Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity

Goyal, Tarun; Paul, Souvik; Choudhury, Arghya Kundu; Sethy, Siddharth Sekhar

doi:10.1007/s00590-021-03145-3

Cited by 21 publications

(17 citation statements)

References 31 publications

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Section: Video Transcriptmentioning

confidence: 99%

“…6,12,15 In addition to primary ACL studies, a recent level 4 study has reported significant improvement in functional outcome scores at 2 years following the use of PL autograft for revision ACL and multiligament reconstructions. 4 In terms of the clinical safety regarding foot and ankle outcomes, the literature largely shows a good safety profile, with no significant postoperative differences in gait parameters, eversion and flexion strength, American Orthopaedic Foot & Ankle Society (AOFAS), and Foot and Ankle Disability Index (FADI) at up to 3 years of follow-up. 4,6,9,11,12,14 However, a few studies suggest a slight functional deficit following PL harvest, with 1 study showing decreased eversion and plantar flexion strength at 6 months, albeit restored at 1-year follow-up.…”

Section: Video Transcriptmentioning

confidence: 99%

“…4 In terms of the clinical safety regarding foot and ankle outcomes, the literature largely shows a good safety profile, with no significant postoperative differences in gait parameters, eversion and flexion strength, American Orthopaedic Foot & Ankle Society (AOFAS), and Foot and Ankle Disability Index (FADI) at up to 3 years of follow-up. 4,6,9,11,12,14 However, a few studies suggest a slight functional deficit following PL harvest, with 1 study showing decreased eversion and plantar flexion strength at 6 months, albeit restored at 1-year follow-up. 15 Additionally, a systematic review with a pooled sample of over 260 patients across 5 studies showed a slight but statistically significant decrease in AOFAS score postoperatively.…”

Section: Video Transcriptmentioning

confidence: 99%

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Full-Thickness Peroneus Longus Tendon Autograft Harvest

Franciozi,

Mameri,

Schumacher

et al. 2023

Video Journal of Sports Medicine

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Background: Despite extensive evidence of excellent biomechanical and clinical outcomes of ligament reconstructions with bone-patellar tendon-bone, hamstring tendon, and quadriceps tendon autografts, these are not without limitations, including knee-related donor site morbidity, decreased range of motion, and potential for anterior knee pain. Therefore, researchers have explored other options, including the peroneus longus (PL) autograft. Indication: Anterior cruciate ligament (ACL) reconstruction (both primary and revision), as well as multiligament reconstruction, particularly in areas where access to allografts is limited. Surgical Technique: A 3-cm longitudinal skin incision is placed 2 fingerbreadths (or 3 cm) proximal to the tip of the lateral malleolus, and 3 mm posterior to the fibula. The PL and peroneus brevis tendons are identified and isolated, followed by a tenodesis at the distal limit of the incision. The PL is whipstitched proximal to the tenodesis site, and then incised between the tenodesis and whipstitched portion. A closed tendon stripper is inserted and advanced proximally until the PL graft is released. Discussion/Conclusion: PL autograft harvest has been shown to generate thicker and longer grafts relative to the semitendinosus, with demonstrated efficacy in terms of both biomechanical and clinical outcomes. Current literature points largely to a good safety profile, although there is still conflicting evidence in terms of foot and ankle morbidity and no mid- to long-term follow-up data available. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

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Section: Video Transcriptmentioning

confidence: 99%

Section: Video Transcriptmentioning

confidence: 99%

Section: Video Transcriptmentioning

confidence: 99%

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Full-Thickness Peroneus Longus Tendon Autograft Harvest

Franciozi,

Mameri,

Schumacher

et al. 2023

Video Journal of Sports Medicine

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“…Recently, the peroneus longus tendon (PLT) is also considered an appropriate graft option. PLT grafts in knee ligament surgery are becoming increasingly popular, with studies showing tensile strength [ 16 ] and favorable functional outcomes [ 17 – 20 ]. However, most studies have not adequately evaluated evidence on the anatomical and biomechanical features of the PLT that are essential parameters for surgical performance.…”

Section: Introductionmentioning

confidence: 99%

Anatomical and Biomechanical Characteristics of Peroneus Longus Tendon: Applications in Knee Cruciate Ligament Reconstruction Surgery

Nguyen Hoang,

Nguyen Manh

2023

Advances in Orthopedics

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Introduction. The peroneus longus tendon is used in many orthopedic surgeries to regenerate the external ligaments of the knee. This study aims to evaluate some anatomical, biomechanical, and load-bearing properties of the peroneus longus tendon for use in cruciate ligament reconstruction. Materials and Methods. The study design is a cross-sectional description. The study subjects were 20 samples of the peroneus longus tendon from fresh carcasses. The leg is still intact, not crushed, is well preserved, and it has never been used in research. Results. The average length of the peroneus longus tendon was 29.25 ± 2.1 cm, and the average distance from the peroneus longus tendon to the deep peroneal nerve was 71.1 ± 8.63 mm. The peroneus longus tendon did not have an accessory ligament, the maximum tension of the peroneus longus tendon was 1170.4 ± 203 N, and the maximum length at break was 14.29 ± 3.88 mm. Conclusion. Removing the peroneus longus tendon will not affect the surrounding anatomical components. The maximum breaking force and the diameter of the peroneus longus tendon are similar to other graft materials, such as the hamstring tendon and patellar tendon.

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“…The peroneus longus tendon (PLT) is a promising alternative autograft for ligament reconstruction in several orthopaedic injuries [11,14]. It has been used in treating cruciate ligament tears [25,31], patellar dislocation [30], acromioclavicular joint dislocation [33], and latfoot [9,29].…”

Section: Introductionmentioning

confidence: 99%

Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions

Rothrauff

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the distances using ultrasound between the supericial peroneal nerve (SPN) and sural nerve along the peroneus longus tendon (PLT) autograft harvest path at diferent ankle or knee positions in order to minimize risk of iatrogenic nerve injury during PLT autograft harvest. Methods Twenty-four fresh-frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft with a tendon stripper. Four specimens were utilized to validate correct identiication of nerves under ultrasound. Sonographically guided perineural injections were performed at the start point and end point of the PLT harvest path using coloured latex, followed by dissection with gross inspection. Using ultrasound, the distance from the peroneus brevis muscle to the sural nerve at diferent ankle positions (20° dorsilexion, neutral, and 20° plantarlexion) was measured, and the distance from the end of the tendon stripper to the SPN at diferent knee positions (full extension and 90° lexion) was also measured. Measurements were performed by two separate observers using ImageJ software. Results Cadaveric dissection showed the presence of latex around nerves in all four specimens. The average distance from the brevis muscle to the sural nerve increased signiicantly from dorsilexion to plantarlexion. The shortest distance from the tenodesis site to the sural nerve was 5.8 ± 1.7 mm. There was no signiicant diference from the end of the tendon stripper to the SPN between full extension or 90° lexion of the knee. Conclusion When harvesting the PLT, it is recommended to place the ankle at plantarlexion. The knee at full extension or 90° lexion had no efect. Joint positions at the time of graft harvest should be monitored to reduce risks of iatrogenic nerve injury.

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Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity

Cited by 21 publications

References 31 publications

Full-Thickness Peroneus Longus Tendon Autograft Harvest

Full-Thickness Peroneus Longus Tendon Autograft Harvest

Anatomical and Biomechanical Characteristics of Peroneus Longus Tendon: Applications in Knee Cruciate Ligament Reconstruction Surgery

Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions

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