SLR - February 2015 - Stephanie Eldridge
Repair of Achilles Tendon Ruptures with Peroneus Brevis Tendon Augmentation
Singh A, Nag E, Roy SP, Gupta RC, Gulati V, Agrawal N. Repair of
Achilles Tendon Ruptures with Peroneus Brevis Tendon Augmentation. J Othop Surg (Hong Kong). 2014 Apr; 22(1): 52-5.
Scientific Literature Review
Reviewed by: Stephanie Eldridge, DPM
Residency Program: Phoenixville Hospital
Complex Achilles tendon ruptures can be challenging to restore to
normal function with end-to-end repair alone. Prior studies have
demonstrated an increased risk for infection, dehiscence, and other
complications. Augmented Achilles tendon repairs with tendon transfers
can also help restore length. They have previously been described using
flexor hallucis longus (FHL), peroneus brevis (PB), or plantaris.
Plantaris may not be present or sufficient in structure to be utilized
for augmentation, while harvest of FHL may weaken the push-off phase of
ambulation. In this article, the authors examine outcomes of tendon
augmentation utilizing peroneus brevis.
authors conducted a retrospective review of their records from 2008 to
2010 including patients who sustained a compound Achilles tendon rupture
and underwent repair with peroneus brevis tendon augmentation.
Exclusion criteria included diabetics, history of steroid injections,
and age >60 years. Injuries were secondary to lacerations or
industrial accidents. 22 patients were included and consisted of 6 women
and 19 men ranging from 21 to 42 years of age.
longitudinal incision was employed and modifications were made if
necessary based on the rupture location. The ruptured tendon was trimmed
and repaired. A separate incision was made at the base of the fifth
metatarsal to identify and free the peroneus brevis tendon for transfer.
The PB tendon was transferred through the aponeurotic septum from the
lateral to the posterior compartment and out of the posterior incision.
PB was further mobilized by freeing up the proximal muscle belly. The
tendon was then passed through a mid-coronal slit in the distal stump
and redirected proximally. The transfer was secured with No. 1 Vicryl
both proximally and distally. The injured extremity was compared to the
contralateral extremity to match the degree of resting equinus. In
situations where the distal Achilles tendon stump was inadequate, PB was
instead passed through a drill hole in the calcaneus. Postoperatively,
an above-knee posterior splint was applied in a gravity ankle equinus
position with 45 degrees of knee flexion. At week 4, patients began
ankle movement exercises and toe-touch weight bearing was allowed. Upon
achieving full ankle ROM at week 8, the patients were allowed full
weight bearing status. The patients had follow up evaluations bimonthly
for two months, monthly for three months, at nine months and one year
utilizing the Foot and Ankle Outcome Score (FAOS).
There were no observed re-ruptures. Three patients had superficial skin
complications and two separate patients developed wounds requiring
debridement. Mean FAOS improved most significantly between months three
through twelve. At final follow-up all patients achieved satisfactory
outcome using FAOS.
Conclusion: This repair should be
considered in younger individuals, runners, and in those who
particularly need to maintain strong hallux plantarflexory force for
push-off. Ankle plantarflexion strength will be largely maintained, with
a possible decrease in ankle eversion strength. Peroneus brevis tendon
augmentation is a viable option for repair of Achilles ruptures in which
end-to-end repair is not sufficient to restore adequate length.