Background: The Pulvertaft method has classically been used for the transfer of various tendon injuries owing to its biomechanical strength; however, this method has been shown to be bulky. We describe the open-book technique, which can offer comparable structural integrity with a decreased bulk. The purpose of this study was to determine whether the openbook technique is biomechanically equivalent to the Pulvertaft method for treating peroneal tendon injuries.

Methods: We evaluated five pairs of human cadaveric ankles. Within each pair, one specimen was randomly assigned to either the Pulvertaft or the open-book group. Using sharp dissection, the tendons were severed in a standardized method. Transfer was performed using one of the two randomly assigned techniques. The transferred peroneal tendons were stressed on a mechanical tensioning device until failure. Data were recorded and analysis was performed.

Results: There was a statistically significant difference (P < 0.001) between the thickness of the Pulvertaft method (7.6 mm) and open-book technique (5.7 mm). There was also a statistically significant difference in elongation, with the Pulvertaft undergoing more elongation at yield (9.7 mm vs 3.7 mm, respectively; P = 0.04). No statistical difference was detected in elongation at peak (P = 0.52), load at yield (P = 0.9), or peak load (P = 0.69).

Conclusions: The open-book technique appears to be a viable biomechanical alternative to the Pulvertaft method for peroneal tendon transfer. The peak load, load at yield, and elongation at peak were biomechanically equivalent. The open-book technique was found to provide a significant decrease in thickness, which could prove advantageous when dealing with anatomical locations.

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