scholarly journals Comparing the Stiffness of Peroneus Longus Tendon Versus Hamstrings in Anterior Cruciate Ligament Reconstruction: A Biomechanical Study

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Sholahuddin Rhatomy ◽  
Hendrian Chaniago ◽  
Faiz Alam Rasyid ◽  
Krisna Yuarno Phatama
Keyword(s):  
Tensile Strength ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Biomechanical Study ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Mean Diameter ◽  
The Mean

Background: The use of autografts originating from either hamstring tendons or peroneus longus tendons is a surgical option in anterior cruciate ligament (ACL) reconstruction. Objectives: This research aimed to compare the tensile strength between the hamstring tendon and the peroneus longus tendon in ACL reconstruction. The hypothesis of this study was: Peroneus longus grafts have tensile strength equal to hamstring grafts based on living donor patients. Methods: This cross-sectional study was a biomechanical study examining means and standard deviations (SD) by comparing the tensile strength of peroneus longus tendons and hamstring tendons when used as autograft donors in ACL reconstruction. Results: In this study, 51 patients with reconstructive ACL were enrolled. The mean diameter of the hamstring tendon was 7.86 with SD ± 0.69, while the mean diameter of peroneus longus tendon was 7.67 with SD ± 0.63. The mean diameter of the peroneus longus graft was not significantly different. The mean displacement on the hamstring tendon was 2.44 with SD ± 0.42, while the peroneus longus tendon was 2.06 with SD ± 0.14. The peroneus longus tendon had significantly more tensile strength compared to the hamstring tendon. Conclusions: Diameter of the peroneus longus graft was not significantly different from the hamstring graft. However, the peroneus longus graft had more tensile strength than the hamstring graft based on living donor patients.

scholarly journals Anterior Cruciatel Ligament Reconstruction with Peroneus Longus Tendon Autograft: Functional Outcome and Donor Site Morbidity

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0008
Author(s):  
Auliana Hayu Kusumastutia ◽  
Tedjo Rukmoyo ◽  
Sholahuddin Rhatomy ◽  
Yudha Mathan Sakti
Keyword(s):  
Functional Outcome ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Hamstring Tendon ◽  
Donor Site Morbidity ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Anterior Cruciate

Anterior Cruciate Ligament (ACL) is a knee ligament that is very important in maintaining the stability of the knee joint. The incidence of isolated ACL tears remain a common orthopaedic injury with significant increase in the rate of ACL reconstruction over time. Several types of autografts used for ACL reconstruction have some potential occurrence of donor site morbidity, including Bone-Patellar Tendon-Bone (BPTB), hamstring tendon, and quadriceps tendon. Peroneus longus tendon can be an option as a graft donor because it has biomechanical characteristics that are not significantly different from the hamstring tendon. Purpose: The aim of the study was to evaluate the functional outcome and donor site morbidity of anterior cruciate ligament (ACL) reconstruction using peroneus longus tendon autograft. Methods: This study was an observational analytical with retrospective cohort design using medical record. The functional outcomes were assessed with IKDC, Modified Cincinnati, Tegner-Lysholm, and KSS scoring system 12 months after surgery. Donor site morbidity was assessed with AOFAS and FADI scoring system, eversion strength, and plantarflexion strength. Results: Seventy five patients fulfilled the inclusion criteria (59 males and 16 females). Mean of peroneus longus tendon graft diameters were 8.39 ± 0.69 mm (range 6.5-10 mm). Significant increase of functional score (p<0.05) were found 12 months after surgery. Mean score of IKDC was 55.26 ± 12.76 preoperative; 96.69 ± 3.36 postoperative, Modified Cincinnati was 65.45 ± 16.25 preoperative; 93.29 ± 7.04 postoperative, Tegner-Lysholm was 67.80 ± 15.29 preoperative; 89.71 ± 8.35 postoperative, KSS (Knee) was 65.33 ± 19.46 preoperative; 95.17 ± 5.94 postoperative, and KSS (Function) was 76.52 ± 20.25 preoperative; 93.20 ± 10.29 postoperative. Mean score of AOFAS was 98.93 ± 3.11 and FADI was 99.80 ± 0.59 at six months after surgery. The eversion and plantarflexion strength were not significantly different (p>0.05) between donor and contralateral side ankle. There was neurapraxia in 3 (4%) patients at six months postoperative. Conclusion: The peroneus longus tendon can be an ideal source of graft for ACL reconstruction because it has good functional outcome and minimal donor site morbidity.

scholarly journals Arthroscopic anterior cruciate ligament reconstruction with semitendinosus graft versus peroneus longus tendon graft

2020 ◽  
Vol 6 (2) ◽  
pp. 386
Author(s):  
Pudari Manoj Kumar ◽  
Ishan Shevte ◽  
Mukesh Phalak ◽  
Abhishek Nair ◽  
Parth .
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Collateral Ligament ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Anterior Cruciate ◽  
Tendon Autograft

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

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

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.

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

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987246 ◽  
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.

Peroneus Longus Tendon Autograft: A Promising Graft for ACL Reconstruction

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.

scholarly journals Anterior Half of the Peroneus Longus Tendon Combined with Semitendinosus and Gracilis Tendons for Anterior Cruciate Ligament Reconstruction: An Athlete Case Report

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Diego Escudeiro de Oliveira ◽  
Melanie Mayumi Horita ◽  
Marconde de Oliveira e Silva ◽  
Victor Eduardo Roman Salas ◽  
Pedro Baches Jorge
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Hamstring Tendon Graft ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Anterior Half ◽  
Anterior Cruciate

In clinical practice, it is observed that the hamstring tendon graft, despite being first choice in knee ligament reconstruction, may not present adequate size. Therefore, it becomes necessary to search for other graft alternatives. In this context, the peroneus longus tendon arises as an option to replace or complement other grafts. The surgeon can opt to use the tendon in its totality or only its anterior half, presenting adequate length, diameter, and biomechanics, without major repercussions for the donor site. In this study, we report a case of an athlete in which the autologous hamstring tendon graft did not present the adequate diameter for anterior cruciate ligament reconstruction. It was, then, necessary to use the anterior half of the peroneus longus tendon.

scholarly journals A study on peroneus longus autograft for anterior cruciate ligament reconstruction

2019 ◽  
Vol 8 (1) ◽  
pp. 183
Author(s):  
Kumar V. K. ◽  
Narayanan S. K. ◽  
Vishal R. B.
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Donor Site ◽  
International Knee Documentation Committee ◽  
Donor Site Morbidity ◽  
Knee Function ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Almost All

Background: To compare the clinical outcome and donor site morbidity of ACL reconstruction with Peroneus longus tendon autografts in patients with isolated ACL injury.Methods: This was a prospective study that included patients who underwent ACL reconstruction using Peroneus longus tendon autograft. Results were assessed via physical examination. Donor site morbidity of the foot and ankle after tendon harvesting was assessed using Medical Research Council (MRC) grading of ankle and foot movements.  Post-operative knee function was evaluated by the International Knee Documentation Committee (IKDC) scoring.Results: In this study sample of 25 patients, the ankle functions at the donor site are grossly preserved in almost all the patients, which was elucidated by grading the power of foot eversion. Post operatively knee function (IKDC scoring) were rated as normal in 92% (23 cases).Conclusions: Peroneus longus is an appropriate autograft source for ACL reconstruction in view of ease of harvest, adequate size, cosmetically appealing, considering excellent post-operative knee scores. And removing the Peroneus longus tendon has no effect on gait parameters and does not lead to instability of the ankle. So, it can be used as an autogenous graft in orthopaedic surgeries.

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

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.

scholarly journals Peroneus Longus Tendon Regeneration after Anterior Cruciate Ligament Reconstruction with Magnetic Resonance Imaging Evaluation

2020 ◽  
Vol 8 (A) ◽  
pp. 916-920
Author(s):  
Sholahuddin Rhatomy ◽  
Bambang Kisworo ◽  
Bunarwan Prihargono ◽  
Faiz Alam Rasyid ◽  
Nolli Kressoni
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Acl Reconstruction ◽  
Ankle Joint ◽  
Cruciate Ligament ◽  
Resonance Imaging ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Significant Difference

BACKGROUND: Peroneus longus graft can be recommended as a superior graft over hamstring in anterior cruciate ligament (ACL) reconstruction. There are many studies concerning hamstring tendon regeneration, but there are few studies on the regeneration of the peroneus longus tendon after ACL reconstruction. AIM: This study aimed to investigate whether regeneration of the peroneus longus tendon occurs after ACL reconstruction with magnetic resonance imaging. METHODS: Twenty-five patients underwent ACL reconstruction with donors from the peroneus longus tendon by the same operator and were followed 12 months later with bilateral crural magnetic resonance imaging (MRI) for comparison of the donor and healthy peroneus longus tendon areas. Regeneration was assessed at 5 cm, 10 cm, and 15 cm from the ankle joint. RESULTS: The average age 30.4 (18-38) years old. There were 17 right and 8 left knees involved in this study. The interval between surgery and MRI was 1 year. The average regeneration presentation was located in the distal part (5 cm from the ankle joint) 66.78%, medial part (10 cm from the joint) 63.2%, and proximal part (15 cm from the ankle joint) 67.53%. There was no significant difference in the presentation of proximal, medial, and distal areas while there was a significant difference between age and regeneration of the proximal area, p <0.05 (p = 0.047). Tissue regeneration was tendinous and it appeared smaller in the place where the tendons grew. CONCLUSION: Regeneration of the peroneus longus tendon occurred after ACL reconstruction at a 1-year follow-up according to MRI.

scholarly journals Comparison of the effect of the graft with double strands peroneus longus tendon and with the four strands hamstring tendon on reconstruction of the posterior cruciate ligament injury

2020 ◽  
Author(s):  
Yue Lu ◽  
Hua Xu ◽  
Zhenyu Zhou ◽  
Lei Fang ◽  
Ran Tao
Keyword(s):  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Group A ◽  
Ikdc Score ◽  
Group B ◽  
Tegner Score ◽  
Pcl Injury

Abstract Background This prospective study was to analyze the clinical effect of double-stranded long peroneal tendon and the four strands hamstring tendon in reconstruction of posterior cruciate ligament (PCL), and to investigate the effectiveness and safety of the two surgical approaches in reconstruction of PCL, so as to provide guidance for clinical treatment of PCL injury. Methods Total 48 patients with complete rupture of PCL treated in our hospital from July 2015 to February 2017 were selected and divided into the Group A (reconstructed with double strands peroneus longus tendon, 25 cases) and the Group B (four strands hamstring tendon, 23 cases) according to the different grafts. Results The intraoperative time for tendon extraction in the Group A (20.87 ± 2.07 min) was significantly shorter than that in the Group B (26.79 ± 2.32 min). Compared with pre-operation, the tibial posterior displacement of the two groups decreased significantly 24 months after operation, and IKDC score, Lysholm score and Tegner score increased significantly. Nevertheless, the IKDC score, Lysholm score, Tegner score, AOFAS score and Maryland score between the two groups before and after operation were no significant differences. Compared with the quadrupled hamstring tendon, the double-stranded peroneal longus tendon has the advantages of simple and safe tendon extraction. Conclusions Both surgical methods are effective for the treatment of PCL injury. When the four strands hamstring tendon is accidental (tendon rupture or tendon variation) or ineffective, the peroneal longus tendon will be a good choice.

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