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Peroneus Brevis Tendon Transfer for Reconstruction of Chronic Tears of the Achilles Tendon: A Long-Term Follow-up Study

Maffulli, Nicola MD, MS, PhD, FRCS(Orth); Spiezia, Filippo MD; Pintore, Ernesto MD; Longo, Umile Giuseppe MD, MSc; Testa, Vittorino MD; Capasso, Giovanni MD; Denaro, Vincenzo MD

Journal of Bone & Joint Surgery - American Volume: 16 May 2012 - Volume 94 - Issue 10 - p 901–905
doi: 10.2106/JBJS.K.00200
Scientific Articles

Background: Chronic tears of the Achilles tendon can result in substantial loss of function. Those tears with a tendon gap of up to 6.5 cm can be treated surgically with use of an autologous peroneus brevis tendon graft.

Methods: At an average follow-up period of 15.5 years after the surgery, we examined sixteen of twenty-two patients who had undergone peroneus brevis tendon graft reconstruction for a chronic Achilles tendon tear. Clinical and functional assessment was performed.

Results: All sixteen patients were able to walk on tiptoe, and no patient used a heel lift or walked with a visible limp. The maximum calf circumference of the involved limb remained significantly decreased. The involved limb was significantly less strong than the contralateral one. One patient had developed a tendinopathy of the opposite Achilles tendon, one had developed a tendinopathy of the reconstructed tendon, and one had ruptured the contralateral Achilles tendon five years after the original injury.

Conclusions: The long-term results of treatment of chronic tears of the Achilles tendon by means of autologous peroneus brevis tendon grafting are encouraging. Patients retain good functional results despite permanently impaired ankle plantar flexion strength and decreased calf circumference.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England. E-mail address:

2Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy

3Clinica Malzoni, via GiovanBattista Vico, 1 84043, Agropoli (SA), Italy

4Olympic Center, Sports Medicine Unit, via dei Goti, 84012 Angri (SA), Italy

5First Institute of Orthopaedics, Second University of Naples Medical School, Via de Crecchio 4, 80100, Napoli, Italy

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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