Operative reconstruction after transverse rupture of the tendons of both peroneus longus and brevis

Abstract

Rupture of the tendons of both peroneus longus and peroneus brevis results in considerable disability. We have performed transfer of flexor digitorum longus (FDL) to peroneus brevis in two patients with lateral instability of the hindfoot due to chronic transverse tears of both tendons for which end-to-end repair was not possible. Both patients had excellent function when reviewed after eight and six years, respectively, with no symptoms. CT showed a normal appearance of the FDL in both patients, but the peroneal muscles looked abnormal. Transfer of the FDL provides a reliable solution to lateral instability of the hindfoot resulting from loss of function of both peronei.J Bone Joint Surg [Br] 1998;80-B:781-4. Received 20 April 1998; Accepted 3 June 1998 There is an increased awareness of acute and chronic injuries of the peroneal tendons especially in athletes. [1][2][3] Longitudinal tears have been well documented, 4,5 while transverse ruptures of peroneus longus may occur in the cuboid tunnel or in association with an os peroneum. Transverse ruptures of both peroneus longus and brevis are uncommon and have been described only twice. 6,7 In neither case was tendon transfer performed. We describe two patients in whom rupture of both peroneal tendons occurred with retraction of the tendon leaving a gap of 8 cm. Transfer of flexor digitorum longus (FDL) to peroneus brevis was performed, a procedure not previously described. Case reportsCase 1. A 60-year-old man presented with pain in the lateral aspect of his right foot and ankle which had lasted for three years. A feeling of instability had forced him to stop playing golf. He had difficulty in descending hills and stairs with severe pain on exercise. Three years previously while walking downhill on a golf course he had had an acute 'snap' in his ankle which he said had felt as if a golf ball had hit him. The ankle had immediately become weak. Over the next three years he was treated with strapping, anti-inflammatory drugs and three cortisone injections with relief for two to three months after each injection. As he became worse he was referred for an orthopaedic opinion. There was nothing of note in his past medical and surgical history. On examination, his calf muscles were wasted and there was tenderness over the lateral aspect of the ankle. The peroneal tendons were not palpable adjacent to the lateral malleolus. Eversion was limited to resistance against gravity only. Radiographs showed no abnormality. MRI showed thickening of both the peroneal tendons proximal to the lateral malleolus and their absence below this. It was decided to explore the peroneal region. Case 2. A 61-year-old retired man presented with pain in the outer side of his left foot and ankle, and instability for seven months. This had a sudden onset when he was rising from a chair and felt a painful 'crack' at the level of the midfoot. He subsequently noted that his ankle tended to invert as he walked and he could not play golf because of pain and instability. He had been treated with or...

Diagnosis and treatment of peroneal tendon injuries

“…Peroneus brevis tears are common [3–14]. Cadaver studies indicate that the incidence ranges from 11% to 37% [10, 11, 14].…”

Ultrasonographic Findings in Peroneus Longus Tendon Rupture

“…Therefore, accurate detection and confirmation on images are imperative. [1][2][3][4][5][6] Ultrasonography allowed a diagnosis of complete transverse rupture of the peroneus longus tendon. The fluidfilled tendon sheath and the discontinuity of the tendon on ultrasonography led to the diagnosis of peroneus longus rupture.…”

“…8 Rupture of the peroneus longus can occur with spontaneous rupture of the tendon occurring through a fracture or posterior dislocation of the os peroneum. 4 The os peroneum is a sesamoid bone that exists within the peroneus longus tendon in the region of the cuboid tunnel. It is present in 20% of adults and is bilateral in 60% of cases.…”

Allograft Reconstruction of Peroneal Tendons

“…Others have recommended tendon transfer, which has also been reported with satisfactory results. 7 Although both of these offer relatively simple and perhaps less technically demanding options, autologous tendon transfers suffer from the pitfalls of donor site morbidity and, in our anecdotal experience, have negatively affected normal gait mechanics.…”

“…Numerous authors have reported satisfactory results of peroneal tendon reconstructions with autograft transfer. 7,30,37 More recently, the use of an acellular dermal matrix has been reported. 26 We have previously published our operative technique for allograft reconstruction.…”