Groove deepening vs Fibular Osteotomy for Peroneal Tendon Injury

Hi Everyone, I was wondering if anyone had experience with surgery for Peroneal tendon subluxation. I have an injury to my superior peroneal retinaculum. The Retinaculum basically peeled off my fibula during a rock climbing injury. I was doing a “ballancy” move with all my weight on my left foot turned outward. I heard a pop and my peroneal tendon went over my fibula. It’s been about 9 months since the injury and i still get subluxation from time to time.

My orthopedic surgeon is recommending a soft tissue repair and a fibular osteotomy. The osteotomy is where they literally cut off your outside ankle bone (fibula) and screw it back on lower so it creates a groove for the peroneal tendon. This is is contrary to the other approach, which is groove deepening where they use a drill to deepen the groove in your fibula where the peroneal tendon sits.

Has anyone had issues getting back into climbing after the fibular osteotomy (I think it’s also called a bone block)? I’m debating getting a second opinion and this approach seems like an over kill (requires a screws/plate and cutting off/reattaching a piece of bone)

Apparently I have a peroneus quartus present as well, but I’m not sure if that matters

I had a partial tear. The retinaculum basically pealed up off my fibula a bit, which is enough to let the peroneal tendon dislocate/sublax.

After doing a bit more research on the subject I can narrow down my concern. Because I have a peroneus quartus (I remember reading that like 10-20% of the population has it) I am predisposed to this type of injury. The quartus crowds the malleolar groove which increases the potential of retinaculum injuries. The bone block surgery is a “one and done”  approach, which means I should not have recurrence of the injury after I do it. It will use bone to physically stop any possible subluxation.  The problem is it involves screws/metal cap, that I would later probably want removed (another surgery). It also involves cutting off and reattaching a piece of bone that can have its own complications (difficulty healing or potential fracturing). The malleolar groove deepening procedure, on the other hand,  makes more room for everything in the malleolar groove; however, you can still have another peroneal dislocation/subluxation injury if you are unlucky.

I guess I’m wondering if anyone with a peroneus quartus had success with the groove deepening procedure (not the bone block osteotomy). 

I’ve had peroneal subluxation, but from years of having a torn ATFL causing hypermobility.

So I can’t comment on the surgery BUT if I know anything about doctors my advice would be:

1. Find the best PT money can buy, look for climber, dancer, musician, etc. Someone who understands movement.

2. Definitely see another surgeon for a second opinion.