SLR - October 2021 - Saakshi Chowdhary
Reference: Zongyu Yang, Fei Liu, Liang Cui, Heda Liu, Junshui Zuo, Lin Liu, Sentian Li. Comparison of the Effects of Reconstruction of the Lateral Ankle Ligaments Using Peroneus Longus and Peroneus Brevis Tendon Graft. Medicine (Baltimore). 2020 Nov 13;99(46)e22912.Level of Evidence: III
Scientific Literature Review
Reviewed By: Saakshi Chowdhary, DPM
Residency Program: St. Joseph Medical Center – Houston, TX
Podiatric Relevance: Chronic lateral ankle instability affects both active and sedentary patients. Due to recurrent injuries that arise from the condition, surgical intervention is often necessary when conservative therapy fails. Direct anatomic repair of the lateral ankle ligaments has proven to be effective. Non-anatomic repair involving tendon transfers is an alternate choice for treating long standing injuries in which soft tissues may be inadequate for direct repair. The peroneus brevis and peroneus longus tendons have been utilized for ligament reconstruction and provide good mechanical stability without complications. This study aimed to further compare the effects between the two tendons when used as graft on ankle pain, function and stabilization.
Methods: A level III retrospective cohort study examined two techniques of lateral ankle ligament reconstruction in 88 patients suffering from chronic lateral ankle instability for a minimum of six months. Group A = 46 patients who underwent reconstruction with anterior half of the peroneus longus tendon while Group B = 42 patients who underwent reconstruction with anterior half of the peroneus brevis tendon. Clinical outcomes were evaluated by comparing preoperative and postoperative American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores for pain and function, visual analog scale (VAS) for pain, and Karlsson-Peterson scores for range of motion and pain. Radiographic outcomes were obtained by performing the talar tilt and anterior talar translation test with applied stress. Finally, a dynamometer quantified postoperative changes in muscle strength during inversion, plantarflexion, dorsiflexion, and valgus. In both groups, muscle strength was also compared with those of the non-operative ankles.
Results: With a follow up period between 12-24 months, both groups showed an improvement in subjective VAS and Karlsson-Peterson pain and range of motion scores without a statistically significant difference. An increase in ankle function and stability was noted with increased AOFAS ankle hindfoot scores and decreased talar tilt and anterior talar translation values in both groups without a statistically significant difference. Dynamometer measures revealed a higher number of patients with decreased postoperative valgus strength in Group B as compared to Group A. Additionally, a greater number of patients in Group B displayed a weaker valgus force in the operative ankle compared to the non-operative ankle. In both groups, there were no changes in dorsiflexion, plantarflexion or inversion muscle strength postoperatively or between the operative and non-operative extremities.
Conclusions: Both the peroneus longus and brevis tendons can serve as a source for lateral ankle ligament reconstruction by decreasing pain level, providing stability and minimizing complications to the ankle joint and adjacent joints. Most notably, sacrificing the brevis tendon resulted in more weakness in eversion, and so had more associated morbidity compared to the longus. While important radiographic and clinical outcomes were taken into account, the study had limitations with a relatively short follow up time and lack of objective measures to assess for residual lateral ankle instability. Tendon transfers are useful autologous methods to augment repair, but a thorough review of biomechanics and patient history is necessary.