Allograft reconstruction of Peroneus longus and brevis tendons tears arising from a single muscular belly. Case report and surgical technique

• Although a myriad of anatomical variations of the peroneal tendons have been described, a single muscular belly dividing into two separate tendons have not been previously reported as a cause of retromalleolar pain. However, anatomical evidence based guidelines on how to address this complex clinical problem are lacking.
• Anatomic variants of the peroneal tendons can overcrowd the retromalleolar space and attenuate the superior peroneal retinaculum, leading to tendon pathology.
• Successful reconstruction of the peroneal tendons using semitendinosus allograft has recently expanded the treatment armamentarium of peroneal tendon pathology and should be considered when addressing this problem.

Anatomic variants of the peroneal tendons may cause tendon disorders. Moreover, there is a lack of evidence on how to address chronic tendon pathology when a variant of the peroneal tendons is causing the patient's symptoms. We present a patient with an uncommon peroneal muscle presentation: a single muscular belly dividing into both the peroneus longus and brevis tendons. After extensive debridement of tendinopathic tissue, primary repair or tenodesis was not possible; therefore a unique solution for this problem was performed, reconstructing both peroneal tendons using a semitendinosus allograft.