Tendoscopic-Assisted Repair of Distal Peroneus Longus Rupture: A Novel Approach and 2 Case Reports

Surgical approaches have been described to treat isolated peroneus longus (PL) injuries when the ruptured tendon ends do not allow for direct end-to-end reapproximation due to distal location beneath the cuboid or beyond. Among these are proximal PL-to-peroneus brevis tenodesis and PL transfer to the lateral border of the calcaneus or cuboid (with or without excision of an associated os peroneum). While these procedures may have utility, it is unlikely that the aforementioned restore the active, simultaneous eversion, abduction, and dynamic plantarflexion of the normal PL muscle-tendon unit. A procedure is described which may be capable of restoring PL function in the presence of these more distal ruptures. This procedure begins with tendoscopic confirmation of the rupture, followed by externalization and debridement of the proximal tendon stump, whip suture preparation, and reinsertion under estimated physiologic tension into the first metatarsal base by way of nonabsorbable suture and endobutton. Two patients whose surgery utilized this technique with a minimum of 7 years follow-up are presented.Levels of Evidence:Level IV: Case Series.