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. The following is a reprint from Operat Orthop Traumatol 2003;15:208–225 and continues the new series of articles at providing continuing education on operative techniques to the European trauma community. Reprint from: Operat Orthop Traumatol 2003;15:208–25 DOI 10.1007/s00064-003-1068-5