove deepening, SPR repair, and modified Brostr\u00f6m-Gould reconstruction, following the latest SCARE 2023 guidelines. Understanding the Pathophysiology Among the most frequent orthopedic emergencies, ankle injuries remain a diagnostic challenge. Peroneal tendon subluxation, [&hellip;]<\/p>","protected":false},"author":1,"featured_media":2097,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_seopress_robots_primary_cat":"none","_seopress_titles_title":"Diagnosis and Surgical Management of Peroneal Tendon Subluxation with Anterior Talofibular Ligament (ATFL) Injury","_seopress_titles_desc":"This article explores the diagnosis and treatment of peroneal tendon subluxation with ATFL tear, including detailed surgical techniques such as peroneal groove deepening, SPR repair, and modified Brostr\u00f6m-Gould reconstruction, following the latest SCARE 2023 guidelines.","_seopress_robots_index":"","footnotes":""},"categories":[1],"tags":[690,688,687,686,681,691,694,684,692,689,682,693,683],"class_list":["post-2094","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-ankle-instability","tag-ankle-rehabilitation","tag-ankle-surgery","tag-atfl-tear","tag-lateral-ligament-repair","tag-modified-brostrom-gould","tag-mri-diagnosis","tag-orthopedic-case","tag-orthopedic-techniques","tag-peroneal-groove-deepening","tag-peroneal-tendon-subluxation","tag-scare-2023","tag-superior-peroneal-retinaculum"],"acf":[],"meta_box":[],"_links":{"self":[{"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/posts\/2094"}],"collection":[{"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/comments?post=2094"}],"version-history":[{"count":1,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/posts\/2094\/revisions"}],"predecessor-version":[{"id":2098,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/posts\/2094\/revisions\/2098"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/media\/2097"}],"wp:attachment":[{"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/media?parent=2094"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/categories?post=2094"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/tags?post=2094"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}