Tendoscopic Double-Row Suture Bridge Peroneal Retinaculum Repair for Recurrent Dislocation of Peroneal Tendons in the Ankle  Akinobu Nishimura, M.D., Ph.D., Shigeto Nakazora, M.D., Ph.D., Naoya Ito, M.D., Aki Fukuda, M.D., Ph.D., Ko Kato, M.D., Ph.D., Akihiro Sudo, M.D., Ph.D.  Arthroscopy Techniques  Volume 5, Issue 3, Pages e441-e446 (June 2016) DOI: 10.1016/j.eats.2016.01.028 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Landmarks and portals: proximal portal (portal 1) and distal portal (portal 2). Portal 1 is placed 2 fingerbreadths proximal to the lateral malleolus tip. Portal 2 is placed 1 fingerbreadth distal to the lateral malleolus tip. Arthroscopy Techniques 2016 5, e441-e446DOI: (10.1016/j.eats.2016.01.028) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) Macroscopic findings showing saline solution injection under ultrasonographic guidance. (B) Ultrasonographic findings. Before a skin incision is made, the position of the peroneal tendons is checked by ultrasound. Some saline solution is injected into the peroneal tendon sheath under ultrasound assistance to introduce the arthroscope into the peroneal tendon sheath. (N, needle; PT, peroneal tendon.) Arthroscopy Techniques 2016 5, e441-e446DOI: (10.1016/j.eats.2016.01.028) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Tendoscopic findings of false pouch (FS). The arthroscope is used in portal 1 and the instruments in portal 2. (FCR, fibrous cartilaginous ridge; PBT, peroneal brevis tendon; PLT, peroneal longus tendon.) Arthroscopy Techniques 2016 5, e441-e446DOI: (10.1016/j.eats.2016.01.028) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Cleaning of lateral surface of lateral malleolus (LM). The lateral surface of the LM under a false pouch is slightly roughened with an arthroscopic burr (AB). Arthroscopy Techniques 2016 5, e441-e446DOI: (10.1016/j.eats.2016.01.028) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Insertion of suture anchor. The arrowheads indicate the drill guide. Suture anchors (1.4-mm JuggerKnot) are inserted into the fibrocartilaginous ridge (FCR) through the portals. Arthroscopy Techniques 2016 5, e441-e446DOI: (10.1016/j.eats.2016.01.028) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Shuttle relay passing through superior peroneal reticulum. An 18-gauge needle, into which a shuttle relay has been looped (No. 2-0 Prolene), is used as a suture lasso to thread through the skin and the superior peroneal retinaculum. (FCR, fibrocartilaginous ridge; FP, false pouch.) Arthroscopy Techniques 2016 5, e441-e446DOI: (10.1016/j.eats.2016.01.028) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Macroscopic findings showing 6 sutures through superior peroneal retinaculum. Three suture anchors are inserted into the fibula, and all 6 threads penetrate the superior peroneal retinaculum and the skin. Arthroscopy Techniques 2016 5, e441-e446DOI: (10.1016/j.eats.2016.01.028) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Suture bridge using knotless anchor. All anchor threads are passed into the eyelet of a knotless anchor. The threads are pulled to the desired tension, and the anchor is inserted into the fibula. Arthroscopy Techniques 2016 5, e441-e446DOI: (10.1016/j.eats.2016.01.028) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions