## 4 Discussion
Surgical treatment yields excellent clinical and functional outcomes in patients with chronic peroneal instability, while less favorable results were observed with rerouting and bony procedures. A'sliding bone-block procedure' can be employed, as described by [PERSON] (1920) and [PERSON] (1965). In this technique, a section of bone is excised from the lateral side of thefibula and repositioned more posteriorly to deepen the malleolar groove (MG). Potential issues are associated with bone block procedures: excessive post-operative wear and tear on the peroneal tendons can occur, especially if the procedure is carried out too distally, where compression and shear forces are more significant [38]. The surgical technique of rerouting the peroneal tendons behind the calcaneofibrular ligament does not directly address the restoration of the superior peroneal retinaculum (SPR) anatomy. Instead, it relies on the calcaneofibrular ligament as a natural alternative restraint. It involves dividing the calcaneofibrular ligament, repositioning the tendons behind it, and then suturing the calcaneofibrular ligament back together. [PERSON] et al. employed this technique and achieved excellent results in 11 patients during a 30-month follow-up with no recurrence, but 2 patients experienced sural nerve injuries [39]. Several authors have also outlined procedures for strengthening or enhancing weakened superior peroneal retinaculum (SPR) through soft tissue transfer, such as for the Achilles tendon, peroneus brevis tendon, plantaris tendon, and peroneus quartus tendon [40]. In summary, our study investigated the medium to long-term clinical outcomes of the surgical deepening of the retro-malleolar peroneal groove for recurrent peroneal tendon dislocation. Employing EFAS and AOFAS scores, most patients achieved excellent results, indicating significant functional improvement and enhanced quality of life post-surgery. Notably, no cases of recurrence were observed, underscoring the high efficacy of the technique in preventing symptom relapse. Furthermore, a noteworthy observation was the return to sports activities within approximately 7 months post-intervention, highlighting both the success of the procedure and its capacity for rapid physical activity resumption. However, it is important to acknowledge the limitation of our study, which lies in its small sample size. The results, therefore, should be interpreted with caution, and larger-scale investigations are warranted for more comprehensive validation. In conclusion, our results demonstrate that surgical deepening of the retro-malleolar peroneal groove is a highly effective and safe option for patients with recurrent peroneal tendon dislocation. This procedure consistently yields excellent outcomes, preventing recurrence and enabling swift resumption of daily and sporting activities. [PERSON] and [PERSON] contributed to the study conceptualization and design. Material preparation and data collection and analysis were performed by L.A.; statistics and software were performed by T.M. ; the first draft of the manuscript was written by [PERSON]; writing--review and editing: [PERSON], [PERSON] and [PERSON]. All authors have read and agreed to the published version of the manuscript. This research received no external funding. All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki. Informed Consent Statement:Informed consent was obtained from all subjects involved in the study. The datasets used and analyzed during the current study are available from the corresponding author ([PERSON] MD) on reasonable request. In order to ensure the confidentiality of data and to avoid data loss or manipulation, precautionary measures have been taken: the data are restricted to authorized members only. Authorized members are [PERSON] MD Prof, [PERSON] MD Prof, [PERSON] MD, [PERSON] MD, [PERSON] MD Prof, and [PERSON] MD.