Allograft Reconstruction Research Articles

Evaluating the Functional Results and Complications of Autograft vs Allograft Use for Reconstruction of the Anterior Cruciate Ligament: A Systematic Review.

The aim of our review is to identify the reconstruction technique that has a superior functional outcome and decreased number of complications for the anterior cruciate ligament (ACL). We have divided our review into 2 sections. Our primary question evaluates the functional results and complications of autografts compared to allografts for ACL reconstruction. Our subsidiary question evaluates the functional results and complications of bone-patellar tendon-bone (BPTB) autografts compared to hamstring tendon autografts. We conducted a systematic review (SR) based on high quality evidence provided by Cochrane, PubMed and National Health Service evidence searches for papers comparing different ACL reconstruction techniques. Results from 2 primary studies, 1 SR and 1 meta-analysis showed no significant statistical difference when comparing clinical outcomes such as pain, range of motion, laxity, International Knee Documentation Committee score, single assessment numerical evaluation score, Tegner activity score and patient reported satisfaction with regards to autografts vs allografts. Allografts had worse outcomes for postoperative tibial tunnelling and graft failure. Results of 3 SRs showed statistically significant differences in incidence of anterior knee pain, kneeling pain and knee stability, which were all found to be greater amongst those who had received a BPTB autograft. Knee extension was significantly reduced in patients with BPTB grafts when compared to patients with Hamstring tendon autografts. However, with regards to return to prior levels of activity, there was no statistically significant difference between those that received BPTB autografts and those that received Hamstring tendon autografts. Autograft reconstruction of the ACL was shown to provide better postoperative outcomes when compared to allograft reconstruction, although the difference was not statistically significant. When researching different autograft options BPTB autografts were associated with greater pain but also greater stability of the knee joint postoperatively when compared to hamstring tendon autografts.

Biologic Inlay Osteochondral Reconstruction: Arthroscopic One-Step Osteochondral Lesion Repair in the Knee Using Morselized Bone Grafting and Hyaluronic Acid-Based Scaffold Embedded With Bone Marrow Aspirate Concentrate

Cartilage injury of the knee that is associated with significant subchondral bone loss can result in great morbidity, and treatment options that provide durable repair are limited. Osteochondral autograft and allograft reconstruction of these lesions has been used extensively; however, these techniques often require a more invasive surgical exposure, and restoring the natural articular surface radius of curvature can be challenging, particularly in larger lesions. Cell-based repair of these lesions, using autologous chondrocytes in conjunction with bone grafting, has been used with success, although this procedure requires the patient to undergo 2 operations, and access is often restricted due to the high associated costs. Comparable medium-term clinical outcomes have been shown with scaffold-associated mesenchymal stem cell grafting, and this cell-based procedure may also be performed arthroscopically to minimize patient morbidity. In cases of cartilage injury associated with bone loss, this procedure has great potential to repair osteochondral injury when used in conjunction with bone grafting. We present the one-step arthroscopic technique of biologic inlay osteochondral reconstruction in the knee, using an autologous bone graft and a hyaluronic acid-based scaffold embedded with bone marrow aspirate concentrate, to treat full-thickness cartilage lesions associated with significant subchondral bone loss.

Allograft Reconstruction for Sarcomas of the Tibia.

Background:Allograft reconstruction of oncologic resections involving the tibia can have unpredictable results. Prior studies have reported a high rate of complications and a long recovery period involving prolonged bracing, repeated procedures and extended periods of antibiotics.Methods:The case details of 30 tibial allografts (12 adults, 18 children; 20 intercalary, 7 hemicortical, 3 other) were reviewed retrospectively. Based on factors including function, pain, healing and infection, clinical outcomes were stratified into three categories: excellent, moderate, and poor.Results:The overall survival rate of the allografts was 66% at a mean follow-up of 42 mos (adults) and 63 mos (children). Healing for metaphyseal junctions was successful in 73% at a mean of 44 weeks and for diaphyseal junctions, 64% at 41 weeks. Intercalary allografts in adults (4 of 20) all became infected and none had excellent results. All hemicortical allografts were performed in adults and 6 of 7 had excellent results. Distal intercalary allografts in children (6 of 20) had either excellent or moderate results with no infections, but had 3 nonunions and 2 fractures. Proximal intercalary allografts in children (8 of 20) had 2 excellent results, but had 6 infections requiring a cement spacer. Five of the six spacers were ultimately revised to another allograft or an arthroplasty.Conclusion:For tibial allograft reconstruction, surgeons and patients should prepare for a prolonged treatment course that may include multiple complications and surgeries. Excellent or moderate results can be achieved eventually in most, but amputation may be necessary in 15-20% of cases.

The Management of Extensor Mechanism Disruption After Total Knee Arthroplasty: A Systematic Review.

We performed a literature search on PubMed, Web of Science, Science Direct/Scopus, Google Scholar, and Google to evaluate results of several techniques to manage disruption of the extensor mechanism after total knee arthroplasty. Different methods to manage extensor mechanism disruption are available at present, with no level I studies informing surgeons in an evidence-based fashion. Primary repair is not indicated. Allograft reconstruction could be effective, providing that appropriate surgical technique and allograft tensioning are implemented.

Arthroscopic Acromioclavicular Joint Reconstruction Using Knotless Coracoclavicular Fixation and Soft-Tissue Anatomic Coracoclavicular Ligament Reconstruction

Acromioclavicular joint injuries are one of the most common shoulder injuries, and there are a variety of treatment options. Recently, there have been newer arthroscopic techniques that have addressed coracoid and clavicle fracture risk by using a knotted suture-button fixation through a single, small bone tunnel with additional looped soft-tissue graft stabilization. Although clinical outcomes have been good to excellent, there have still been instances of knot and hardware irritation. The described technique builds on the latest advances and achieves an anatomic coracoclavicular (CC) reconstruction through a single knotless CC fixation device with additional soft-tissue allograft reconstruction of the CC ligaments. This technique minimizes the risks of coracoid and clavicle fractures and knot and hardware irritation while maintaining excellent stability.

Fertility, Cardiac, and Orthopedic Challenges in Survivors of Adult and Childhood Sarcoma

The combination of cisplatin, doxorubicin, and methotrexate was established as the standard backbone of contemporary osteosarcoma therapy in 1986. Since then, however, further improving the survival of patients with osteosarcoma has been challenging-30% to 40% of patients with osteosarcoma still die of this disease. In addition, these patients often experience loss of fertility at a young age, short- and long-term treatment-related cardiotoxicity, and adverse orthopedic effects from surgical resection of the tumor or endoprosthetic reconstructions. Cancer treatment often markedly increases the risk of infertility later in life, causing many patients substantial distress and regret. Sperm banking and oocyte cryopreservation are standard of care and should be available to all at-risk patients. Newer techniques, such as autologous gonadal tissue transplant for prepubertal children, are being developed, and newer systemic agents have infertility risk profiles that remain undefined and warrant further study. Cost and access remain barriers to these options. The late effects of anthracycline-induced cardiotoxicity are also increasingly a problem for these patients. These effects are often progressive and can be disabling. Adding dexrazoxane to doxorubicin therapy significantly reduces the risk for most adverse cardiac outcomes without compromising the efficacy of induction chemotherapy. Limb salvage surgery remains the standard of care for treatment in the majority of patients with extremity sarcomas. Modular metal prostheses and allograft reconstructions comprised the majority of surgical procedures for limb salvage surgery. The most common mechanism of failure of these implants is infection and mechanical failure of the implant.

Anatomic reconstruction of lateral ligament with tendon allograft for chronic lateral ankle instability

Objective To observe the efficacy of tendon allograft reconstruction of chronic lateral ankle instability (CLAI). Methods We retrospectively reviewed the 30 CLAI patients who had received tendon allograft reconstruction of lateral ligament between January 2013 and January 2014. They were 12 men and 18 women, aged from 23 to 45 years (average, 35.3 years). Their American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, Karlsson-Peterson score, Sefton articular stability scale, anterior talar translation and talar tilt angle were compared between preoperation and the last follow-up. Results Of this series, 26 cases (26 ankles) were followed up for an average period of 20.3 months (from 15 to 27 months). Follow-up at 6 weeks after surgery showed they could complete non-weight-bearing walking and follow-up at 12 weeks observed that they achieved weight-bearing walking. X-ray films showed negative results of stress ankle varus test and anterior drawer test. At the last follow-up, all patients recovered normal life without obvious discomfort. Their AOFAS ankle and hindfoot score (87.1±4.9), Karlsson-Peterson score (89.6±4.5), Sefton articular stability scale (grade Ⅱ), anterior talar translation (3.5±0.4 mm) and talar tilt angle (3.9 °±0.9°) at the last follow-up were significantly improved in comparison with the preoperative values (56.3±11.0, 51.1±7.5, grade Ⅳ, 7.6±0.8 mm, 14.3°±2.2°, respectively)(P<0.05). The follow-up showed 15 excellent, 6 good and 5 poor ankles, yielding a patient satisfaction rate of 80.8%. Conclusions Anatomic reconstruction with tendon allograft is safe and effective for chronic lateral ankle instability. Key words: Transplantation, allogeneic; Ankle joint; Bone screws; Tendon; Anatomic reconstruction

Reconstruction of Isolated Inferior Right Hepatic Vein(s) in Right Lobe Living Donor Liver Transplantation Using Polytetrafluoroethylene Grafts: A New Feasible Concept, Technique of 'Bridging Conduit Venoplasty' and Outcomes.

BACKGROUND Right lobe living donor liver transplantation (LDLT) remains the most common form of liver transplantation in Asia. However, reconstruction of the venous outflow in a right liver allograft may pose technical difficulties if hepatic venous variations are present. Recently, much emphasis has been given to the reconstruction of large and multiple inferior right hepatic veins (IRHVs). The method of reconstructive technique, type of vascular grafts, and the outcome after the procedure have been a point of debate. In this report we discuss the IRHV reconstruction techniques using expanded polytetrafluoroethylene (ePTFE) vascular grafts and the outcomes after such reconstruction. MATERIAL AND METHODS Out of 262 right liver allografts that underwent venous reconstruction using ePTFE vascular grafts, IRHVs required either venoplasty or second inferior vena cava (IVC) anastomosis in 99 recipients. Depending upon type of IRHV reconstruction, the recipients were divided in 2 groups: Group A (n=52): IRHV venoplasty using ePTFE graft, and group B (n=47): Direct IRHV-to-IVC anastomosis. The outcome after LDLT was compared for these 2 groups. RESULTS The ePTFE venoplasty group had significantly shorter warm ischemia time as compared to the direct to IVC anastomosis group (p<0.01, 95% confidence interval -10.96 to -2.92). There were no thrombotic complications in either group of recipients; 4.2% of the recipients from group B developed hepatic venous stenosis but with no clinical deterioration; and 1 patient from group A developed ePTFE graft migration in the second portion of the duodenum that required surgical exploration. CONCLUSIONS The IRHVs drain a considerable portion of the posterior sector of right liver allografts and thus must be reconstructed. Use of ePTFE vascular grafts for IRHV venoplasty is a safe and feasible concept that facilitates the outflow reconstruction of liver allografts.

Arthroscopic Interpositional Arthroplasty of the Second Metatarsophalangeal Joint

Painful degenerative diseases of the second metatarsophalangeal joint are frequently progressive and difficult to treat. Surgical options for the degenerated second metatarsophalangeal joint include joint debridement and synovectomy, drilling and microfracture, core decompression, dorsal closing-wedge metatarsal osteotomies, joint arthroplasty (implant or interpositional), elevation of the depressed articular fragment and bone graft, distraction arthroplasty, osteochondral plug transplantation, osteochondral distal metatarsal allograft reconstruction, and resection arthroplasty (phalangeal base or metatarsal head). This technical note describes the arthroscopic approach of interpositional arthroplasty of the second metatarsophalangeal joint using the extensor digitorum brevis tendon. It is indicated in adult patients with extensive involvement of the metatarsal head cartilage, especially when cartilage degeneration of the proximal phalanx is also present. It is contraindicated if there is significant bone loss of the metatarsal head or the extensor digitorum brevis tendon is flimsy.

Surgery for bone sarcomas of the lower extremity

Surgery for lower extremity bone sarcomas encompasses a wide array of surgical options beyond the classic treatment of amputation. Limb salvage surgery (LSS) in the form of arthroplasty, arthrodesis, or allograft reconstruction is now possible for most patients. Patient function, in addition to survival, has been increasingly emphasized as the 5-year survival is now typically over 60%. Recent research looking at the activity levels of patients after endoprosthetic reconstruction is reviewed. Advances in surgical navigation, expandable endoprostheses, and in treating infected allografts and endoprostheses are summarized. Long-term functional outcomes and neurologic plasticity in patients with rotationplasties are examined as well. Surgery for bone sarcomas remains a high-risk, high-reward endeavor that continues to improve through innovation.

The effect of cement augmentation and anteromedial plating on proximal humerus allograft reconstruction.

Limb salvage following the resection of tumor from the proximal part of the humerus, poses many challenges, and there is no consensus regarding the best reconstructive technique after proximal humerus resection. The aim of this study was to evaluate the effect of anteromedial placing of the plate in the absence of deltoid muscle and cement augmentation on the functional outcome, complication rate and survival of proximal humerus allograft reconstruction. A number of 36 osteoarticular allograft reconstructions of proximal humerus were included in final study. In 26 cases, medullary canal of the allograft was filled by cement and the complication rate and survival was compared to non-cemented allografts. In addition, anteromedial placement of plate was applied for all resection type IB (18 cases), in which the deltoid muscle was resected. The mean follow-up of patients was 46 months. In total, 12 complications including 3 fractures, 4 resorptions, 3 infections and 2 nonunions were reported. Complication rates were significantly lower in cemented allografts (p=0.001). Five year survival rates of cemented and non-cemented allografts were found to be 82% and 70%, respectively. The mean MSTS score was 84.9%, ranging 76-90. According to our results, cement augmentation improves survival and reduces the complication rate of allografts. Moreover, our results showed that anteromedial placing of the plate in resection type IB could improve the functional outcome of allografts. However, the detailed effect of anteromedial plating should be further investigated in future studies.

Paper #19 - Clinical and radiographic outcomes of distal tibia allograft reconstruction for glenoid bone defects in recurrent anterior shoulder instability

Paper #19 - Clinical and radiographic outcomes of distal tibia allograft reconstruction for glenoid bone defects in recurrent anterior shoulder instability

Hot Topics in the Multicenter Orthopedics Outcomes Network: Anterior Cruciate Ligament.

Since 2015, the Multicenter Orthopedic Outcomes Network (MOON) has addressed several factors associated with patient outcome after anterior cruciate ligament (ACL) injury. These factors include predictors of high grade knee laxity, the impact of meniscus treatment on joint space narrowing after surgery, graft selection, treating diabetic patients, predictors of clinically significant pain, and outcomes of patients where meniscus tears were left in situ without treatment. The presence of meniscus tears and generalized laxity predict a lax examination under anesthesia prior to surgery. Allograft reconstructions carry a 5.2 times increased risk of re-tear compared to autograft. Patients with diabetes should be counseled they may be at increased risk (odds ratio 18.8) for infection after surgery. Subsequent ipsilateral knee surgery is the strongest predictor of postoperative pain after ACLR. Stable, partial thickness meniscus tears measuring less than 1 cm can be left alone without treatment with low re-operation rates at 6-years.

Allograft selection for distal femur through cutting contour registration.

Allograft reconstruction is an acceptable procedure for the recovery of normal anatomy after the bone tumor resection. During the past few years, several automated methods have been proposed to select the best anatomically matching allograft from the virtual donor bone bank. The surface-based automated method uses the contralateral healthy bone to obtain the normal surface shape of the diseased bone, which could achieve good matching of the defect and the selected allograft. However, the surface-based method focuses on the matching of the whole bone so that the matching of the contact surface between the allograft and the recipient bone may not be optimal. To deal with the above problem, we propose a cutting contour based method for the allograft selection. Cutting contour from the recipient bone could reflect the structural information of the defect and is seldom influenced by tumor. Thus the cutting contour can be used as the matching template to find the optimal alignment of the recipient bone and the allograft. The proposed method is validated using the data of distal femurs where bone transplantation is commonly performed. Experimental results show that the proposed method generally outperforms the surface-based method within modest extra time. Overall, our contour-based method is an effective complementary technique for allograft selection in the virtual bone bank.

Osteoarticular allograft reconstruction of post-traumatic defect of distal femur in a pediatric patient: A case report and literature review

Successful results of osteoarticular allografts in reconstruction of periarticular bone defect after tumor resection encouraged its utilization in post-traumatic defects. Here we describe a case of post-traumatic skeletal defect in a 4 year-old girl treated with osteoarticular allograft reconstruction. Due to severity of the associated soft tissue injury and contamination at presentation staged treatment with antibiotic spacer followed by the reconstruction was carried out. At the end of one year the patient achieved ‘Musculoskeletal tumor society‘ functional score of 27 points and radiographic score of 93%. Reconstruction immediately after healing of soft tissues prevented development of any varus or valgus deformity of the knee. Our case demonstrates utility of osteoarticular allograft in a pediatric post-traumatic skeletal defect.

Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction.

Background:Revision anterior cruciate ligament (ACL) reconstruction surgery occurs in 5% to 15% of individuals undergoing ACL reconstruction. Identifying predictors for revision ACL surgery is of essence in the pursuit of creating adequate prevention programs and to identify individuals at risk for reinjury and revision.Purpose:To determine predictors of revision ACL surgery after failed primary ACL reconstruction.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 251 participants (mean age ± SD, 26.1 ± 9.9 years) who had undergone primary ACL reconstruction 1 to 5 years earlier completed a comprehensive survey to determine predictors of revision ACL surgery at a mean 3.4 ± 1.3 years after the primary ACL reconstruction. Potential predictors that were assessed included subject characteristics (age at the time of surgery, time from injury to surgery, sex, body mass index, preinjury activity level, return to sport status), details of the initial injury (mechanism; concomitant injury to other ligaments, menisci, and cartilage), surgical details of the primary reconstruction (Lachman and pivot shift tests under anesthesia, graft type, femoral drilling technique, reconstruction technique), and postoperative course (length of rehabilitation, complications). Univariate and multivariate logistic regression analyses were performed to identify factors that predicted the need for revision ACL surgery.Results:Overall, 21 (8.4%) subjects underwent revision ACL surgery. Univariate analysis showed that younger age at the time of surgery (P = .003), participation in sports at a competitive level (P = .023), and double-bundle ACL reconstruction (P = .024) predicted increased risk of revision ACL surgery. Allograft reconstructions also demonstrated a trend toward greater risk of revision ACL surgery (P = .076). No other variables were significantly associated with revision ACL surgery. Multivariate analysis revealed that revision ACL surgery was only predicted by age at the time of surgery and graft type (autograft vs allograft).Conclusion:The overall revision ACL surgery rate after primary unilateral ACL reconstruction was 8.4%. Univariate predictors of revision ACL reconstruction included younger age at the time of surgery, competitive baseline activity level, and double-bundle ACL reconstruction. However, multivariable logistic regression analysis indicated that age and reconstruction performed with allograft were the only independent predictors of revision ACL reconstruction.

Osteoarticular Allograft for Reconstruction of Acute Distal Humerus Fractures With Massive Bone Loss

Introduction: Reconstruction of the elbow with restoration of function can be challenging, particularly with large osseous defects created from tumor resection or trauma. Osteoarticular allograft reconstruction is an option in patients with massive periarticular elbow bone loss secondary to tumor surgery or trauma. Surgical reconstruction of a posttraumatic elbow with extensive bone loss remains a challenging problem. The clinical success with osteoarticular allograft reconstruction has been documented in several series of oncological limb salvage surgery; but reports of using hemiarticular elbow allografts in the reconstruction of postraumatic elbows are few. Objective: To present a clinical case of a 46-year-old female patient with open (Gustilo 1) Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C3 fracture of the distal humerus after high-energy trauma, treated operatively with the use of osteoarticular allograft to restore posttraumatic articular defects and massive bone loss, and to perform a bibliographic review. Materials and Methods: We report our experience with hemiarticular elbow allograft reconstructions after severe elbow trauma in a young patient, as first treatment. An extensive resection of distal humerus was performed through a posterior approach with Chevron osteotomy. The defect was reconstructed with distal humerus osteoarticular allograft with a stable internal fixation with compression plates and screws. Patient’s epicondyles with collateral ligaments and tendon insertions were carefully preserved and fixed with mini-screws. The ulnar nerve was transposed anteriorly. Results: At a follow-up of 30 months, the arc of motion was 120° and the rotational arc of motion was 100°, without clinical complications. The Mayo Elbow Performance Score and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, used to assess clinical outcomes and patient satisfaction, were satisfactory. Radiographic results demonstrated radiographic incorporation of the allograft with the maintenance of the joint congruity. Conclusions: Management of a posttraumatic elbow injury with significant articular defects and deficient bone can pose a major reconstructive challenge and is especially concerning given the increased frequency of such injuries as a result of an escalating rate of high-energy trauma among young adults. Large bone allograft transplants have been successfully used to reconstruct skeletal defects created by tumor resections and failed arthroplasties, but little has been reported on their use in traumatic defects. The reconstruction of distal humerus with osteoarticular allograft respecting the autogenous collateral ligaments is a viable alternative in salvage situations involving massive bone loss and young patients who are not conventional candidates for total elbow arthroplasty. The preservation of collateral ligaments in conjunction with tendon insertions, at the short-term observation, may improve elbow stability. This study suggests that large bone allografts are of value in reconstructing traumatic skeletal defects, especially those involving an articular surface in a young patient. However, long-term results are still unknown. Although not recommended for routine use, this operation is viewed as a salvage procedure.

Outcome of Immediate Allograft Reconstruction of Long Span Defects of the Inferior Alveolar Nerve

Contemporary management of ablative jaw defects includes not only bony and soft tissue reconstruction, but also addresses restoration of neurosensory function. The goal of this study is to determine the outcome of immediate reconstruction of long span defects (≥5 cm) of the inferior alveolar nerve (IAN) following ablative mandibular resection using allogenic nerve grafts.

Immediate Nerve Allograft Reconstruction With Ablation of Mandible for Benign Pathology

Immediate Nerve Allograft Reconstruction With Ablation of Mandible for Benign Pathology

2016 IFFAS Award for Excellence - Peroneal Tendon Repairs

Category: Sports. Introduction/Purpose: Irreparable peroneal tendon tears are rare and there is scant evidence to guide surgeons on the appropriate treatment. In general, if more than 50% of the tendon is affected, segmental resection of the tendon and tenodesis to the remaining healthy tendon is recommended. We hypothesized that normal tension at the insertions of the peroneal tendons after an irreparable tear cannot be reestablished by tenodesis to the remaining tendon and can only be restored by allograft reconstruction. Methods: To assess tendon loading at their insertions, custom-made strain gage-based tension transducers were implanted into the peroneus longus (PL) and brevis (PB) tendons adjacent to their insertions on the 1st and 5th metatarsal bases in 12 fresh- frozen cadaver feet. Axial load was applied to the foot, and the peroneal tendons, tibialis anterior and posterior tendons were tensioned to 50% and 100% of physiologic load. Transducer outputs were recorded in this normal tendon condition and after sequential PB to PL tenodesis and peroneus brevis allograft reconstruction. The tendon force transmission was quantified in five different foot inversion/eversion and plantarflexion/dorsiflexion positions. The distal peroneal tendons and 1st and 5th metatarsals were then excised along with the implanted transducers, and calibration was performed by applying incremental tendon loads in a materials testing machine. Insertion site tensile loading in each surgical condition was then expressed as a percentage of normal. Results of the allograft and tenodesis procedures were compared using paired t tests. Results: Under 50% of physiologic load, tendon tension at the PB insertion ranged from 3% to 28% of normal after tenodesis. After allograft reconstruction, PB insertion tension increased to 73% to 101% of normal. Tension at the PL insertion site was 102% to 117% of normal after tenodesis, and 84% to 93% of normal after allograft reconstruction. The treatment outcomes differed significantly, with p-values &lt; 0.02. Under the 100% loading condition, tension at the PB site ranged from 6% to 43% of normal after tenodesis and 88% to 99% of normal after repair with allograft. Tension at the PL insertion site was 101% to 120% and 94% to 101% after tenodesis and PB allograft reconstruction, respectively. The treatments differed significantly, with p-values &lt; 0.02, in all comparisons except for PL tension in inverted and neutral foot positions. Conclusion: Allograft reconstruction of a peroneus brevis tendon tear substantially restored tension at both the PB and PL insertion sites when the tendons and their antagonists were loaded to 50% and 100% of physiologic load. In comparison, peroneus brevis tenodesis to PL did not effectively restore tendon tension under most of the tested conditions, suggesting that this procedure may result in an imbalanced foot when applied clinically. Clinical comparative studies are necessary to determine if the results of this cadaveric, biomechanical study have similar in-vivo consequences.