Peroneus Brevis Allograft Reconstruction: Clinical Outcomes and Complications

Clinical data are limited for allograft reconstruction of peroneus brevis tears, and its complication profile remains poorly defined.

Retrospective chart review was conducted for patients with peroneus brevis tears who underwent tendon reconstruction with semitendinosus allograft at a single tertiary center between March 2010 and July 2019. A total of 68 patients (69 feet), 24 men and 44 women, were identified with mean age at surgery 51.8 (range, 23-74) years and mean follow-up 20.2 (range, 3.4-71.4) months. At the time of chart review, patients were contacted by phone to assess satisfaction, brace use, and work status.

Visual analog scale (VAS) pain score was significantly lower postoperatively (4.0 ± 2.7 vs 2.4 ± 2.8, P = .0018) in the 54 patients with VAS pain data. A total of 40 (58%) feet had at least 1 complication. The most common complications were sural neuralgia in 18 (26%) feet and allograft failure in 7 (10%) feet. Fifteen feet (21%) required reoperation, including 7 for graft failure. In the 30 feet with prior peroneal tendon surgery, there was no association between prior surgery and complications (P = .21). Of the 24 (35%) patients available for phone survey, 20 (83%) were employed prior to surgery and 18 (90%) of these employed patients returned to work and 14 (58%) did not use an assistive device at final follow-up. Sixteen (67%) of the 24 patients contacted reported being very satisfied or satisfied with the procedure.

This is the largest case series to date, demonstrating significant pain improvement and high return-to-work rates in complex cases, but also a 58% overall complication rate and 10% graft failure. Allograft reconstruction may be effective when few options exist, yet careful patient selection and awareness of technical challenges are essential.Level of Evidence: Level IV, case series.