Peroneus Longus Tenodesis for Chronic Instability of the Distal Tibiofibular Syndesmosis

Abstract

Objective:

Reconstruction of the three-point dynamic suspension of the fibula in the fibular groove of the tibia. Elimination of pain and functional disturbances. Prevention of posttraumatic osteoarthritis.

Indications:

Chronic symptomatic insufficiency of the distal tibiofibular syndesmosis with widening of the mortise.

Contraindications:

Poor skin and soft tissue conditions. Advanced osteoarthritis of ankle.

Surgical Technique:

Reconstruction of the three most important ligaments of the distal syndesmosis complex: the anterior and posterior as well as the interosseous tibiofibular ligaments, with a halved, distally pedicled tendon of the peroneus longus tendon.

Results:

Ten tenodeses (eight women, two men, average age 40 years) were done between January 1998 and December 1999. The syndesmosis insufficiency persisted after surgical treatment of eight pronation-eversion and two -abduction fractures. Average duration of follow-up 11.4 months. Using the Karlsson score, the subjective and functional assessment of all patients reached 88 out of 100 points. One patient reached only 70 points on account of a preoperatively present dysesthesia in the territory of the tibial nerve giving rise to persistent pain.