He was taken to the operating room and placed in a supine position. After adequate general anesthesia introduced, popliteal block placed, IV antibiotics administered. Right ankle was prepped and draped in the usual sterile fashion. The leg was elevated, exsanguinated and the tourniquet inflated. An incision was made along the peroneal tendons. Blunt dissection was carried down through the subcutaneous tissue. The peroneal tendon sheath was identified and opened. It was noted to be evulsed off the posterior lateral corner. In the area of the evulsion, the peroneal tendons were inspected. The peroneus longus was normal. The peroneus brevis was flattened and torn. In fact, it had developed a pseudotendon sheath on the lateral aspect of the distal fibula.
At this point, the peroneus brevis was repaired with a running 3-0 PDS suture. Once this tubulization was completed, they were placed back behind the fibula. At this point, two 5-0 Stryker suture ankles were placed. The posterior aspect of the retinaculum and the posterior aspect of the fibula were roughened. The posterior arm of the retinaculum was then tied down back into the groove in the posterior portion of the fibula. This was carried out to the tip of the fibula approximately 3 cm proximal. Once this was completed, the addendum and excessive retinaculum pants-over-vest repaired with a 2-0 PDS suture. The foot was inverted and everted and showed good excursion of the tendons in the newly reconstructed tendon sheath.
The tourniquet was released at this time and hemostasis obtained with electrocautery. The overlying peroneal tendon sheath was repaired with additional 3-0 PDS. Subcuticular tissue was closed with 3-0 Vicryl and skin closed with 4-0 Nylon. The incisional areas were injected with high percent Marcaine, sterile dressing applied, including a posterior splint. Overall, the patient tolerated the procedure well.