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Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity

Abstract

Purpose

Peroneus longus tendon (PLT) autograft has been successfully used for isolated anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction cases. Being a powerful evertor and flexor of great toe, there might be associated ankle morbidity with this autograft option. However, there are only a few studies exploring whether the ankle morbidity is significant or not. This study aims to assess the functional outcomes, donor site morbidity, and ankle strength after harvesting ipsilateral peroneus longus autograft for ACL reconstruction in revision ACL and multi-ligament injury cases.

Methods

This was a prospective case series. All of the patients were evaluated by clinical examination for knee for laxity, ankle joint stability, and using visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, and Lysholm score, preoperatively and postoperatively at two-year follow-up. Morbidity of donor ankle was assessed using American Orthopedic Foot and Ankle Society (AOFAS) score, bilateral evertors, and first ray plantarflexion strength measurement using an isometer (Innovative Design Orthopedics) at two-year follow-up.

Results

Ipsilateral PLT graft was used in ten patients of revision ACL reconstruction and 27 patients of the multi-ligament knee injury. The mean length of PLT harvested (cm) was 26.2 (standard deviation 2.6, range 22–31), and mean diameter of the doubled graft (mm) was 7.9 (standard deviation 0.68, range 7.5–8.5). There was a significant improvement in VAS score for pain, Lysholm, and IKDC scores (p =  < 0.001) at two -year follow-up. There were no cases of graft failure, superficial, or deep infection. Ankle dorsiflexion(p = 0.32), ankle plantarflexion (p = 0.19), eversion strength(p = 0.6), first ray plantarflexion strength(p = 0.52), and AOFAS score(p = 0.29) were found to be comparable to the normal side in all patients.

Conclusions

Peroneus longus autograft can be considered as a potential autograft option for ACL reconstruction in multi-ligament knee injuries and revision ACL reconstruction. No significant donor site morbidity was noted at follow-up.

Level of evidence

Level IV.

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Funding

There was no funding source.

Author information

Affiliations

Authors

Contributions

TG: Planning of study, patient enrollment, writing of manuscript. SP: Evaluation of functional outcomes, patient enrollment, writing of manuscript, manuscript preparation. AKC: Patient enrollment, Data collection SSS: Patient enrollment, Data collection.

Corresponding author

Correspondence to Tarun Goyal.

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Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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The author(s) give consent for publication of this article.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethical approval

The institutional ethics committee approved the study (AIIMS/IEC/18/189).

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Informed consent was obtained from all individual participants included in the study.

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Goyal, T., Paul, S., Choudhury, A.K. et al. Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity. Eur J Orthop Surg Traumatol (2021). https://doi.org/10.1007/s00590-021-03145-3

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Keywords

  • Peroneus longus
  • Autograft
  • Anterior cruciate ligament
  • Ankle
  • Multi-ligament injury