Peroneus Longus Tendon Autograft is a Safe and Effective Alternative for Anterior Cruciate Ligament Reconstruction

Abstract

The ipsilateral peroneus longus tendon (PLT) was utilized as an autograft for anterior cruciate ligament (ACL) reconstruction of patients with acute ACL rupture and grade III medial collateral ligament (MCL) injury. We investigated the efficacy and safety of this alternative autograft compared with autologous hamstring tendon (HT). Biomechanical testing of the graft options was performed and compared with the native ACL. Thirty-eight patients with acute ACL ruptures and grade III MCL injuries were treated with ACL reconstruction with a doubled autologous PLT or quadrupled autologous HT. Knee stability and function was evaluated clinically with the Lachman test and KT-2000 arthometer as well as subjectively with functional scores. Effects on the donor ankle were evaluated by biomechanical testing. The ultimate tensile strengths of doubled PLT and quadrupled HT were significantly higher than that of the native ACL and the ultimate tensile strength of doubled PLT was comparable with that of quadrupled HT. There were no significant differences in clinical or functional scores between the two groups. There were no significant differences in pre- and postoperative biomechanical testing of the donor ankle. PLT is a suitable alternative autograft for an ACL reconstruction in patients with a concomitant grade III MCL injury without a significant biomechanical disadvantage to the ankle donor site.

Keywords

ACL reconstruction - peroneus longus - autograft

• References

• 1 Aglietti P, Buzzi R, Zaccherotti G, De Biase P. Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med 1994; 22 (02) 211-217
• 2 Bonamo JJ, Krinick RM, Sporn AA. Rupture of the patellar ligament after use of its central third for anterior cruciate reconstruction. A report of two cases. J Bone Joint Surg Am 1984; 66 (08) 1294-1297
• 3 Fahey M, Indelicato P. Bone tunnel enlargement after ACL allograft reconstruction. Orthop Trans 1993; 17: 231
• 4 Fulkerson JP, Langeland R. An alternative cruciate reconstruction graft: the central quadriceps tendon. Arthroscopy 1995; 11 (02) 252-254
• 5 Sachs RA, Daniel DM, Stone ML, Garfein RF. Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 1989; 17 (06) 760-765
• 6 Thompson W, Harner C, Jamison J. Immunologic response to fresh frozen patellar tendon allograft anterior cruciate ligament reconstruction. Trans Orthop Res Soc 1994; 19: 624
• 7 Atkinson TS, Atkinson PJ, Mendenhall HV, Haut RC. Patellar tendon and infrapatellar fat pad healing after harvest of an ACL graft. J Surg Res 1998; 79 (01) 25-30
• 8 Christen B, Jakob RP. Fractures associated with patellar ligament grafts in cruciate ligament surgery. J Bone Joint Surg Br 1992; 74 (04) 617-619
• 9 Kartus J, Ejerhed L, Sernert N, Brandsson S, Karlsson J. Comparison of traditional and subcutaneous patellar tendon harvest. A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques. Am J Sports Med 2000; 28 (03) 328-335
• 10 Ahn JH, Lee SH. Risk factors for knee instability after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24 (09) 2936-2942
• 11 Figueroa D, Calvo R, Vaisman A, Campero M, Moraga C. Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study. Knee 2008; 15 (05) 360-363
• 12 Nelissen E, van Arkel ER, Hazelbag HM. Traumatic neuroma of the infrapatellar branch of the saphenous nerve after hamstring harvesting. J Knee Surg 2010; 23 (04) 233-236
• 13 Bates NA, McPherson AL, Rao MB, Myer GD, Hewett TE. Characteristics of inpatient anterior cruciate ligament reconstructions and concomitant injuries. Knee Surg Sports Traumatol Arthrosc 2016; 24 (09) 2778-2786
• 14 Duncan JB, Hunter R, Purnell M, Freeman J. Meniscal injuries associated with acute anterior cruciate ligament tears in alpine skiers. Am J Sports Med 1995; 23 (02) 170-172
• 15 Yoon KH, Yoo JH, Kim KI. Bone contusion and associated meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture. J Bone Joint Surg Am 2011; 93 (16) 1510-1518
• 16 Kerimoğlu S, Aynaci O, Saraçoğlu M, Aydin H, Turhan AU. Anterior cruciate ligament reconstruction with the peroneus longus tendon [in Turkish]. Acta Orthop Traumatol Turc 2008; 42 (01) 38-43
• 17 Zhao JZ, Huangfu XQ. The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source. AM J Sports Med 2012; 40(3): 662-671
• 18 Nazem K, Barzegar M, Hosseini A, Karimi M. Can we use peroneus longus in addition to hamstring tendons for anterior cruciate ligament reconstruction?. Adv Biomed Res 2014; 3: 115
• 19 Brown Jr CH, Steiner ME, Carson EW. The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and results. Clin Sports Med 1993; 12 (04) 723-756
• 20 McKernan D, Weiss J, Deffner K, Greenwald R. Tensile properties of gracilis, semitendinosus and patellar tendons from the same donor. Trans Orthop Res Soc 1995; 20: 39
• 21 Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 1984; 66 (03) 344-352