Peroneus Longus to Peroneus Brevis Tenodesis Does Not Improve Ankle Functional Outcomes: A Prospective Cohort Study

Peroneus longus (PL) graft harvest has recently gained popularity for various ligament reconstruction surgeries. A recent systematic review shows it is a safe and reproducible technique with low morbidity of donor sites (1). The method for PL harvest routinely involves tenodesis of the PL stump to the peroneus brevis (PB). To the authors' best knowledge, no study exists in the literature that has compared the outcomes of tenodesis versus no tenodesis on post-operative ankle functional outcome scores. The purpose of the present study is to assess the importance of tenodesis on post-operative ankle scores.

A total of 200 consecutive patients from July 2022 to November 2022 were included in the study: 72 in the no tenodesis group and 128 in the tenodesis group. Institutional ethics approval was obtained from the institutional ethics review committee before the initiation of the study. Demographic variables (age, gender and level of play) were recorded. Pre-operative American Orthopaedic Foot and Ankle Society Score (AOFAS) and Functional Ankle Disability Index (FADI) scores were calculated for both groups and compared with post-operative scores at six weeks, three months, six months and one-year follow-up.

For the entire study population (n = 200), we found that AOFAS and FADI scores showed no significant difference at any interval except for lower scores at six weeks of follow-up for both groups compared to baseline. We found that the no tenodesis group had slightly better AOFAS and FADI scores at the six-week follow-up, which were statistically significant (p < 0.05). However, the magnitude of variance (0.13 and 0.20, respectively) was too small to be clinically significant. Age, gender and level of play had no impact on ankle functional outcomes.

Tenodesis of the PL to the PB has been the standard norm in PL graft harvest for various ligament surgeries. The present high-powered prospective cohort study shows that tenodesis.does not improve ankle functional outcome scores compared to no tenodesis. Further work is needed to assess the impact of tenodesis or no tenodesis on ankle biomechanics (eversion, plantarflexion and gait).

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