Peroneus Brevis Tendon Tears: Pathophysiology, Surgical Reconstruction, and Clinical Results

Abstract

Chronic peroneus brevis tendon tears are frequently overlooked or misdiagnosed. They are a more common problem than previously noted. Twenty patients were reviewed in the largest clinical series of its kind. The most reliable diagnostic sign was persistent swelling along the peroneal tendon sheath. The pathophysiologic mechanism is subclinical, or overt, subluxation of the tendon over the posterolateral edge of the fibula. This produces multiple longitudinal splits. Treatment is primarily surgical and must address both the split tendon and the subluxation that caused it. A new classification that guides surgical treatment is proposed. Debridement and repair are recommended for grade 1 tendons, which have damage to less than 50% of the cross-sectional area. Excision of the damaged segment and tenodesis to the peroneus longus are recommended for grade 2 tendons, which have destruction of greater than 50% of the cross-sectional area. Both methods must be augmented by stabilization of the etiologic subluxation. The average postoperative AOFAS score was 85. Return to maximum function is prolonged, but good-to-excellent results were found in the majority of patients.

Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report

“…Eleven were treated with tubularization. 4 They did not find a significant difference in outcome between groups. While all of the patients in the tenodesis group were satisfied with their results, only four of the nine had resumed unlimited activities and two-thirds had pain with activity.…”

“…1,2 The symptoms of peroneal tendon disorders are also often vague and misdiagnosed on initial presentation. [2][3][4] Peroneal tendon dysfunction can be attributed to tendonitis, chronic tenosynovitis, subluxation, fraying, longitudinal fissuring, partial tears and complete tears. [5][6][7][8][9] These abnormalities can be observed with concomitant chronic ankle instability, cavovarus foot deformities, low-lying peroneus brevis muscle bellies, superior peroneal retinacular insufficiency, fibular bone spurs, and following severe ankle sprains.…”

“…6,[10][11][12] Several classification systems have been described to characterize peroneal tendon tears in order to improve the decision-making in operative management. 4,13 Acute partial thickness tears can often be tubularized or repaired primarily. However, chronic tendon injuries often require other treatment options including autologous tendon transfers, tendon lengthening, allograft reconstructions or synthetic graft reconstruction.…”

Peroneal Tenodesis With the Use of Tendoscopy: Surgical Technique and Report of 1 Case

“…These lesions frequently may take time to be diagnosed because the symptoms presented are similar to those of lateral-ankle ligament injury. 1,2 The clinical condition is usually characterized by pain in the lateral region of the ankle together with swelling and loss of strength for rear-foot eversion. 3 Imaging examinations may assist in determining the diagnosis; however, ultrasonography and magnetic resonance imaging are very sensitive and can yield too many falsepositive results.…”

“…Surgical treatment may be indicated for refractory cases. 2 Krause and Brodsky 2 proposed a classification to guide treatment. For lesions affecting less than 50% of the tendon diameter, they recommend resection of the injured area and insertion of tubes, whereas for lesions affecting more than 50% of the tendon diameter, tenodesis is indicated.…”