Harvesting the Peroneus Longus Does Not Lead to Peroneal Brevis Hypertrophy: Prospective Ultrasound-Based Study of 40...

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); however, recent work has shown no impact on ankle functional outcomes with or without tenodesis. Harvesting of the PL should theoretically lead to a hypertrophy of the PB to compensate for its function. The purpose of the present study was to assess the effect of PL harvest on the PB.

Institutional ethics approval was obtained from the institutional ethics review board (January 2024). A total of 40 consecutive patients from January 2024 to February 2024 were included in the study: 20 patients in the no tenodesis group and 20 patients in the tenodesis group. Demographic variables (age, gender, and level of play) were recorded. Pre-operative American Orthopedic 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. Ultrasound scan of bilateral ankle to assess PL and PB diameters was performed pre-operatively and tracked at three months, six months, and one year post-surgery.

For the entire study population (n = 40), we found that AOFAS and FADI scores showed no significant difference at any interval. Age, gender, and level of play had no impact on ankle functional outcomes. Harvesting the PL did not significantly increase ipsilateral PB or contralateral PL diameter post-surgery. There was no significant difference between the tenodesis and no tenodesis groups regarding either PL or PB diameter at any time.

Tenodesis of the PL to the PB has been the standard procedure for harvesting PL grafts for various ligament surgeries. Recent work has shown that tenodesis or no tenodesis does not impact ankle functional outcomes. The present ultrasound-based study indicates that the PB does not hypertrophy to compensate for a harvested PL. Further, tenodesis or no tenodesis has no impact on either PB or PL diameters.