L-lengthening peroneal tenodesis with concurrent modified Brostrom Gould for peroneal brevis rupture and chronic ankle instability: A case report
L-lengthening peroneal tenodesis with concurrent modified Brostrom Gould for peroneal brevis rupture and chronic ankle instability: A case report
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Introduction: A large proportion of patients here with chronic lateral ankle instability suffer from recurrent ankle sprains and develop concurrent peroneal tendon pathology.This is associated with significant pain, post-traumatic ankle osteoarthritis and severe impairments in quality of life.Currently, evidence-based treatment guidelines for peroneal pathology are lacking despite a high failure rate with nonoperative management of tears or ruptures.
This case report details the first cited peroneal L-lengthening tenodesis and modified Brostrom-Gould to date.Case presentation: A 56-year-old male presented with chronic pain, disability and instability following a forced ankle plantarflexion-inversion injury.The patient was diagnosed with a complete rupture of the peroneus brevis tendon at the level of the retro-malleolar groove with 5 cm retraction, marked peroneal tenosynovitis and tendinopathy, and chronic lateral ankle ligament deficiency.
Surgical management was successful, involving an L-lengthening peroneal tendon repair and tenodesis, with a concurrent modified Brostrom-Gould procedure.Following 12 months follow-up after” surgical management, the patient returned to activities of normal living and sports with significant improvements in pain levels and reported quality of life.Conclusions: A high index of suspicion is necessary for peroneal tendon injury following inversion ankle trauma, especially in the presence of chronic ankle instability.
The reported surgical technique may be considered as a feasible option for patients with chronic ankle instability and concurrent peroneal tendon rupture.Further research is warranted to johnny cash style clothing establish evidence-based guidelines to facilitate clinical decision-making.