Pathological rupture of the distal peroneal retinaculum with dislocation of the peroneus longus tendon in a high jump champion : A 15-year case study

Background: Hypertrophy of the peroneal tubercle and/or a local cortisone injection promoted a pathological rupture of the distal peroneal retinaculum with dislocation of the peroneus longus tendon.

Objective: Presentation of a distal peroneal retinaculum replacement using a periosteal flap after remodelling of the hypertrophied peroneal tubercle by creating the natural sulcus below it, which enable safe and permanent guidance of the peroneus longus tendon.

Methods: A 21-year-old high jump athlete suffered a painful crack on the outer left foot while running a right hand curve without any trauma. Clinically, there was a painful, palpable reproducible dislocation of the peroneus longus tendon probably due to an extremely oversized peroneal tubercle. A local cortisone injection had been given 5 months previously because of local pain. The X‑ray, computed tomography (CT) and magnetic resonance imaging (MRI) examinations showed substantial hypertrophy of the left peroneal tubercle with a riding dislocation of the peroneus longus tendon on it. As conservative therapy was known to be insufficient, surgery was indicated.

Results: There was no recurrence over the course of 15 years. In the year following the operation, the patient became German champion in the high jump discipline and another 5 years later, German champion in the triple jump.

Conclusions: If hypertrophy of the peroneal tubercle and/or the local cortisone injection alone caused the pathological rupture of the distal retinaculum with dislocation of the tendon remained unclear. A secure and longstanding tendon guidance with restoration of full jumping strength can only be surgically achieved.