Clinical Outcomes and Complications of Peroneus Brevis Allograft Reconstruction

Category: Ankle; Other Introduction/Purpose: Peroneus brevis (PB) tendon tears are an important cause of lateral ankle pain. When PB tears are irreparable, allograft reconstruction maintains native anatomy and avoids the morbidity of tenodesis and tendon transfer procedures. Current data on allograft PB reconstruction is limited to small case series. We sought to retrospectively determine the clinical outcomes and complications in a large series of patients who underwent PB tendon reconstruction with semitendinosus allograft. Methods: After institutional review board approval, patients with PB tears who underwent tendon reconstruction with semitendinosus allograft at a single tertiary center between March 2010 and January 2020 were retrospectively reviewed. Hospital records, preoperative and postoperative visual analog pain scale (VAS), and complications were evaluated. A phone survey was conducted to assess postoperative work status, use of assistive devices, satisfaction, and patient-reported outcomes (PROMIS scores). Results: Sixty-eight patients (69 feet) (24 men,44 women) were identified. Mean age at surgery was 51.7 years (range, 23.0-74.0) and mean follow-up was 20.4 months (range, 3.4-71.4). VAS pain scale improved postoperatively (4.0±2.7 vs 2.4±2.8, p=0.0012). Most common complication was sural neuralgia in 18 (26.1%) feet, but only 2 (11%) required surgery. The allograft failed in 7 (10.1%) feet (Table 1).Of 29 (42.6%) patients available for survey, 25 (86.2%) were employed preoperatively, of whom 23 (92.0%) returned to work. Of the 29 survey patients, 25 (86.2%) did not use an assistive device, 20 (69.0%) reported being satisfied, and average T-scores for physical function and pain interference were 49.5±9.7 and 50.8±9.7, respectively. Revision PB surgery (30 [43%] feet) was not associated with sural neuralgia or patient satisfaction. Conclusion: This study demonstrated a relatively high rate of postoperative transient sural neuralgia after PB reconstruction with semitendinosus allograft, but the rate of reoperation for this complication was low. Among the subgroup of patients who completed a phone survey, there was a high rate of return to work, low rate of assistive device use, and good patient satisfaction after the procedure. These findings suggest that allograft reconstruction is a clinically effective treatment for irreparable PB tendon tears when few other options exist.