Peroneal tendon balance procedure

1989 ◽  
Vol 79 (1) ◽  
pp. 15-23 ◽  
Author(s):  
NA Grumbine ◽  
RE Van Enoo ◽  
JP Santoro
Keyword(s):  
Surgical Procedure ◽  
Proximal Portion ◽  
Peroneal Tendon ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
First Ray ◽  
Peroneus Brevis

The authors introduce the peroneal tendon balance procedure and discuss normal and hypermobile function of the first ray. The procedure is based on the theory that the peroneus longus tendon is a primary retrograde stabilizer of the proximal portion of the first ray. The theory emphasizes that abnormal pronation results in a positional weakness of the peroneus longus tendon, which induces first ray hypermobility. This surgical procedure involves an anastomosis of the peroneus longus to the peroneus brevis tendon. It is designed to increase the force of the peroneus longus tendon in order to reduce first ray hypermobility.

scholarly journals Ankle Eversion and First Ray Plantar Flexion Muscle Strength After Peroneus Longus Tendon Harvest for Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0007
Author(s):  
Fidelis H. Wicaksono ◽  
Sholahuddin Rhatomy ◽  
Nicolaas C. Budipharama
Keyword(s):  
Cruciate Ligament ◽  
Plantar Flexion ◽  
Donor Site ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Ankle Eversion ◽  
Significant Difference ◽  
First Ray ◽  
Flexion Strength

The peroneus longus tendon has been used for a graft in orthopedic reconstruction surgery due to its comparable biomechanical strength to the native Anterior Cruciate Ligament (ACL) and hamstring tendon. However, one of the considerations in choosing autograft is donor site morbidity. This study aimed to compare ankle eversion and first ray plantar flexion strength between donor site and its contralateral. Hypothesis: The study hypothesis was that the eversion and first ray plantar flexion muscle strength were different between harvest site and contralateral healthy site. Methods: From March 2017 to December 2018, patients who underwent ACL reconstruction using peroneus longus tendon autograft were included in this study. From the first day after surgery, the patients followed rehabilitation protocol. Ankle eversion and first ray plantar flexion strength were measured using a modifieddynamometer 6-months after surgery. Donor site morbidities were assessed 6 months after surgery using the Foot and Ankle Disability Index and American Orthopedic Foot and Ankle Society scoring system for ankle and hindfoot. Results: Thirty-one patients fulfilled the inclusion criteria, with 22 males and 9 females, ranging from 18-45 years of age (mean: 27.58±8.69). There was no significant difference in ankle eversion strength at donor site compared to contralateral (p=0.54) with means 65.87±7.63 N and 66.96±8.38 N, respectively. Also, there was no significant difference in ankle first ray plantar flexion strength at donor site compared to contralateral (p=0.68) with means 150.64±11.67 N and 152.10±12.16 N, respectively. The FADI score of 99.71±0.57 and AOFAS score of 98.71±3.03 were considered excellent results. Conclusion: Our study shows that donor site ankle eversion and first ray plantar flexion strengths were similar with the contralateral healthy site with no donor site morbidity. This suggests that peroneus longus tendon is a promising graft in ACL reconstruction.

scholarly journals Eversion and First Ray Plantarflexion Muscle Strength in Anterior Cruciate Ligament Reconstruction Using a Peroneus Longus Tendon Graft

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987246 ◽  
Author(s):  
Sholahuddin Rhatomy ◽  
Fidelis H. Wicaksono ◽  
Noha Roshadiansyah Soekarno ◽  
Riky Setyawan ◽  
Shinta Primasara ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Ankle Eversion ◽  
Significant Difference ◽  
First Ray

Background: The peroneus longus tendon has been used as a graft in orthopaedic reconstruction surgery because of its comparable biomechanical strength with the native anterior cruciate ligament (ACL) and hamstring tendon. However, one of the considerations in choosing an autograft is donor site morbidity. Purpose/Hypothesis: This study aimed to compare ankle eversion and first ray plantarflexion strength between the donor site and its contralateral site after ACL reconstruction. The study hypothesis was that strength measurements will be different between the harvest site and contralateral healthy site. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ACL reconstruction using a peroneus longus tendon autograft between March 2017 and December 2018 were included in this study. Patients followed a rehabilitation protocol from the first day after surgery. Ankle eversion and first ray plantarflexion strength were measured using a modified dynamometer 6 months after surgery. Donor site morbidity was assessed 6 months after surgery using the Foot & Ankle Disability Index (FADI) and American Orthopaedic Foot & Ankle Society (AOFAS) scoring system for the ankle and hindfoot. Results: A total of 31 patients (22 male, 9 female; mean age, 27.58 ± 8.69 years [range, 18.00-45.00 years]) fulfilled the inclusion criteria. There was no significant difference in ankle eversion strength at the donor site compared with the contralateral site ( P = .55), with means of 65.87 ± 7.63 N and 66.96 ± 8.38 N, respectively. Also, there was no significant difference in ankle first ray plantarflexion strength at the donor site compared with the contralateral site ( P = .68), with means of 150.64 ± 11.67 N and 152.10 ± 12.16 N, respectively. The mean FADI score of 99.71 ± 0.57 and mean AOFAS score of 98.71 ± 3.03 at the donor site were considered excellent results. Conclusion: Ankle eversion and first ray plantarflexion strength at the donor site were similar to those at the contralateral healthy site, with no donor site morbidity. This suggests that the peroneus longus tendon is a promising graft in ACL reconstruction.

Achilles mechanism reconstruction in four dogs Murdoch University Veterinary Hospital, Murdoch, WA, Australia

2001 ◽  
Vol 14 (01) ◽  
pp. 25-31 ◽  
Author(s):  
A. M. Marchevsky ◽  
R. A. Read ◽  
C. Eger ◽  
R. K. Sivacolundhu
Keyword(s):  
External Fixator ◽  
Type Ii ◽  
Chronic Injury ◽  
Peroneus Longus Tendon ◽  
Excellent Outcome ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Peroneus Brevis ◽  
Bone Tunnels ◽  
Veterinary Hospital

SummaryChronic Achilles mechanism injuries require aggressive treatment with excision of degenerate tissue. Following excision of degenerate tendon, the defect created may be too large to allow simple apposition of tendon to bone. Use of peroneus brevis and peroneus longus tendon transpositions (passing through bone tunnels drilled in the calcaneus), +/− lengthening of the gastrocnemius tendon, and reinforcement with a free fascial strip graft allows reconstruction of the area. Postoperative support should be provided using a type II transarticular external fixator for four weeks, followed by a splint or Robert Jones bandage for three weeks. Treatment, in all four of the dogs in this report, resulted in a good to excellent outcome. Based on the favourable results in this series, resection of all grossly abnormal tendon should be considered in cases of Achilles mechanism rupture, even though reconstruction of the area is more complex.Five Achilles mechanism reconstructions were performed in four dogs with chronic injury to the tendon. Following excision of degenerate tendon the area was reconstructed, in each case using peroneus brevis and peroneus longus tendon transpositions, lengthening of the gastrocnemius tendon and reinforcement with a free fascial strip graft. Post-operative support was provided in the form of a type II trans-articular external fixator for four to five weeks, followed by a splint or Robert Jones bandage for two to three weeks. The results in all of the dogs were good to excellent. One dog returned to full working capacity. Two dogs returned to unrestricted exercise without any observable lameness. One dog (bilateral injury) is sound but the owners have decided to limit the dog’s access to unrestricted activity.

Satisfactory functional and MRI outcomes at the foot and ankle following harvesting of full thickness peroneus longus tendon graft

2020 ◽  
Vol 102-B (2) ◽  
pp. 205-211
Author(s):  
Xiexiang Shao ◽  
Lewis L. Shi ◽  
Eric M. Bluman ◽  
Shaobai Wang ◽  
Xiaoming Xu ◽  
...  
Keyword(s):  
Peak Force ◽  
Peroneal Tendon ◽  
Healthy Controls ◽  
Full Thickness ◽  
Foot And Ankle ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Hop Test

Aims To evaluate the donor site morbidity and tendon morphology after harvesting whole length, full-thickness peroneus longus tendon (PLT) proximal to the lateral malleolus for ligament reconstructions or tendon transfer. Methods A total of 21 eligible patients (mean age 34.0 years (standard deviation (SD) 11.2); mean follow-up period 31.8 months (SD 7.7), and 12 healthy controls (mean age, 26.8 years (SD 5.9) were included. For patients, clinical evaluation of the donor ankle was performed preoperatively and postoperatively. Square hop test, ankle strength assessment, and MRI of distal calf were assessed bilaterally in the final follow-up. The morphological symmetry of peroneal tendons bilaterally was evaluated by MRI in healthy controls. Results Among the patients, the mean pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Karlsson-Peterson score were 98.7 (SD 2.5; p = 0.480) and 98.5 (SD 2.4; p = 0.480), and 98.3 (SD 2.4; p = 0.162) and 97.9 (SD 2.5; p = 0.162), respectively. There was no significant difference between square hop test bilaterally (p = 0.109) and plantar flexion peak force bilaterally (p = 0.371). The harvested limb had significantly less eversion peak force compared to the contralateral limb (p < 0.001). Evidence of probable tendon regeneration was observed in all the patients by MRI and the total bilateral peroneal tendon index (mean ratio of harvested side cross-sectional area of peroneal tendon compared with the contralateral side) was 82.9% (SD 17.4). In 12 healthy controls, peroneal tendons (mean 99.4% (SD 4.3) were found to be morphologically symmetrical between the two sides. Conclusion The current study showed satisfactory clinical foot and ankle outcomes after full-thickness PLT harvesting and indicated the regenerative potential of PLT after its removal. Level of Evidence: Level IV, therapeutic retrospective case series. Cite this article: Bone Joint J 2020;102-B(2):205–211.

Peroneus longus tendon and peroneus brevis tendon dislocation. A case report

1990 ◽  
Vol 80 (5) ◽  
pp. 263-265 ◽  
Author(s):  
MD Montes ◽  
JR Black
Keyword(s):  
Case Report ◽  
Ankle Sprain ◽  
Recurrent Dislocation ◽  
Accurate Diagnosis ◽  
Therapeutic Options ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Diagnosis And Management ◽  
Peroneus Brevis

Trauma that produces recurrent dislocation of the peroneal tendons often is mistaken for an ankle sprain, or occurs in conjunction with an inversion ankle sprain. Self-diagnosis and self-treatment may preclude accurate diagnosis and management. The authors present a case that illustrates this scenario and review anatomical considerations, the mechanism of the injury, and therapeutic options.

The Peroneal Tubercle: Description, Classification, and Relevance to Peroneus Longus Tendon Pathology

2005 ◽  
Vol 26 (11) ◽  
pp. 947-950 ◽  
Author(s):  
Christopher F. Hyer ◽  
John M. Dawson ◽  
Terrence M. Philbin ◽  
Gregory C. Berlet ◽  
Thomas H. Lee
Keyword(s):  
Classification Scheme ◽  
Average Length ◽  
Peroneal Tendon ◽  
Peroneus Longus Tendon ◽  
Poor Condition ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
The Poor ◽  
Tendon Tears ◽  
Tendon Pathology

Background: The size and configuration of the peroneal tubercle has been implicated in the pathogenesis of peroneal tendon tears and tenosynovitis. The purpose of this study was to determine the size and prevalence of the peroneal tubercle and devise a classification scheme according to the structure of the tubercle. Methods: One hundred and seventeen calcanei were selected from 59 human skeletons in an osteological collection (one calcaneus was missing). Three were excluded because of the poor condition, leaving 114 calcanei. The peroneal tubercle was measured in length, height, and depth and its structure subjectively described as flat, prominent, concave, or tunnel for each specimen when present. Results: This study revealed a peroneal tubercle prevalence of 90.4% (103) in 114 calcanei. The average length, height, and depth of the tubercle were 13.04 mm (range 3.61 mm to 26.66 mm), 9.44 mm (range 3.67 mm to 23.40 mm), and 3.13 mm (range 1 to 10), respectively. The peroneal tubercle was classified structurally as flat in 44 (42.7%), prominent in 30 (29.1%), concave in 28 (27.2%), and tunnel in one (1.0%). Conclusion: This data may further help to understand the size and assorted configurations of the peroneal tubercle and how they relate to peroneus longus tendon pathology.

scholarly journals Chronic Peroneal Tendon Dislocation: A Case Report

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1882-e1886
Author(s):  
Kiya Shazadeh Safavi ◽  
Saruthija Ratnasingam ◽  
Cory F Janney
Keyword(s):  
Sports Injury ◽  
Acute Onset ◽  
Peroneal Tendon ◽  
Peroneus Longus Tendon ◽  
Lateral Ankle ◽  
Peroneus Longus ◽  
Patient Reported ◽  
History Of ◽  
Peroneus Brevis

Abstract We present a unique case of chronic peroneal tendon dislocation in a 47-year-old active duty military member with a 2-mo history of acute onset lateral ankle pain due to sports injury. Magnetic resonance imaging revealed superficial peroneal retinaculum (SPR) disruption, a flattened retrofibular groove, dislocation of the peroneus longus tendon, and a tear of the peroneus brevis tendon. The patient was managed operatively with fibular groove deepening, SPR reconstruction, peroneus brevis debridement, and peroneus longus tubulurization. No complications were observed during the intra- or perioperative periods. At their 3-mo follow-up, the patient reported near complete resolution of pain and the ability to ambulate without any brace or support. He returned to running and was able to deploy fit for full duty 4.5 mo from injury.

scholarly journals Successful reconstruction of distal peroneus longus tendon dislocation associated with a split lesion – a case report

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Heinz Lohrer
Keyword(s):  
Peroneal Tendon ◽  
Peroneus Longus Tendon ◽  
Ankle Motion ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Operative Exploration ◽  
Partial Tears ◽  
Tendon Entrapment ◽  
Longitudinal Split ◽  
Patient’S History

Abstract Background Peroneal tendon injuries are one of the differential diagnoses in lateral ankle and rearfoot pain. While partial tears are not uncommon, peroneal tendon dislocation at the peroneal tubercle is very rare. Until now, only three papers have been published, presenting five cases of peroneus longus tendon dislocation over the peroneal tubercle. This report adds a previously undescribed case of a peroneus longus tendon split tear that was partially dislocated and entrapped over the peroneal tubercle. The respective operative approach and the outcome are described. Case presentation A 25-year-old international top-level speed skater developed a painful mass over the lateral calcaneal wall. There was no specific inducing injury in his medical history. In contrast to previous reports, according to the patient’s history, a snapping phenomenon was not present. Conservative treatment was not effective. By inspection and palpation an enlarged peroneal tubercle was assumed. During operative exploration, we found an incomplete longitudinal split tear of the peroneus longus tendon, which was partially dislocated and entrapped over the peroneal tubercle. This mimicked an enlarged peroneal tubercle. A portion of the split tendon was resected. A deepening procedure of the flat groove of the peroneus longus tendon below the peroneal tubercle and a transosseous reconstruction of the avulsed inferior peroneal retinaculum were performed. After six months, the patient had completely reintegrated into his elite sport and has been free of symptoms since then. Conclusions From the presented case it can be speculated that the inferior peroneal retinaculum was overused, worn out, detached, or ruptured due to overpronation and friction the lateral edge of the low-cut speed skating shoe. Then the peroneus longus tendon experienced substantial friction with the peroneal tubercle with possible dislocation during ankle motion. This frictional contact may have finally led to further degeneration and a longitudinal tear of the tendon. Obviously, dislocations can develop insidiously resulting in lesions of the peroneus longus tendon at the peroneal tubercle, ultimately leading to a tendon entrapment. This mimics an enlarged tubercle. The pathology is very rare and can be successfully addressed surgically.

Microvascular Anatomy of the Peroneal Tendons

Foot & Ankle ◽  
1992 ◽  
Vol 13 (8) ◽  
pp. 469-472 ◽  
Author(s):  
Mark Sobel ◽  
Mark J. Geppert ◽  
Jo A. Hannafin ◽  
Walther H. O. Bohne ◽  
Steven P. Arnoczky
Keyword(s):  
Compressive Load ◽  
Vascular Supply ◽  
Peroneal Artery ◽  
Peroneus Longus Tendon ◽  
Peroneal Tendons ◽  
Longitudinal Splitting ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
India Ink ◽  
Peroneus Brevis

The etiology of longitudinal splitting of the peroneus brevis tendon is unclear. It has been hypothesized that compressive load applied to the tendon as it passes through the fibular groove may compromise the vascularity of the tendon with resultant inhibition of the repair response and degeneration of tendon structure. To investigate this possibility, a study of the microvascularity of the peroneal tendons was undertaken. Twelve fresh, frozen cadaveric limbs were injected with India ink. The vascularity of the peroneal tendons was examined in situ and the tendons were harvested and cleared using a modified Spalteholz technique. The vascularity of the cleared tendons was evaluated utilizing a dissecting microscope. The vascular supply of the peroneal tendons arises from two posterolateral vincula, one for the peroneus longus tendon and one for the peroneus brevis tendon. These vincula are supplied by branches of the posterior peroneal artery. A zone of hypovascularity within the peroneus brevis or peroneus longus tendon correlating with the site of peroneus brevis splits was not found. There was no relationship between increasing age of specimens and alteration in vascular supply.

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