Peroneus brevis rerouting:
Evan's procedure: Transected peroneus brevis tendon is directly attached to distal fibula and is used to reconstruct anterior TFL
Modified Evans procedure: Transected Peroneus brevis is rerouted in distal-to-proximal direction through surgically created tunnel in fibula and then reattached at initial transection site
Plain radiograph - obliquely vertical fibular tunnel in the course of peroneus.
Us & MR - peroneus brevis enters fibular tunnel at fibular tip and exits superiorly from posterior end of tunnel. Artifact from suture material may be seen
Peroneus brevis tendon loop:
Lee procedure: Transected peroneus brevis tendon is rerouted through the fibula, but not reattached at the initial transection site, instead it is looped around distal fibula and sutured distally back upon itself. Done in association with reconstruction of anterior TFL
Watson-Jones procedure: two fibular tunnels and talar tunnel
Radiograph - fibular tunnel with AP orientation.
MR - tendon enters posterior end of fibular tunnel, exits through anterior end. Sutured distally upon itself near fibular tip. Artifact from suture material at proximal belly of peroneus brevis, which is sutured to peroneus longus tendon.
Peroneus brevis split and rerouting:
Chrisman-Snook procedure: Tendon is split longitudinally. One half courses beneath talus, through fibular tunnel in AP direction, under a segment of calcaneal periosteum, then courses anteriorly and sutured near 5th metatarsal. It is done to reconstruct anterior TFL and CFL. Other half is left for peroneus brevis function
References:
Chien AJ et al. Imaging Appearances of Lateral Ankle Ligament Reconstruction. RadioGraphics 2004;24:999-1008
