Clinical Outcomes and Donor Site Morbidity of Anterior Cruciate Ligament Reconstruction with Full Thickness Peroneus Longus Tendon

Abstract

Backgroud: Anterior cruciate ligament (ACL) is an important anatomical structure for maintaining the stability and moveability of a knee joint. When the load exceeds its strength, ACL will be damaged or broken. The main therapy for a fractured ACL is the arthroscopic ligament reconstruction technique. Commonly used reconstruction materials are grouped into three categories: autologous tendons, allogeneic tendons and artificial materials. Peroneal longus tendon(PLT) is an autograft, its superficial location and easier access contribute to its increasing application as a new graft substitute in cruciate ligament reconstructions over recent years. Our research is aiming to investigate the functional recovery of the knee joint after anterior cruciate ligament transplantation with autologous peroneus longus tendon under arthroscopy and its influence on the ankle joint of the donor site.Methods: During the research period of our retrospective analysis from January 2015 to July 2019, the single-bundle double-stranded anatomical reconstruction technique was applied under arthroscopy on 32 patients with acute anterior cruciate ligament ruptures (consisting of 22 males and 10 females in the 16–45 (31.1 ± 8.6) age bracket, and among them, 18 cases suffered knee injury on the left limb and the other 14 on the right one) within three weeks of their injury, and the graft for the anterior cruciate ligament (fixed with an Endobutton plate on one end and a screw on the other) was the autologous peroneus longus tendon on the ipsilateral limb. The IKDC score, KOOS score and Lysholm score were used to evaluate the functionality of the affected knee joints and the AOFAS score that of the tendons and ankle joints.Results: All patients were followed up for 1 year (14.5 ± 1.6 months). One case developed postoperative knee joint infection but recovered soon following active treatments, and all the patients turned negative in the postoperative Lachman tests and pivot-shift tests. At the last follow-up, IKDC score, KOOS symptom score, KOOS pain score, KOOS functional life score, KOOS sports entertainment score, KOOS life quality score and Lysholm score were 82.1 ± 13.5, 90.8 ± 15.5, 90.4 ± 5.9, 97.8 ± 4.3, 73.7 ± 26, 83.9 ± 18.1 and 87.3 ± 12.0, respectively, showing marked improvements on and statistically significant differences (P < 0.05) from the preoperative figures. The AOFAS score of the affected ankle joints was 94.7 ± 10.8, signifying a good functional recovery. MRI observation one year later showed that the reconstructed ligament had extended continuously to the position satisfying the requirements of anatomical reduction, and the bone tunnels and tendons had healed well.Conclusion: Reconstruction of the anterior cruciate ligament with a single-bundle of double-stranded peroneus longus tendon can satisfactorily restore the function of an injured knee joint without a significant impact on the donor ankle joint.