The role of the peroneal tendons in passive stabilisation of the ankle joint: an in vitro study

Knee Surg Sports Traumatol Arthrosc. 2013 Jun;21(6):1404-8. doi: 10.1007/s00167-012-2273-2. Epub 2012 Oct 30.


Purpose: Peroneal tendons are known as active stabilizer in acute ankle sprain while an intact ankle mortise and intact lateral ligaments are required for passive stability of the ankle joint. The goal of this study is to determine the peroneal tendons as passive stabilizer in case of lateral ligament instability.

Methods: Twelve (12) human lower leg cadaver specimens underwent a torsion simulation in the testing system, 858 Mini Bionix(®) (MTS(®) Systems Corporation, Eden Prairie, MN, USA) and a specially designed mounting platform for the specimens. The preset torsion between tibia and calcaneus was primarily set at 30° of internal rotation during plantar flexion and hindfoot inversion. The resisting torque around mechanical tibial axis was recorded which ensures stability in ankle sprain trauma. The first series of measurements were performed on healthy specimens and the following after transecting structures in following order: ATFL (anterior talofibular ligament) in combination with CFL (calcaneofibular ligament), followed by peroneus longus tendon and finally peroneus brevis tendon.

Results: The combined lateral ATFL and CFL instability shows a decrease of the resisting torque which ensures stability in ankle sprain trauma. Only a transection of PLT with existing lateral dual-ligament instability results in a significant decrease in torque (p < 0.0001).

Conclusion: The PLT has a substantial effect on passive stability at a present lateral ligament lesion in ankle sprain trauma. A deficiency in viscoelastic properties of the peroneus longus tendon must be considered in diagnostic and treatment for ankle instability.

MeSH terms

  • Ankle Injuries / physiopathology*
  • Ankle Joint / physiopathology*
  • Cadaver
  • Humans
  • Joint Instability / physiopathology*
  • Leg
  • Ligaments, Articular / physiopathology*
  • Tendons / physiopathology*
  • Torsion, Mechanical