The superior peroneal retinaculum (SPR) is the fibrous band from the posterolateral fibula to the calcaneal lateral wall that maintains the peroneal tendons in their retromalleolar groove. It forms a fibro-osseous tunnel with the fibular retromalleolar sulcus. The SPR has been classified into four types based on the configuration of its fibrocartilaginous lip — the ridge of fibrocartilage at the posterior fibular edge that deepens the groove. SPR incompetence from traumatic avulsion or lax retinaculum allows peroneal tendon dislocation.
Acute peroneal tendon dislocation from ankle dorsiflexion inversion injury tears or avulses the SPR from the fibula, producing a 'snap' with the tendons displacing anteriorly over the fibular tip. The Eckert and Davis classification grades SPR injuries: Grade I (fibrocartilaginous lip stripped from fibular periosteum), Grade II (fibrous lip avulsed with periosteum), Grade III (bony fibular avulsion), Grade IV (superior retinaculum stripped from the calcaneus). Surgical repair of acute Grade I-III SPR tears to the fibular periosteum prevents recurrent peroneal dislocation.
Ankle inversion with sudden peroneal contraction strips the superior peroneal retinaculum fibrocartilaginous lip from the fibular periosteum, allowing the peroneal tendons to snap anteriorly over the fibular tip; acute SPR repair within 2 weeks through a posterolateral incision prevents chronic recurrent dislocation with its associated peroneal tendon splits.
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