The retromalleolar groove is the concave posterior surface of the lateral malleolus through which the peroneal tendons pass, converted into a fibro-osseous tunnel by the superior peroneal retinaculum. The groove depth determines the stability of peroneal tendon containment.
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| Landmarks |
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| Ossification | Part of the primary fibular ossification centre; the retromalleolar surface shape is determined by peroneal tendon mechanical remodelling during growth. |
A shallow or convex retromalleolar groove predisposes to peroneal tendon subluxation. Groove deepening (retromalleolar groove deepening procedure) is performed surgically for recurrent peroneal tendon dislocation by creating a deeper channel in the posterior fibular cortex. The groove is assessed on axial MRI at the level of the lateral malleolus tip.
A shallow or flat retromalleolar groove predisposes the peroneal tendons to dislocate over the lateral malleolus after retinacular injury.
The brevis tendon can split longitudinally as it is compressed against the fibular groove by peroneus longus.
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