Purpose This review aimed to assess whether peroneus longus tendon (PLT) autograft would have comparable functional outcomes and graft survival rates when compared to hamstring tendon (HT) autograft for anterior cruciate ligament (ACL) reconstruction. Methods PubMed, Web of Science, Cochrane Library, Ovid (MEDICINE), and EMBASE databases were queried for original articles from clinical studies including the keywords: ACL reconstruction and PLT autograft. Studies comparing PLT autograft versus HT autograft were included in this analysis and the following data were extracted from studies meeting the inclusion criteria: graft diameter, functional outcomes (Tegner activity scale, Lysholm score, and International Knee Documentation Committee (IKDC) subjective score), knee laxity (Lachman test), and complications (donor site pain or paresthesia, graft failure). Besides, the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Foot and Ankle Disability Index (FADI) pre-operation and at last follow-up were also compared among patients using PLT autograft. Meta-analysis was applied using Review Manager 5.3 and p < 0.05 was considered statistically signiicant. Results Twenty-three studies including 925 patients with ACL reconstruction met inclusion criteria. Of these, 5 studies included a direct comparison of PLT autograft (164 patients) versus HT autograft (174 patients). No signiicant diference was observed between PLT and HT autografts for Tegner activity scale, Lachman test, donor site pain, or graft failure. However, PLT groups demonstrated better Lysholm score (mean diference between PLT and HT groups, 1.55; 95% CI 0.20-2.89; p = 0.02) and IKDC subjective score (mean diference between PLT and HT groups, 3.24; 95% CI 0.29-6.19; p = 0.03). No diference of FADI was found (n.s.) but AOFAS was slightly decreased at last post-operative follow-up for patients with PLT autograft compared with pre-operative scores (mean diference of 0.31, 95% CI 0.07-0.54, p = 0.01). Conclusion PLT autograft demonstrated comparable functional outcomes and graft survival rates compared with HT autograft for ACL reconstruction. However, a slight decrease in AOFAS score should be considered during surgical planning. Hence, the PLT is a suitable autograft harvested outside the knee for ACL reconstruction to avoid the complication of quadriceps-hamstring imbalance which can occur when harvesting autografts from the knee. Level of evidence Level II.

This study showed that single-bundle ACL reconstruction alone was not able to restore anterior tibial translation, valgus rotation, and external rotation of the intact knee with combined ACL and sMCL injuries and sMCL reconstruction was also required. The combined ACL and parallel sMCL reconstruction better restored valgus and external rotation stability, while the combined ACL and triangular vector method better restored anterior tibial translation. With combined ACL and severe sMCL injury, both ligaments should be reconstructed. The two sMCL reconstruction techniques exhibited slightly different kinematics and graft force; however, there was not enough difference to recommend one over the other.

PurposeThe aim of this study was to evaluate the effects of knee biomechanics with an irreparable lateral meniscus defect using the centralization capsular meniscus support procedure in the setting of the ACL‐reconstructed knee in a porcine model. The hypothesis is the arthroscopic centralization will decrease the laxity and rotation of the ACL‐reconstructed knee. MethodsTwelve fresh‐frozen porcine knees were tested using a robotic testing system under the following loading conditions: (a) an 89.0 N anterior tibial load; (b) 4.0 N m internal and external rotational torques. Anatomic single‐bundle ACL reconstruction with a 7 mm‐diameter bovine extensor tendon graft was performed. A massive, middle segment, lateral meniscus defect was created via arthroscopy, and arthroscopic centralization was performed with a 1.4 mm anchor with a #2 suture. The LM states with ACL reconstruction evaluated were: intact, massive middle segment defect and with the lateral meniscus centralization procedure. ResultsThe rotation of the ACL reconstructed knee with the lateral meniscus defect was significantly higher than with the centralized lateral meniscus under an external rotational torque at 30° of knee flexion, and under an internal rotational torque at 30° and 45° of knee flexion. There were no systematic and consistent effects of LM centralization under anterior tibial translation. ConclusionsIn this porcine model, the capsular support of middle segment of the lateral meniscus using arthroscopic centralization improved the residual rotational laxity of the ACL‐reconstructed knee accompanied with lateral meniscus dysfunction due to massive meniscus defect. This study quantifies the benefit to knee kinematics of arthroscopic centralization by restoring the lateral meniscal function.

Purpose The purpose of this study was to evaluate and compare knee kinematics and kinetics following either single bundle, modified triangular or double‐bundle reconstruction of the superficial medial collateral ligament (sMCL) with single bundle anatomic ACL reconstruction. Methods Using a cadaveric model (n = 10), the knee kinematics and kinetics following three MCL reconstructions (single‐bundle (SB), double‐bundle (DB), modified triangular) with single bundle anatomic ACL reconstruction were compared with the intact and deficient knee state. The knees were tested under (1) an 89‐N anterior tibial load, (2) 5 N‐m internal and external rotational tibial torques, and (3) a 7 N‐m valgus torque. Results Anatomic ACL reconstruction with SB MCL reconstruction was able to restore anterior tibial translation and external rotation to intact knee values but failed to the internal and valgus rotatory stability. Anatomical DB MCL reconstruction (with SB ACL reconstruction) and the modified triangular MCL reconstruction (with SB ACL reconstruction) restored all knee kinematics to the intact value. Conclusion This study shows that clinical presentation with combined ACL and severe sMCL injury, single‐bundle MCL with single‐bundle ACL reconstruction does not restore knee kinematics. Anatomical double‐bundle MCL reconstruction may produce slightly better biomechanical stability than the modified triangular MCL reconstruction, but the modified triangular reconstruction might be more clinically practical with the advantages of being less invasive and technically simpler while at the same time can restore a nearly normal knee joint.

Fixation of the ACL graft at 30° of knee flexion followed by fixation of the PCL graft can best restore the tibiofemoral position of the intact knee. This study has clinical relevance in regard to the effect of graft fixation sequence on the position of the tibia relative to the femur in one-stage ACL and PCL reconstruction.