Achilles Tendon Ruptures—Peroneus Brevis Transfer

Abstract

Peroneus brevis tendon transfer has been utilized in 40 individuals during the last 13 years. All cases consisted of complete Achilles tendon ruptures. In 34 cases the rupture was in the distal one-third of the tendon substance, in four cases bony avulsion of the calcaneal tuberosity occurred, and in two cases there was a diffuse tear in the proximal two-thirds of the tendon near the musculotendinous junction. The middle-aged athlete sustained the majority of these injuries during sports. Eleven patients were less than 30 years old, 23 patients were 30 to 40 years old, and six were over 40 years old. Five patients had reruptures that involved prior nonoperative treatment of cast immobilization, and one had undergone simple direct suture. This repair has been used in acute, chronic, and recurrent ruptures of the tendoachillis. Thirty-three patients presented within 1 week of injury, and seven after more than 1 week. A. Perez Teuffer personally described the preferred technique in 1971 and subsequently published in 1978. The transfer of the peroneus brevis is combined with a direct end-to-end suture of the triceps surae tendon that allows a secure reconstruction with the foot at a right angle. The peroneus brevis tendon is detached from the base of the fifth metatarsal and then tunnelled through the distal Achilles tendon stump. The distal portion of the tendon transfer is then drawn proximally along the medial calcaneal tendon border. The proximal triceps surae tendon is pulled distally and secured to the peroneal tendon. The ruptured ends of the Achilles tendon are sandwiched between the U-shaped peroneal tendon transfer, which acts as a biologic scaffold for the reparitive process. Several advantages are apparent when compared to nonoperative care and other operative techniques including simple Achilles tendon repair, plantaris tendon transfers, reconstructive fascial flaps, and synthetic substitutes. A strong repair with the foot at the neutral position is possible even when the Achilles tendon is shredded. The transfer provides an active motor, adds some power to the damaged triceps, and avoids the danger of rerupture. No reruptures have occurred after this surgical procedure. Calf weakness is minimized because the proximal fragment of the damaged Achilles tendon is sutured securely under physiologic tension into the peroneus brevis. Immobilization postoperatively in a short leg cast at a right angle and early weightbearing facilitate the rehabilitation period and avoid the many months necessary to regain dorsiflexion after 6 to 8 weeks of casting in plantarflexion. The bulk and profile of the repaired Achilles tendon is restored. A healthy tendon transfer is an additional benefit. Strength after the peroneus brevis U-shaped tendon transfer is superior to other methods of treatment and is particularly advantageous in the sports-oriented individual.