The choice of an appropriate autologous graft becomes difficult in cases of revision ACL surgeries or multi-ligament reconstructions, where more than one tendon may be needed. Allografts can be used in such situations but they are not easily available, and carry a small but definite risk of transmission of blood-borne infections and a higher rate of graft rupture. Peroneus longustendon (PLT) is gaining popularity as a graft option in knee ligament reconstructions, showing clinical outcomes comparable to quadrupled hamstring grafts.
This study aims to assess the functional outcomes, donor site morbidity and ankle strength after using ipsilateral peroneus longus autograft for anterior cruciate ligament (ACL) reconstruction in cases of revision ACL and multiligament injuries.
Study Design & Methods
This was a prospective observational study. All of the patients were evaluated by clinical examination for knee for laxity, ankle joint stability, and using visual analogue 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 Orthopaedic Foot and Ankle Society (AOFAS) score, bilateral evertors, and first ray plantar-flexion strength measurement using an isometer (Innovative Design Orthopaedics) at two-year follow-up.
Ankle range of motion was started soon after pain relief and no specific rehabilitation changes were made for PLT harvest.
Ipsilateral PLT graft was used in ten patients of revision ACL reconstruction, and 27 patients of the multi-ligament 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=0.1), ankle plantarflexion (p=0.21), eversion strength(p=0.13), first ray plantarflexion strength(p=0.26), and AOFAS score(p=0.29) were found to be comparable to the normal side in all patients. ??None of the patients complained of hypoaesthesia around the graft harvest site on clinical examination. Ankle range of motion was comparable on both sides.
PLT autograft had sufficient length and diameter while using in ACL reconstruction. Peroneus longus graft can be considered as a potential autograft option for ACL reconstruction in multi-ligament knee injuries and revision ACL reconstruction. No donor site morbidity was seen as PLT harvesting didn’t affect the ankle range of motion and evertor or first ray plantarflexion strength at follow up.