Using a peroneus longus tendon as an autograft in primary plastic surgery of the anterior cruciate ligament (systematic review)

Abstract

Introduction: The purpose of this systematic review was to compare and analyze the outcomes of ACL grafting using the PLT with respect to restoration of knee and foot functions and biomechanics, knee stability, pain or paresthesia at the site of harvest, graft survival, and clinical studies comparing peroneus longus tendon autograft with ST and GT autograft in ACL reconstruction. Materials and methods: Original articles from numerous clinical trials were retrieved from science databases. These articles also included a number of keywords: ("peroneus longus tendon" or "fibularis longus tendon") and (anterior cruciate ligament reconstruction" or "ACL reconstruction"). These studies also directly compared the results of PLT, GT and ST, and moreover biomechanical studies.Therefore , the following parameters that met the exact inclusion criteria were extracted: functional outcomes, including the mean Lysholm scale score, in which the percentage of Lysholm scores was greater than 84 points, the mean subjective score of the IKDC score, percentage of normal or near-normal subjective IKDC scores; mean autograft diameter; and knee instability; treatment results of developed foot and ankle pathology after peroneus longus tendon removal, including the average pre- and post operative AOFAS and FADI scores, as well as an assessment of foot and ankle biomechanical parameters. Results: A total number of 2,322 patients that underwent ACL reconstruction using an PLT autograft were analyzed-1,660 patients and 662 patients from publications comparing the results using PLT, ST and GT autografts. The postoperative average AOFAS score from the peroneus longus tendon harvest was 96.47 ± 2.71, whereas, the FADI scale was 97.72 ± 2.58. The best IKDC scale score in the PLT group - 94.13 ± 4.66 and in the ST and GT group - 95.12 ± 0.73. The best Tegner-Lysholm scale score in the PLT patient group was 99.15 ± 2.89, and in the ST and GT group - 99.85 ± 0.37. Moreover, the plantar flexion and eversion strength of the foot were evaluated in 31 patients. Ultimately , there was no difference in foot eversion and plantar flexion strengths between the donor and healthy side. Conclusion: Overall, peroneus longus tendon autograft had significantly better subjective scores on the Tegner-Lysholm and the IKDC scales, compared to the gracious and semitendinosus tendon autographs. However, there was a small, but statistically insignificant decrease in AOFAS and FADI scores on the autograft harvest side.