Predicting the peroneus longus tendon autograft size in ACL reconstruction by using anthropometric parameters: A study in South Sulawesi population

Background: Arthroscopic anterior cruciate ligament (ACL) reconstruction can be performed using autograft from various sources namely, bone patellar tendon graft, hamstring tendons (semitendinosus, gracilis) or peroneus longus tendon.Methods: A prospective study of 30 patients who underwent arthroscopic ACL reconstruction using quadrupled semitendinosus tendon autograft and peroneus longus tendon autograft during the study period.Results: Statistically, there is very little comparable difference between semitendinosus and peroneus longus when used for arthroscopic ACL reconstruction. However, peroneus longus tendon shows superior results when used in patients with grade 3 medial collateral ligament (MCL) injury combined with ACL injury.Conclusions: Our study brings forth the superior efficacy and quality of the double stranded peroneus longus tendon especially in cases associated with complicated injuries involving the medial collateral ligament with a follow up date of about 2 years and as a healthy supplement to other choices of autografts and revision cases.

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Peroneus Longus Tendon Autograft: A Promising Graft for ACL Reconstruction

Video Journal of Sports Medicine ◽

10.1177/26350254211009888 ◽

2021 ◽

Vol 1 (4) ◽

pp. 263502542110098

Author(s):

Nicolaas C. Budhiparama ◽

Sholahuddin Rhatomy ◽

Krisna Yuarno Phatama ◽

William Chandra ◽

Asep Santoso ◽

...

Keyword(s):

Acl Reconstruction ◽

Donor Site ◽

Hamstring Tendon ◽

Tendon Graft ◽

Skin Incision ◽

Peroneus Longus Tendon ◽

Longus Tendon ◽

Peroneus Longus ◽

Tendon Autograft ◽

Primary Acl Reconstruction

Background: With the increasing use of hamstring tendon as an autograft in anterior cruciate ligament (ACL) reconstruction, some shortcomings have been found on the donor site. Therefore, an alternative autograft option with adequate strength and less donor site morbidity will be very valuable. Peroneus longus tendon has been found to be a promising option. Indication: Primary ACL reconstruction. Technique Description: Peroneus longus tendon graft is harvested with a longitudinal skin incision at 2 to 3 cm (2 finger-breadths) above and 1 cm (1 finger-breadth) behind the lateral malleolus, followed by superficial fascia incision in line with skin incision. The peroneus longus and peroneus brevis tendons were then identified. The tendon division location was marked at 2 to 3 cm above the level of the lateral malleolus. After that, an end-to-side suture was performed between the distal part of the peroneus longus tendon and peroneus brevis tendon. The peroneus longus tendon was stripped proximally with a tendon stripper to at least 5 cm from the fibular head to prevent peroneal nerve injury. Graft preparation was performed with a standard procedure to obtain the suitable graft size. In routine arthroscopic ACL reconstruction, peroneus longus tendon graft fixation can be performed with a cortical suspension device, bioabsorbable screws, or a combined technique. Results: Recent studies showed that peroneus longus autograft had a comparable outcome with hamstring tendon autograft in primary ACL reconstruction at a 1-year follow-up. The use of peroneus longus tendon autograft resulted in larger graft diameter and less thigh hypotrophy. The mean (±SD) for the AOFAS-Hindfoot Score in the peroneus longus group was 97.3 ± 4.2, while the mean FADI score was 98 ± 3.4, both of which were considered excellent results. Discussion/Conclusion: The use of peroneus longus autograft in primary ACL reconstruction is a safe procedure with an excellent outcome. Peroneus longus tendon autograft can be recommended as an alternative graft in single-bundle ACL reconstruction. Further study of the functional outcome and knee stability evaluation is recommended.

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COMPARATIVE STUDY OF SINGLE BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING THE PERONEUS LONGUS TENDON AUTOGRAFT VERSUS HAMSTRING TENDON AUTOGRAFT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i9.2188 ◽

2021 ◽

Vol 5 (9) ◽

Author(s):

Pankaj Jain ◽

Rajesh Kumar Kushwaha ◽

Ahteshyam Khan ◽

Prashant Modi ◽

Hari Saini

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Functional Score ◽

Peroneus Longus Tendon ◽

Longus Tendon ◽

Peroneus Longus ◽

Anterior Cruciate ◽

Tendon Autograft ◽

Graft Diameter

Introduction: Arthroscopic anterior cruciate ligament (ACL) reconstruction can be performed using autograft from various sources namely bone patellar tendon bone graft, hamstring graft, or peroneus longus tendon. Purpose of this study was to compare the clinical outcome and donor site morbidity of ACL reconstruction with peroneus longus tendon versus hamstring tendon autograft in patients with an isolated ACL injury. Methods: Patients who undervent isolated single bundle ACL reconstruction were allocated in peroneus and hamstring groups and observed prospectively. Functional score (IKDC, & Modified Cincinnati score) was recorded preoperatively and 1 year post-operatively. Graft diameter was measured intra-operatively. Donor site morbidity were assessed with thigh circumference measurments and ankle scoring by MRC grading and FADI Score. Results: 56 patients (28-Hamstring and 28-peroneus group) met the inclusion criteria. The average Peroneus longus graft diameter (8.8±0.8) was significantly larger than the Hamstring graft diameter (8.1±0.9). In terms of 1-year postoperative outcomes statistically there is very little comparable difference between both these grafts when used for arthroscopic ACL reconstruction. Conclusion: Our study brings forth the superior efficacy and quality of double stranded peroneus longus tendon autograft in term of good functional score (IKDC, & Modified Cincinnati score), larger graft diameter, less thigh hypotrophy, and excellent ankle function based on FADI Score. Prospective cohort study, level II. Abbreviations: ACL- Anterior cruciate ligament BPTB- Bone-patellar tendon-bone IKDC – International knee documentation committee FADI- Foot and ankle disability index.

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Extensor mechanism reconstruction with peroneus longus tendon autograft for neglected patellar fracture, report of 2 cases

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2019.05.020 ◽

2019 ◽

Vol 10 ◽

pp. S226-S230 ◽

Cited By ~ 1

Author(s):

Muhammet Salih Ayas ◽

Orkun Gül ◽

Ahmet Emin Okutan ◽

Ahmet Uğur Turhan

Keyword(s):

Extensor Mechanism ◽

Patellar Fracture ◽

Peroneus Longus Tendon ◽

Longus Tendon ◽

Peroneus Longus ◽

Tendon Autograft

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ACL reconstruction: Which grafts can be used if hamstring is too small?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00458 ◽

2019 ◽

Vol 7 (11_suppl6) ◽

pp. 2325967119S0045

Author(s):

Andri Lubis

Keyword(s):

Acl Reconstruction ◽

Anterior Knee Pain ◽

Good Alternative ◽

Hamstring Tendon ◽

Peroneus Longus Tendon ◽

Longus Tendon ◽

Peroneus Longus ◽

Small Incision ◽

Anterior Knee ◽

Hamstring Grafts

Hamstring grafts are the most often grafts used for ACL reconstruction procedures. Especially in Asia, hamstrings are preferable since small incision for taking the graft, and not produce anterior knee pain during kneeling, since there is no bony part taken. However, sometimes hamstring is too small for the graft. Many literatures mention that at least 7-8 mm needed for the best result of ACL reconstruction using hamstring tendon. It is not easy to predict the size of the hamstring tendon before surgery. Quadriceps tendons are good alternative as the grafts for ACL reconstruction. However, sometimes surgeons realize that hamstring is too small after they took the hamstring. The peroneus longus tendon can be added to the small hamstring. Even though peroneus longus tendon should not be used routinely, it could be considered if the hamstring that has been taken is too small.

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Higher Rate of Patellofemoral Problems After Anterior Cruciate Ligament Reconstruction using Hamstring Autograft

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6626 ◽

2021 ◽

Vol 9 (B) ◽

pp. 811-815

Author(s):

Krisna Yuarno Phatama ◽

Romy Darmawansa ◽

I Gusti Ngurah Arga Aldrian Oktafandi ◽

Felix Cendikiawan ◽

Alva Pribadi ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Single Bundle ◽

Hamstring Autograft ◽

Peroneus Longus Tendon ◽

Peroneus Longus ◽

Kujala Score ◽

Anterior Cruciate ◽

Tendon Autograft

Background: Patellofemoral problems are not uncommon among post-anterior cruciate ligament (ACL) reconstruction patients. Hamstring autograft harvesting-related factor is one of the suspected causes. A lack of tibiofemoral internal rotation force due to strength deficit causes the patella tends to shift laterally. Purposes: Peroneus longus tendon has been proposed as an alternative graft source due to its adequate tensile strength and minimal donor site morbidity to the knee biomechanics, including the patellofemoral joint. This tendon does not cross the knee joint and thus does not affect patellofemoral alignment and biomechanics. This study aims to compare patellofemoral problems between hamstring and peroneus longus autograft harvested-patients following ACL reconstruction. Material and methods: Thirty-one subjects who underwent primary single-bundle ACL reconstruction between September 2018 and September 2019 and met the inclusion criteria were grouped into the hamstring group (n=16) and peroneus longus group (n=15). Both groups were evaluated retrospectively. The follow-up assessment was conducted on the phase II rehabilitation program. The assessed variables were pain, crepitus, and the Indonesian-validated Kujala score. Results: No significant differences in pain and crepitus were found between both groups. There were significant differences in the Kujala score between both groups (P < .001). The peroneus longus group reported an averagely higher score than the hamstring group. Conclusion: Single bundle ACL reconstruction using peroneus longus tendon autograft produces less patellofemoral symptoms and functional limitation than using hamstring tendon autograft.

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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

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-03145-3 ◽

2021 ◽

Author(s):

Tarun Goyal ◽

Souvik Paul ◽

Arghya Kundu Choudhury ◽

Siddharth S. Sethy

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Ligament Injury ◽

Full Thickness ◽

Peroneus Longus Tendon ◽

Longus Tendon ◽

Peroneus Longus ◽

Anterior Cruciate ◽

Tendon Autograft

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Eversion and First Ray Plantarflexion Muscle Strength in Anterior Cruciate Ligament Reconstruction Using a Peroneus Longus Tendon Graft

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119872462 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711987246 ◽

Cited By ~ 3

Author(s):

Sholahuddin Rhatomy ◽

Fidelis H. Wicaksono ◽

Noha Roshadiansyah Soekarno ◽

Riky Setyawan ◽

Shinta Primasara ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Donor Site ◽

Donor Site Morbidity ◽

Peroneus Longus Tendon ◽

Longus Tendon ◽

Peroneus Longus ◽

Ankle Eversion ◽

Significant Difference ◽

First Ray

Background: The peroneus longus tendon has been used as a graft in orthopaedic reconstruction surgery because of its comparable biomechanical strength with the native anterior cruciate ligament (ACL) and hamstring tendon. However, one of the considerations in choosing an autograft is donor site morbidity. Purpose/Hypothesis: This study aimed to compare ankle eversion and first ray plantarflexion strength between the donor site and its contralateral site after ACL reconstruction. The study hypothesis was that strength measurements will be different between the harvest site and contralateral healthy site. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ACL reconstruction using a peroneus longus tendon autograft between March 2017 and December 2018 were included in this study. Patients followed a rehabilitation protocol from the first day after surgery. Ankle eversion and first ray plantarflexion strength were measured using a modified dynamometer 6 months after surgery. Donor site morbidity was assessed 6 months after surgery using the Foot & Ankle Disability Index (FADI) and American Orthopaedic Foot & Ankle Society (AOFAS) scoring system for the ankle and hindfoot. Results: A total of 31 patients (22 male, 9 female; mean age, 27.58 ± 8.69 years [range, 18.00-45.00 years]) fulfilled the inclusion criteria. There was no significant difference in ankle eversion strength at the donor site compared with the contralateral site ( P = .55), with means of 65.87 ± 7.63 N and 66.96 ± 8.38 N, respectively. Also, there was no significant difference in ankle first ray plantarflexion strength at the donor site compared with the contralateral site ( P = .68), with means of 150.64 ± 11.67 N and 152.10 ± 12.16 N, respectively. The mean FADI score of 99.71 ± 0.57 and mean AOFAS score of 98.71 ± 3.03 at the donor site were considered excellent results. Conclusion: Ankle eversion and first ray plantarflexion strength at the donor site were similar to those at the contralateral healthy site, with no donor site morbidity. This suggests that the peroneus longus tendon is a promising graft in ACL reconstruction.

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