title: Effectiveness of Allograft Reconstruction vs Tenodesis for Irreparable Peroneus Brevis Tears: A Cadaveric Model.
abstract: BACKGROUND
  Irreparable peroneus brevis tendon tears are uncommon, and there is scant evidence on which to base operative treatment. Options include tendon transfer, segmental resection with tenodesis to the peroneus longus tendon, and allograft reconstruction. However, the relative effectiveness of the latter 2 procedures in restoring peroneus brevis function has not been established.
  
  
  METHODS
  Custom-made strain gage-based tension transducers were implanted into the peroneus longus and brevis tendons near their distal insertions in 10 fresh-frozen cadaver feet. Axial load was applied to the foot, and the peroneal tendons and antagonistic tibialis anterior and posterior tendons were tensioned to 50% and 100% of physiologic load. Distal tendon tension was recorded in this normal condition and after sequential peroneus brevis-to-longus tenodesis and peroneus brevis allograft reconstruction. Measurements were made in 5 foot inversion/eversion and plantarflexion/dorsiflexion positions.
  
  
  RESULTS
  Distal peroneus brevis tendon tension after allograft reconstruction significantly exceeded that measured after tenodesis in all tested loading conditions (P ≤ 0.022). With 50% of physiologic load applied, peroneus brevis tension was 1% to 28% of normal (depending on foot position) after tenodesis and 73% to 101% of normal after allograft reconstruction. Under the 100% loading condition, peroneus brevis tension was 6% to 43% of normal after tenodesis and 88% to 99% of normal after reconstruction with allograft. Distal peroneus longus tension remained within 20% of normal under all operative and loading conditions.
  
  
  CONCLUSIONS
  Allograft reconstruction of a peroneus brevis tendon tear in this model substantially restored distal tension when the peroneal tendons and their antagonists were loaded to 50% and 100% of physiologic load. Tenodesis to the peroneus longus tendon did not effectively restore peroneus brevis tension under the tested conditions.
  
  
  CONCLUSIONS
  Because tenodesis was demonstrated to be ineffective for restoration of peroneus brevis function, this procedure may result in an imbalanced foot clinically.
authors.affiliation: Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile mpellegrini@hcuch.cl.
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Pellegrini
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Glisson
authors.affiliation: Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Schiff
authors.affiliation: Department of Orthopaedics, Tel-Aviv University Hospital, Tel-Aviv, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Laver
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Easley
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Nunley
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012421:Rupture / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000601:surgery*; D053656:Tenodesis
keywords: peroneus brevis; peroneus longus; tenodesis