1. Intrasheath Subluxation of the Peroneal Tendons by Steven M. Raikin JBJS Essent Surg Tech Volume os-91(Supplement 2 Part 1):146-155 March 1, 2009 ©2009 by The Journal of Bone and Joint Surgery, Inc.

2. View of the lateral aspect of the ankle with the fibula (dotted lines) and peroneal tendons (solid blue lines) marked out. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

3. In extra sheath (standard) peroneal subluxation, the peroneal retinaculum is elevated off the fibula and the peroneal tendons come to lie within this pouch, out of their natural groove. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

4. The incision into the retinaculum is made, leaving a 1-mm rim of retinacular tissue remaining attached to the fibula. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

5. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

6. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

7. In this T1-weighted axial magnetic resonance imaging study, the peroneal tendons are reduced posterior to the fibula. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

8. The fibro-osseous sheath is osteotomized with a thin sliver of bone off the posterior aspect of the fibula. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

9. The fibro-osseous sheath is then reflected, exposing the underlying cancellous bone. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

10. A 3-mm round burr is used to deepen the peroneal groove. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

11. A 7 to 9-mm segment of bone is removed to adequately deepen the groove. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

12. A bone tamp is utilized to gently reduce the fibro-osseous sheath back down to the deepened floor of the peroneal groove. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

13. Four drill-holes are made along the anterior edge of the roof of the deepened groove. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

14. The peroneal retinaculum is reattached to the undersurface of the anterior lip of the groove with nonabsorbable suture. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

15. The sutures are not tied until they are all placed, and they are used to pull the retinaculum down under the anterior edge for reattachment. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

16. A line drawing demonstrating the repaired peroneal retinaculum attached under the deep anterior surface of the groove with use of a pants-over-vest suture repair. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

17. The retinacular rim that remained attached to the fibula when the sheath was opened is mobilized and repaired back to the reconstructed retinaculum in a reefed configuration, creating a double row repair. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.

18. A line drawing demonstrating a cross-sectional view of the deepened groove with the peroneal tendons reduced and the retinaculum repaired under the roof of the groove. Steven M. Raikin J Bone Joint Surg Am 2009;os-91:146-155 ©2009 by The Journal of Bone and Joint Surgery, Inc.