Staged Reconstruction for Chronic Rupture of Both Peroneal Tendons Using Hunter Rod and Flexor Hallucis Longus Tendon Transfer

Abstract

Chronic lateral ankle pain can have many different etiologies. Peroneal tendon pathology is a major cause. Fissuring and longitudinal splitting of the peroneus brevis and longus tendons have been reported as a common etiology for chronic lateral ankle pain and functional instability. Patients with advanced pathology who have failed both primary repair and anastomosis of peroneus brevis and longus present a surgical challenge, especially in young active patients where the goal is to achieve dynamic stabilization of the ankle and to restore peroneal tendon function. Staged reconstruction using a Hunter rod and the flexor hallucis longus (FHL) tendon has been described as a salvage procedure for treatment of chronic ruptures of both peroneal tendons. The first stage involves debridement of the remaining portion of the peroneal tendons and sheath followed by implantation of a Hunter rod to the insertion of the peroneus brevis. Passive range-of-motion exercises for 3 months are allowed before removal of the Hunter rod. The second stage involves removal of the Hunter rod and transfer of the flexor hallucis longus (FHL) into the newly formed sheath, attaching it to the insertion of the peroneus brevis on the fifth metatarsal base.