Peroneal Longus to Brevis Transfer Augmentation With TeKBrace Synthetic Graft

Abstract

Background

Peroneal tendon disorders, encompassing tendinopathy, tears, subluxation, and instability, represent a significant source of lateral ankle pain and functional impairment, often exacerbated by underlying conditions such as cavovarus foot deformities or chronic lateral ankle instability. In cases of severe peroneus brevis degeneration or irreparable tears, peroneal longus to brevis tendon transfer is an effective technique to restore eversion strength and dynamic stability, though challenges persist in patients with poor tissue quality necessitating augmentation.

Purpose

To present a novel case of peroneus longus-to-brevis transfer augmented with the TeKBrace synthetic graft for complex peroneal pathology. Case Presentation. A 31-year-old man presented with persistent lateral ankle pain following an inversion injury 6 months prior. Conservative management, including an orthopaedic boot, home exercises, nonsteroidal anti-inflammatory drugs, physical therapy, and a peroneal tendon steroid injection, provided limited relief. Physical examination revealed cavus foot posture, tenderness over the peroneal tendons and lateral ligaments and pain with eversion. Magnetic resonance imaging showed tears in both peroneal tendons and increased signal at the peroneal tubercle. Surgery involved lateral incision, excision of the torn peroneus brevis segment, side-to-side anastomosis of the peroneal longus to brevis, peroneal tubercle planing, and lateral ankle ligament imbrication using anchors. The anastomosis was reinforced with TeKBrace synthetic graft. Postoperative protocol included non-weight-bearing in a posterior splint for 1 week, short leg cast for 2 weeks, and full weight-bearing in a walking boot at 3 weeks.

Results

The augmentation facilitated early mobilization and protected weightbearing, resulting in minimal muscle atrophy, shorter rehabilitation time, rapid return to activities, and no device-related complications (infection, foreign body reaction, or mechanical failure).

Conclusion

This single case highlights the feasible use of TeKBrace augmentation in peroneal longus to brevis transfer, suggesting potential benefits for select patients with complex peroneal tendon reconstructions. Larger series with longer-term outcomes are needed to confirm durability, integration, and any advantage over nonaugmented transfers or other reinforcement options.