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

Background Surgery 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. Methods We 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. Results No 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). Conclusion In 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