Summary

To compare the clinical effect of the use of 1/2 autologous bilateral peroneus longus tendons and hamstring tendons to reconstruct the anterior cruciate ligament by arthroscopy and the effect on ankle joints after the excision of 1/2 peroneus longus tendons

Abstract

Objectives To compare the clinical effect of the use of 1/2 autologous bilateral peroneus longus tendons and hamstring tendons to reconstruct the anterior cruciate ligament by arthroscopy and the effect on ankle joints after the excision of 1/2 peroneus longus tendons.

Methods

From February 2013 to January 2015, 63 patients, who were diagnosed as anterior cruciate ligament (ACL) rupture, received reconstruction operations by arthroscopy, and all the cases were divided into two groups due to different tendons transplantation. Group 1 (29 cases): cut down 1/2 bilateral peroneus longus tendons and knit 6 bundles as transplant to reconstruct single-bundle ACL; Group 2 (34 cases): cut down ipsilateral hamstring tendons and knit 4 bundles as transplant to reconstruct single-bundle ACL. All the patients were followed up by 13-38 months postoperation. Through knee joint test, observe the complications of tendons donor part and KT-2000 test. To evaluate the function of knees by using of Lysholm score and IKDC score. Use AOFAS ankle-foot rating scale to evaluate the function of the bilateral ankles and feet before and after operations.

Results

The mean diameter of 6 bundles of 1/2 bilateral peroneus longus tendons is 9.4 cm, and the mean diameter of 4 bundles of hamstring tendons is 6.8 cm. The incisions of the two groups were all healed without infection. There was only one case in group 1 suffered from slight pain on the tendon donor part, and the pain relieved after one month. There were three cases in group 2 suffered from slight pain and numbness on the tendon donor part, and the symptoms continued in only one case. At the last time follow-up, the positive rate of pivot shift test in group 1 (3.4%, 1/29) was 1/3 of group 2 (11.8%,4/34). Under 134N, there was significant difference of KT-2000 test between group 1 (1.3±0.8mm) and group 2 (2.1±1.3mm). There was no significant difference of Lysholm score between group 1 (91.7±5.2 points) and group 2 (89.8±4.3 points). There was no significant difference of IKDC score between group 1 (91.2±4.7 points) and group 2 (89.8±4.3 points). There was no significant difference of bilateral AOFAS ankle-foot rating scale in group 1 before operation (92.2±4.3 points) and after operation (94.8±6.1 points).

Conclusions

Although the 4 bundles of hamstring tendons have gradually taken the place of bone-patellar tendon-bone and have been the choice of reconstruction method, there is still an obvious instability of anterior knee joint in some cases postoperation. The insufficiency of the diameter and the strength of the transplant tendon may be one of the main reasons. Special attention should be paid to the effect on the original function loss of the lower limbs after the excision of the whole gracilis and semitendinosus tendons. In addition, saphenous nerve injury always occurs during the excision of hamstring tendon. The peroneus longus is superficial and has a long tendon, therefore it is gotten easily. After half excision of the peroneus longus, the left part can still maintain the function, and there is a slight effect on ankle and less complications. The mean diameter of 6 bundles of 1/2 bilateral peroneus longus tendons is 9 cm, which is greater than normal ACL. Compared with 4 bundles of hamstring tendon, the peroneus longus tendons can be a better solution to solve the problem of the degree of anterior relaxation after the reconstruction operation of ACL due to the advantages of itself.