title: Allograft reconstruction of peroneal tendons: operative technique and clinical outcomes.
abstract: BACKGROUND
  Irreparable peroneal tendon tears are uncommon and require complex surgical decision making. Intercalary segment allograft reconstruction has been previously described as a treatment option; however, there are no reports of the outcomes of this technique in the literature. We describe our technique and present our results using this method.
  
  
  METHODS
  A retrospective chart review was conducted to identify all patients who underwent intercalary allograft reconstruction of the peroneal tendons. Mechanism of injury, concomitant operative procedures, pertinent radiographic findings, pre- and postoperative physical examination, intercalary graft length, medical history, visual analog scale (VAS) score for pain, Short Form-12 (SF-12) physical health survey, Lower Extremity Functional Score (LEFS), and complications were reviewed.
  
  
  RESULTS
  Fourteen patients with peroneal tendon ruptures requiring reconstruction were identified. Mean follow-up was 17 months (range, 7-47 months; median, 12 months). The average length of the intercalary segment reconstructed was 10.8 ± 3.8 cm (range, 6-20 cm). The average postoperative VAS score decreased to 1.0 ± 1.4 (P = .0005). No patient had a higher postoperative pain score than preoperative pain score. Average postoperative eversion strength as categorized by the Medical Research Council grading scale improved to 4.8 ± 0.5 (P = .001). The average SF-12 score improved to 48.8 ± 7.8 (P = .02). The average LEFS improved to 86.4. ± 14.9 (P = .00001). Four patients experienced sensory numbness in the sural nerve distribution, and 2 of these were transient. There were no postoperative wound healing complications, infections, tendon reruptures, or reoperations. No allograft associated complications were encountered. All patients returned to their preinjury activity levels.
  
  
  CONCLUSIONS
  Allograft reconstruction of the peroneal tendons can improve strength, decrease pain, and yield satisfactory patient-reported outcomes. It can be performed without incurring the deleterious effects associated with tendon transfer procedures. We believe that allograft reconstruction is a safe and useful alternative in the treatment of irreparable peroneal tendon ruptures.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Mook
authors.forename: Selene G
authors.initials: SG
authors.lastname: Parekh
authors.forename: James A
authors.initials: JA
authors.lastname: Nunley
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012421:Rupture; D013709:Tendon Transfer; D053656:Tenodesis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: allograft; peroneal tendon; tendon reconstruction; tendon rupture