L-lengthening peroneal tenodesis with concurrent modified Brostrom Gould for peroneal brevis rupture and chronic ankle instability: A case report

Introduction: A large proportion of patients 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 establish evidence-based guidelines to facilitate clinical decision-making.