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.
Similar content being viewed by others
References
West RV, Harner CD (2005) Graft selection in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 13(3):197–207. https://doi.org/10.5435/00124635-200505000-00006
Romanini E, D’Angelo F, De Masi S et al (2010) Graft selection in arthroscopic anterior cruciate ligament reconstruction. J Orthop Traumatol 11:211–219
Lobo Gajiwala A (2003) Tissue banking in India: gamma-irradiated allografts. Cell Tissue Bank 4:203–211. https://doi.org/10.1023/B:CATB.0000007022.91458.00
Goyal T, Paul S, Das L, Choudhury AK (2020) Correlation between anthropometric measurements and activity level on length and diameter of semitendinosus tendon autograft in knee ligament surgery: a prospective observational study. SICOT-J. https://doi.org/10.1051/sicotj/2020007
Armour T, Forwell L, Litchfield R et al (2004) Isokinetic evaluation of internal/external tibial rotation strength after the use of hamstring tendons for anterior cruciate ligament reconstruction. Am J Sports Med 32:1639–1643. https://doi.org/10.1177/0363546504263405
Ohkoshi Y, Inoue C, Yamane S et al (1998) Changes in muscle strength properties caused by harvesting of autogenous semitendinosus tendon for reconstruction of contralateral anterior cruciate ligament. Arthroscopy 14:580–584. https://doi.org/10.1016/s0749-8063(98)70053-2
Tashiro T, Kurosawa H, Kawakami A et al (2003) Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction: a detailed evaluation with comparison of single- and double-tendon harvest. Am J Sports Med 31:522–529. https://doi.org/10.1177/31.4.522
Goradia VK, Grana WA, Pearson SE (2006) Factors associated with decreased muscle strength after anterior cruciate ligament reconstruction with hamstring tendon grafts. Arthrosc - J Arthrosc Relat Surg 22:80.e1-80.e15. https://doi.org/10.1016/j.arthro.2005.10.012
Charlton WP, Randolph DA Jr, Lemos S, Shields CL Jr (2003) Clinical outcome of anterior cruciate ligament reconstruction with quadrupled hamstring tendon graft and bioabsorbable interference screw fixation. Am J Sports Med 31(4):518–521. https://doi.org/10.1177/03635465030310040701
Sanders B, Rolf R, McClelland W, Xerogeanes J (2007) Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch Injury. Arthrosc - J Arthrosc Relat Surg 23:956–963. https://doi.org/10.1016/j.arthro.2007.03.099
Ruffilli A, De Fine M, Traina F et al (2017) Saphenous nerve injury during hamstring tendons harvest: does the incision matter? A systematic review. Knee Surg Sport Traumatol Arthrosc 25:3140–3145
Sherman OH, Banffy MB (2004) Anterior cruciate ligament reconstruction: Which graft is best? Arthrosc J Arthrosc Relat Surg 20:974–980. https://doi.org/10.1016/j.arthro.2004.08.001
Hardy A, Casabianca L, Andrieu K et al (2017) Complications following harvesting of patellar tendon or hamstring tendon grafts for anterior cruciate ligament reconstruction: systematic review of literature. Orthop Traumatol Surg Res 103:S245–S248
Goyal T, Paul S, Banerjee S, Das L (2021) Outcomes of one-stage reconstruction for chronic multiligament injuries of knee. Knee Surg Relat Res. https://doi.org/10.1186/s43019-020-00083-y
Shi F-D, Hess DE, Zuo J-Z et al (2019) Peroneus longus tendon autograft is a safe and effective alternative for anterior cruciate ligament reconstruction. J Knee Surg 32:804–811. https://doi.org/10.1055/s-0038-1669951
Ertoğrul R, Sezer HB, Armağan R et al (2017) Comparison of clinical outcomes after anterior cruciate ligament reconstruction with autogenous hamstring tendons and peroneus longus allograft. Orthop J Sport Med. https://doi.org/10.1177/2325967117S00042
Setyawan R, Soekarno NR, Asikin AIZ, Rhatomy S (2019) Posterior cruciate ligament reconstruction with peroneus longus tendon graft: 2-years follow-up. Ann Med Surg 43:38–43. https://doi.org/10.1016/j.amsu.2019.05.009
Bi M, Zhao C, Zhang S et al (2018) All-inside single-bundle reconstruction of the anterior cruciate ligament with the anterior half of the peroneus longus tendon compared to the semitendinosus tendon: a two-year follow-up study. J Knee Surg 31:1022–1030. https://doi.org/10.1055/s-0038-1627466
Rhatomy S, Asikin AIZ, Wardani AE et al (2019) Peroneus longus autograft can be recommended as a superior graft to hamstring tendon in single-bundle ACL reconstruction. Knee Surg, Sport Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05455-w
Rhatomy S, Wicaksono FH, Soekarno NR et al (2019) Eversion and first ray plantarflexion muscle strength in anterior cruciate ligament reconstruction using a peroneus longus tendon graft. Orthop J Sport Med 7:232596711987246. https://doi.org/10.1177/2325967119872462
Angthong C, Chernchujit B, Apivatgaroon A et al (2015) The anterior cruciate ligament reconstruction with the peroneus longus tendon: a biomechanical and clinical evaluation of the donor ankle morbidity. J Med Assoc Thai 98:555–560
Kerimoǧlu S, Aynaci O, Saracoǧlu M et al (2008) Anterior cruciate ligament reconstruction with the peroneus longus tendon. Acta Orthop Traumatol Turc 42:38–43. https://doi.org/10.3944/AOTT.2008.42.1.038
Ellis SJ, Williams BR, Wagshul AD et al (2010) Deltoid ligament reconstruction with peroneus longus autograft in flatfoot deformity. Foot Ankle Int 31:781–789. https://doi.org/10.3113/FAI.2010.0781
Zhao J, Huangfu X (2012) The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source. Am J Sports Med 40:662–671. https://doi.org/10.1177/0363546511428782
Xu C, Zhao J, Xie G (2016) Medial patella-femoral ligament reconstruction using the anterior half of the peroneus longus tendon as a combined procedure for recurrent patellar instability. Asia-Pacific J Sport Med Arthrosc Rehabil Technol 4:21–26. https://doi.org/10.1016/j.asmart.2016.03.001
Rudy ME, Phatama KY (2017) Tensile strength comparison between peroneus longus and hamstring tendons: a biomechanical study. Int J Surg Open 9:41–44. https://doi.org/10.1016/j.ijso.2017.10.002
Phatama KY, Hidayat M, Mustamsir E et al (2019) Tensile strength comparison between hamstring tendon, patellar tendon, quadriceps tendon and peroneus longus tendon: a cadaver research. J Arthrosc Jt Surg 6:114–116. https://doi.org/10.1016/j.jajs.2019.02.003
Barzegar M, Hosseini A, Karimi M, Nazem K (2014) Can we use peroneus longus in addition to hamstring tendons for anterior cruciate ligament reconstruction? Adv Biomed Res 3:115. https://doi.org/10.4103/2277-9175.132696
Sasetyo DR, Rhatomy S, Pontoh LA (2017) Peroneus longus tendon: the promising graft for anterior cruciate ligament reconstruction surgery. Asia-Pacific J Sport Med Arthrosc Rehabil Technol 9:25. https://doi.org/10.1016/j.asmart.2017.05.033
Legnani C, Zini S, Borgo E, Ventura A (2016) Can graft choice affect return to sport following revision anterior cruciate ligament reconstruction surgery? Arch Orthop Trauma Surg 136:527–531. https://doi.org/10.1007/s00402-015-2387-3
Riegger CL (1988) Anatomy of the ankle and foot. Phys Ther 68:1802–1814. https://doi.org/10.1093/ptj/68.12.1802
Otis JC, Deland JT, Lee S, Gordon J (2004) Peroneus brevis is a more effective evertor than peroneus longus. Foot Ankle Int 25:242–246. https://doi.org/10.1177/107110070402500408
Funding
There was no funding source.
Author information
Authors and Affiliations
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
Ethics declarations
Conflict of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Consent for publication
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).
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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 33, 21–27 (2023). https://doi.org/10.1007/s00590-021-03145-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-021-03145-3