Split Peroneus Brevis Research Articles

High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability

PurposeTo evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft.MethodsTwenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24–112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed.ResultsPatients reported a Karlsson score of 82.1 ± 17.5 (37–100), a FAOS score of 87.8 ± 8.4 (73–99), a median Tegner activity scale of 5.0 (IQR 4–6) and a VAS for pain of 0.5 ± 0.9 (0–4) at rest and of 2.0 ± 2.1 (0–7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0–24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed.ConclusionGood patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients’ expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory.Level of evidenceIV.

Autograft versus allograft tenodesis for chronic ankle instability: a single-center retrospective comparative study.

Aim: To compare the outcomes of patients who underwent autograft tenodesis with those who underwent allografttenodesis for the treatment of chronic mechanical ankle instability. Patients &methods: Ten patients who underwent allograft lateral tenodesis were compared with 15 patients who underwent lateral tenodesis using a split peroneus brevis tendon. Patients were followed up after an average time of 10.5years. Results: No statistically significant differences concerning American Orthopaedic Foot and Ankle Society and Karlsson-Peterson scores were reported (p=n.s.). A reduced average radiographic anterior talar translation was observed in the autograft group compared with the allograft group (1.4and 4.0mm respectively, p<0.001). Conclusion: Both surgical techniques significantly improved subjective and objective outcomes in patients suffering from chronic ankle instability compared with pre-operatory status. Autograft stabilization provided reduced post-operative anterior talar translation compared with allograft tenodesis.

A Comparison of Split Peroneus Brevis Tendon and Semitendinosus Allograft Tendon for Lateral Ankle Ligament Reconstruction

Lateral ankle instability is a debilitating condition that is often unresponsive to conservative therapy. Many techniques for operative repair have been proposed, most commonly performed as the Broström or modified Broström procedure. In patients with failed primary repair, hereditary collagen disorders, strenuous work activity, obesity, or ligamentous laxity, the Broström repair is less likely to be successful, and anatomic or nonanatomic reconstruction should be considered. The purpose of this study was to compare the functional outcomes and patient satisfaction between anatomic and nonanatomic reconstruction of the lateral ankle ligament complex for lateral ankle instability using a retrospective cohort study. We evaluated 64 ankles in 62 patients who underwent either a split peroneus brevis tendon (n = 36) or semitendinosus allograft tendon reconstruction (n = 28) for lateral ankle instability performed by the same surgeon. Postoperative American Orthopedic Foot and Ankle Society (p = .943) and patient satisfaction (p = .279) found no significant difference between either technique. Our results suggest that both split peroneus brevis and semitendinosus allograft may be viable alternatives for lateral ankle instability when primary ligamentous repair is not attainable.

Technique using the modified rolling hitch for split peroneus brevis tendon transfer in lateral ankle stabilization.

We report our technique for split peroneus brevis lateral ankle stabilization using the modified rolling hitch for tendon graft fixation. Applying the modified rolling hitch for tendon grasping in this procedure was useful, and it could decrease the surgical time and avoid the tendon injury caused by the needle.

Ankle lateral ligament reconstruction for chronic instability.

To report the outcome of a technique combining direct anatomic reconstruction of the anterior talofibular ligament (ATFL) with augmented reconstruction using the peroneus brevis tendon fixed by a bio-absorbable interference screw. 13 men and 2 women aged 17 to 36 (mean, 24) years with recurrent inversion injuries of the right (n=5) and left (n=10) ankles underwent lateral ankle reconstruction by a single surgeon. All patients had a positive anterior drawer test and heel eversion stress test, and some degree of tenderness to palpation over the anterolateral joint capsule. All patients had complete or partial tear of the ATFL and the calcaneofibular ligament, except for one. The torn ligaments were repaired anatomically and reinforced with a split peroneus brevis tendon rerouted through the fibula and fixed with a bioabsorbable interference screw. The outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and the Foot and Ankle Outcome Score (FAOS) at 6 months. The mean time from injury to surgery was 40.5 months. The mean follow-up duration was 13.6 (range, 6-26) months. No patient had surgical or wound complications. The mean AOFAS ankle and hindfoot score was 91.5 (median, 93; range, 79-100). The mean FAOS was 78.8 (median, 77; range, 61-100). 10 patients had no limitation in both daily and recreational activities; 3 had limitation in recreational activities, and 2 had limitation in both. 12 patients had normal and 3 had moderate limitation in hindfoot motion. One patient had hindfoot instability. The combination of augmented and direct anatomic reconstructions enables early mobilisation despite limitation in hindfoot motion and is a viable option for chronic hindfoot instability.

Split Peroneus Brevis Tendon: An Unusual Cause of Ankle Pain and Instability

Tears of the peroneus brevis tendon may cause ankle pain, swelling, and instability. Supportive therapy with ankle bracing and analgesics is the mainstay of therapy, but surgical repair is often required in patients with ongoing symptoms. Surgical options include debridement, tubularization, or, in severe cases, resection of the damaged tendon and tenodesis. We describe a 64-year-old woman with a split peroneus brevis tendon presenting with lateral ankle pain, swelling, and instability, and we review the literature regarding presentation, diagnostic testing, pathophysiology, predisposing factors, and treatment recommendations. Primary care physicians should consider peroneal tendon injuries in patients with chronic lateral ankle pain and instability.

Technique for Utilization of an Interference Screw for Split Peroneus Brevis Tendon Transfer in Lateral Ankle Stabilization

We present a technique for split peroneous brevis lateral ankle stabilization using an interference screw as the fixation device. The interference screw provided stable fixation by way of physiologic tension and restored lateral ankle instability while preserving the range of motion in the surrounding joints.

Anatomy of the Superior Peroneal Tunnel

Standard texts of anatomy provide cursory and varied descriptions of the superior peroneal retinaculum and the contents of the tunnel formed by it. The available clinical literature suggests that the boundaries and contents of the superior peroneal tunnel have a direct bearing on the causation of peroneal tendinopathies. Knowledge of the anatomy of this region is essential for successful diagnosis and treatment. Fifty-eight embalmed lower limbs were dissected and the boundaries and contents of the superior peroneal tunnel were ascertained. Sixty dry fibulas were also studied to observe the contour of the retromalleolar groove. The tunnel was spacious, with the superior peroneal retinaculum forming its roof. The floor of the tunnel has an osseous and a nonosseous component. The osseous component is formed by the retromalleolar groove of the fibula, and the nonosseous component is formed by the lower part of the posterior intermuscular septum of the leg. Muscle fibers of the peroneus brevis muscle were the most frequent additional contents followed by an aberrant muscle, termed the peroneus quartus. A split peroneus brevis tendon, a double peroneus longus tendon, and an accessory peroneal nerve were some of the variants observed. In the study of the dry fibulas, it was observed that the contour of the retromalleolar groove was constantly concave. The study suggests that frequent additional structures can normally exist within the spacious superior peroneal tunnel. The retromalleolar groove has a concave contour and forms only a part of the floor of the tunnel and so is an unlikely cause of tendinopathies. The findings may facilitate radiographic evaluation of the tunnel and lead to improvements in the treatment of peroneal tendinopathies.

Modified Chrisman–Snook repair for the treatment of chronic ankle ligamentous instability in children and adolescents

Chronic ankle ligamentous instability is not uncommonly encountered in children and adolescents. A number of operative procedures have been developed and described in the literature, including variations on the original Chrisman-Snook (CS) repair. The purpose of this study is to describe a modification of the CS repair and report the outcomes of this surgery for the treatment of chronic ankle ligamentous instability in children and adolescents. A retrospective review was conducted of 100 consecutive surgeries in 66 children performed by a single surgeon who modified the CS repair using a split peroneus brevis tendon to reinforce the anterior talofibular and calcaneofibular ligaments in chronic ligamentously lax patients. All charts were reviewed for complications. Fifty-three cases had at least a 2-year follow-up and were evaluated for the following outcomes: return to activity, ligamentous laxity, pain, and subsequent sprains. Of the 100 surgeries performed, no patient required repeat ligamentous repair. There were no deep wound infections. There were 10 cases of minor wound healing problems and two cases of temporary nerve dysfunction, one of which resolved without surgical intervention and the other is resolving with no plans for surgical intervention. There were two cases of sural nerve branch entrapment which required subsequent surgery due to neuroma formation. Of the 53 cases with at least a 2-year follow-up, the following outcomes were obtained: all patients returned to full activities of their choice; all but one case maintained ≤45° of ankle inversion postoperatively; all patients were pain free or had only occasional discomfort; and 23% of the ankles experienced subsequent minor sprains, but all were minor and resolved without consequence. A modification of the CS repair where the split peroneus brevis tendon is used to create ankle stability has been routinely successful in 100 consecutive cases of chronic ligamentous instability in children and adolescents with very few complications.

Special Report: Highlights of the Twentieth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society, Seattle, Washington, July 29–31, 2004

I. Surgical pearls: Fibular sesamoidectomy may be performed from a plantar approach, but the surgical defect should be closed [1]. Subluxing peroneal tendons may be managed with a stabilization procedure that includes superior peroneal retinaculoplasty with an anterior-based periosteal flap and fibular groove deepening [2]. Subtalar hypermobility and inversion instability may result in subtalar joint pain; management may include a split peroneus brevis tenodesis to limit subtalar excursion [3]. II. Meet the researcher: There were 80 poster presentations that covered diverse basic science and clinical studies. III. International orthopaedic perspectives: The AOFAS outreach mission to Vietnam (2002–2004) included

Late-term reconstruction of lateral ankle ligaments using a split peroneus brevis tendon graft (Colville's technique) in patients with chronic lateral instability of the ankle.

We reviewed 14 patients with chronic lateral instability of the ankle treated by Colville's technique between 1996 and 2001. The mean patient age was 25 (20-35) years and all were men. The mean period between injury and surgery was 25 (18-32) months, and the mean follow-up was 20 (14-32) months. Twelve of the results were excellent and two were good according to the criteria of Chrisman and Snook. All patients returned to normal daily activity levels at an average of 6 months following surgery.

Reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft.

Thirty-one consecutive ankles in 30 patients with chronic lateral ankle instability were reconstructed using a split peroneus brevis tendon graft. All patients had pain and instability despite adequate treatment and a rehabilitation program. Six patients had clinical and radiographic evidence of associated subtalar laxity. Four patients (four ankles) had prior Brostrom ligament reconstructions. The average time from the initial injury or treatment to surgery was 23 months. At a mean follow-up of 44 months (range, 24-64 months), the functional results included excellent in 20 ankles, good in 9, fair in 1, and poor in 1. Ankle stability, which did not deteriorate with time, was achieved in 30 of 31 ankles. This procedure is simple, safe, and reliable with a 94% good to excellent clinical result and 97% mechanical stability. It is an excellent reconstruction choice for those individuals with high demand ankles, with a longstanding ankle instability with or without subtalar instability, and for failed primary reconstruction.

Revision lateral ankle ligament reconstruction using Achilles tendon graft: a case report

This report is of a patient with chronic ankle instability, who underwent revision lateral ligament reconstruction using a graft from the lateral quarter of the Achilles tendon. The split peroneus brevis tendon had failed following a previous Evan's procedure. It illustrates the use of the lateral quarter of the Achilles tendon as a graft for reconstruction and illustrates its benefit for revision lateral ankle ligament reconstruction surgery.

Anatomic reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft.

Fifteen patients with recurrent inversion ankle sprains and documented lateral ankle instability were treated with an anatomically oriented ligament reconstruction using a split peroneus brevis tendon graft. This reconstruction is designed to augment repair of the anterior talofibular and calcaneofibular ligaments without restricting subtalar motion. Of the 12 patients available for long-term followup, all were functionally improved, with no recurrences of instability. Stress radiographic examination at followup confirmed that mechanical stability had been restored in all ankles. Eversion strength and subtalar joint motion were maintained after surgery. We recommend this procedure in patients who require augmented reconstruction of the lateral ankle ligaments.

Surgical treatment of lateral ankle instability syndrome.

Lateral ankle instability syndrome is defined by pain and instability caused by ligament laxity. Anterior talofibular ligament laxity, with or without calcaneofibular laxity and other abnormalities, is often present in conjunction with peroneus brevis tendon tears, abnormal ligament placement, tibialis posterior tendon tears, osteochondritis dissecans, arthritis, synovitis, loose bodies, and tarsal coalition. Surgical reconstructions were performed on 43 ankles using a split peroneus brevis tendon graft routed through osseous tunnels in the talus, fibula, and calcaneus and resutured to the reconstructed anterior talofibular and calcaneofibular ligaments. The tunnel locations, transfer routes, and tendon reinforcement were modifications based on the Elmslie procedure. Good and excellent results were achieved in 91% of the patients. Ninety-eight percent of the patients achieved stability. Followup was from 9 months to 11 years. Twenty-one patients had preoperative and intraoperative findings that required additional procedures. Thorough evaluation of patients with lateral ankle instability syndrome increases the frequency of finding associated abnormalities, which if left uncorrected, may adversely affect the outcome of surgery.

A biomechanical study of human lateral ankle ligaments and autogenous reconstructive grafts.

The purpose of this study was to investigate the biomechanical behavior of human anterior talofibular and calcaneofibular ligaments, as well as peroneus brevis, split peroneus brevis, and toe extensor tendon grafts. This article represents the first published data comparing the most frequently injured ankle ligaments to the most commonly used autogenous reconstructive grafts. Twenty fresh human ankles provided the bone-ligament-bone and tendon graft specimens for biomechanical testing on a Minneapolis Testing System. Protocol consisted of cyclic loading at physiologic deflections, followed by several load-deflection tests at varying velocities, followed by a final extremely rapid load to failure test. The load-deflection data for all ligaments and tendons demonstrated nonlinearity and strain rate dependence. The maximum load to failure for the anterior talofibular ligament was the lowest of all specimens tested, while its strain to failure was the highest. The loads to failure of the peroneus brevis and split peroneus tendons were significantly greater than the anterior talofibular ligament and approximately equal to the calcaneofibular ligament. Strains to failure for all tendons were significantly less than ligament strains. The high strain to failure of the anterior talofibular ligament demonstrates its physiologic function of allowing increased ankle plantar flexion-internal rotation, while its low load to failure shows its propensity for injury. The greater strength of the tendon grafts explains the success of most reconstructive procedures in reestablishing stability in chronic ankle sprains; at the same time, the data presented suggest that those surgical procedures sacrificing the entire peroneus brevis tendon are unnecessary.(ABSTRACT TRUNCATED AT 250 WORDS)