Clinical and Patient-Reported Outcomes Following Peroneus Brevis Reconstruction With Hamstring Tendon Autograft

Abstract

Background: Peroneal tendon injuries are a common cause of lateral ankle pain and instability. While the use of hamstring autograft has been proposed as a viable surgical option for peroneus brevis reconstruction, reported outcomes with this technique are limited in the literature. We present patient-reported and clinical outcomes for patients who underwent peroneus brevis reconstruction with hamstring autograft. Methods: Thirty-one patients were retrospectively identified who underwent a procedure including peroneus brevis reconstruction with hamstring autograft for peroneal tendinopathy between February 2016 and May 2019. All patients who had a peroneus brevis reconstruction were included, and all concomitant procedures were noted. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were prospectively collected preoperatively and at a minimum of 1 year postoperatively (mean, 24.3; range, 12-52.7) months. Retrospective chart review was performed to evaluate the incidence of postoperative complications and reoperations. Results: When evaluating pre- and postoperative patient-reported outcome surveys (n = 26; 84%), on average, patients reported improvement in every PROMIS domain evaluated, with significant improvement in Physical Function (+5.99; P = .006), Pain Interference (–8.11; P < .001), Pain Intensity (–9.02; P < .001), and Global Physical Health (+7.29; P = .001). Three patients reported persistent pain at a minimum of 1 year postoperatively, of whom 2 required reoperation. No patient reported persistent pain or discomfort at the harvest site of the hamstring autograft. Conclusion: Patients undergoing peroneus brevis reconstruction with hamstring autograft experienced clinically significant improvement in patient-reported and clinical outcomes. Few postoperative complications were observed, and patients reported improvements across all patient-reported outcome domains, with significant improvements for pain and function domains. Reconstruction with hamstring autograft represents a viable surgical option in the setting of peroneal tendinitis or tears. Level of Evidence: Level IV, case series.

A Biomechanical Analysis of Peroneus Brevis Split Lesions, Repair, and Partial Resection

“…6,22 A reconstruction technique with hamstring tendon autograft also showed promising results in a recent case series. 7…”

“…Otherwise, a transfer of the peroneus brevis to the peroneus longus tendon or a graft interposition is considered to be a viable option. 7,12,13,18 No clear consensus exists regarding peroneal tendon tear treatment in cases with damaged tendon substance, when only a portion of the tendon can be preserved. A biomechanical cadaver study by Wagner et al suggested that resection of two-thirds of the tendon does not necessarily increase the risk of spontaneous tendon rupture.…”

Contemporary Review: An Overview of the Utility of Patient-Reported Outcome Measurement Information System (PROMIS) in Foot and Ankle Surgery

“…This responsiveness may suggest that peroneus brevis reconstruction with hamstring autograft represents a viable surgical option for patients with peroneal tendinopathy. 9 However, such data must be interpreted cautiously: validity is limited as there was no control group and there are no current studies validating PROMIS in peroneal tendon disorders.…”

Postoperative Ankle Imaging, 2022

“…However, our surgeons prefer to perform a reconstruction of the peroneal tendon using a hamstring autograft. 69…”