SLR - August 2018 - Samantha A. Luer
Reference: Bourgault C, Pouges C, Szymanski C, Lalanne C, Thioun A, Soudy K, Maynou C. Clinical Results of Peroneal Tendon Repair in a Retrospective Series of 30 Patients. Orthop Traumatol Surg Res. 2018 Jun;104(4):511–517.Scientific Literature Review
Reviewed By: Samantha A. Luer, DPM
Residency Program: HealthPartners Institute/Regions Hospital, St. Paul, MN
Podiatric Relevance: Peroneal tendon repair is a common podiatric procedure. Peroneal tendon lesions often result from trauma and/or predisposing anatomic factors. Many foot and ankle surgeons perform primary tendon repair without addressing the influence of the hindfoot (cavovarus foot structure). This study was aimed to analyze medium-term results of surgical treatment of posttraumatic peroneal tendon tear by repair or by tenodesis and to assess the influence of hindfoot stasis on outcome. The hypothesis was that hindfoot varus impairs medium-term results.
Methods: A retrospective single-center study included patients operated on for peroneal tendon tear between 2007 and 2013. Inclusion criteria consisted of surgical repair of peroneal tendon radiologically proven (ultrasound, MRI) and resistant to medical treatment, >18 years old and minimum follow-up of six months. Patients who had adjunctive surgical procedures (calcaneal osteotomy or ligament reconstruction) were excluded.
Surgical procedure performed depended on the amount of tendon remaining. Tubularization performed when >50 percent of tendon diameter remained vs. tenodesis performed when <50 percent of tendon diameter remained. Postop protocol consisted of six weeks nonweightbearing in cast boot for both procedures.
Outcome measures included pre- and postoperative AOFAS scores and follow-up Foot and Ankle Ability Measure (FAAM) score at follow-up. The talocalcaneal angle on Méary cerclage view was also measured to determine hindfoot alignment.
Results: Three of 37 patients were lost to follow-up, and four were excluded due to associated procedures, N=30. Mean follow-up of 20 months (six to 60 months). For all patients, mean AOFAS score improved from 74.5 ± 11.2 (range, 58–82) preoperatively to 86.7 ± 9.4 (range, 58–100) at follow-up. Mean FAAM score, out of 84, at last follow-up was 78 ± 8.5 (range, 41–84). In the 26 patients who underwent tubularization, mean FAAM score was 77.1 ± 8.8 (range, 41–84), and mean AOFAS score improved from 73.6 ± 11.8 to 85.4 ± 9.3. Compared to the four patients with tenodesis, the AOFAS scores improved from 79.4 to 94, and mean FAAM score was 84.
The impact of hindfoot alignment on clinical outcome was assessed in 28 patients (two radiology files missing), distinguishing a “varus” group (n=17) with talocalcaneal angle ≤4° valgus on Méary cerclage view and a “valgus” group (n=11) with >4° valgus. Mean AOFAS score at follow-up was 93/100 in the “valgus” group and 82/100 in the “varus” group, the difference being significant (p=0.0003).Conclusions: In general, patients who undergo peroneal tendon repair surgery (tubularization or tenodesis) have satisfactory results. However, there is a significant difference in AOFAS scores of patients with hindfoot varus vs. valgus. This stresses the importance of full biomechanical and radiographic evaluations preoperatively and may justify adjunctive calcaneal osteotomy in patients with calcaneal varus. At minimum, patients should be educated on the possibility of lower functional results if they have a hindfoot varus.