Most authors have reported debridement and suture of longitudinal tears, with tubulisation of the remaining tendon. Krause et al (1998) recommended repair for tears of peroneus brevis where more than 50% of the tendon was intact, but where there was less than 50% tendon remaining they excised the abnormal segment and attached the ends to the peroneus longus.
Krause and Brodsky (1998) reported 20 patients at an average of 39 months after brevis repairs. The mean AOFAS score at review was 85 and 19 patients were satisfied. However, 13/20 patients had pain on activity, 10 had retromalleolar tenderness and 6 had swelling. Saxena and Cassidy (2003) reported 41 patients with 24 brevis, 11 longus and 7 combined tears. Mean AOFAS scores improved from 52 pre-op to 90 post-op and there was no difference between the results in different tendons. 14/16 athletes returned to sport. Steel and deOrio (2007) reported 30 patients who had repairs of peroneus brevis tears (21), longus tears (5) or combined tears (4). Four patients also had calcaneal osteotomies. Half had residual pain or swelling at an average follow-up of 31 months, and only half returned to sport. It seems best to be cautious in predicting the results of peroneal tendon debridement/repair when counselling patients.
Where there is a complete tear with discontinuity of the tendon ends repair without tension is usually impossible except in the acute setting, and the ends of the tendon should be sutured to the adjacent tendon. Obviously, complete tears of both tendons preclude this, and a tendon transfer is required – flexor digitorum longus transfer has been reported in two patients by Borton et al (1998) and staged FHL transfer in six patients by Wapner (2006).
Peroneus longus tears at the os peroneum may be debrided and repaired. A fragmented os peroneum is usually excised. Occasionally a defect in the tendon needs to be bridged with a tendon graft (plantaris).
Peroneus brevis tears often have associated SPR laxity and this should be repaired at the same time as the tendon. Stenosing tenosynovitis of peroneus longus may require release of the IPR and/or reduction of the peroneal tubercle.
Van Dijk (1998) described endoscopic debridement and suture of the peroneal tendons. There have been no comparative studies with open surgery.