Background: The peroneus longus tendon has been used as a graft in orthopaedic reconstruction surgery because of its comparable biomechanical strength with the native anterior cruciate ligament (ACL) and hamstring tendon. However, one of the considerations in choosing an autograft is donor site morbidity. Purpose/Hypothesis: This study aimed to compare ankle eversion and first ray plantarflexion strength between the donor site and its contralateral site after ACL reconstruction. The study hypothesis was that strength measurements will be different between the harvest site and contralateral healthy site. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ACL reconstruction using a peroneus longus tendon autograft between March 2017 and December 2018 were included in this study. Patients followed a rehabilitation protocol from the first day after surgery. Ankle eversion and first ray plantarflexion strength were measured using a modified dynamometer 6 months after surgery. Donor site morbidity was assessed 6 months after surgery using the Foot & Ankle Disability Index (FADI) and American Orthopaedic Foot & Ankle Society (AOFAS) scoring system for the ankle and hindfoot. Results: A total of 31 patients (22 male, 9 female; mean age, 27.58 ± 8.69 years [range, 18.00-45.00 years]) fulfilled the inclusion criteria. There was no significant difference in ankle eversion strength at the donor site compared with the contralateral site ( P = .55), with means of 65.87 ± 7.63 N and 66.96 ± 8.38 N, respectively. Also, there was no significant difference in ankle first ray plantarflexion strength at the donor site compared with the contralateral site ( P = .68), with means of 150.64 ± 11.67 N and 152.10 ± 12.16 N, respectively. The mean FADI score of 99.71 ± 0.57 and mean AOFAS score of 98.71 ± 3.03 at the donor site were considered excellent results. Conclusion: Ankle eversion and first ray plantarflexion strength at the donor site were similar to those at the contralateral healthy site, with no donor site morbidity. This suggests that the peroneus longus tendon is a promising graft in ACL reconstruction.

Background: Peroneus longus tendon autograft resembles hamstring tendon's biomechanical strength. Thus, peroneus longus is a potential graft in reconstructive orthopaedic procedures. However, there was few study in evaluation of peroneus longus usage in ACL reconstruction. This study aimed to quantify the clinical outcome and donor site morbidity in ACL reconstruction using peroneus longus tendon autograft. Methods: Patients who suffered isolated ACL injury were enrolled and underwent isolated single bundle ACL reconstruction using peroneus longus autograft. Functional score (IKDC, Modified Cincinnati, and Tegner-Lysholm score) were assessed at pre-operative and 2-years after surgery. Graft diameter was measured intraoperative. Donor site morbidities were assessed with thigh circumference measurement and ankle scoring using AOFAS and FADI. We also measured serial hop test. Results: Seventy-five patients fulfilled inclusion criteria. Peroneus longus graft diameter was 8.38 ± 0.68 mm. There was significant difference between pre and 2-years post-operative functional score in IKDC, Modified Cincinnati, and Tegner-Lysholm score. Mean of AOFAS was 98.93 ± 3.10 and FADI was 99.79 ± 0.59 with no significant decrease of thigh circumference, and good serial hop test result. Conclusion: ACL reconstruction with peroneus longus autograft has excellent functional score in IKDC, Modified Cincinnati, Tegner-Lysholm score at 2-years follow up with the advantages of greater graft diameter, less thigh hypotrophy, good serial hop test result, and excellent ankle function based on AOFAS and FADI score.

Background Several study that evaluate the usage of peroneus longus tendon (PLT) autograft in Anterior Cruciate Ligament reconstruction shows good result. Regardless the potential, there was no study about the use of PLT autograft in Posterior Cruciate Ligament (PCL) reconstruction. The purpose of this study is to evaluate the functional outcome and donor site morbidity after single bundle PCL reconstruction using PLT autograft. Methods Patient who met inclusion criteria, enrolled to this study and underwent single bundle PCL reconstruction using PL tendon autograft. Clinical outcomes were assessed with International Knee Documentation Committee (IKDC), Modified Cincinnati scoring systems, Lysholm score, and Serial hop test (single hop test and triple hop test) 2-year after surgery. Donor site morbidity was assessed with Foot and Ankle Disability Index (FADI) and American Orthopaedic Foot and Ankle (AOFAS) scoring system. Results Fifteen patients fulfilled the inclusion criteria (11 males and 4 females). PLT graft diameters were 7.5–10 mm (mean: 8.30 ± 0.65 mm). Significant increase of functional score ( p < 0.05) were found two years after surgery. Mean score of IKDC was 47.58 ± 11.75 pre-operative; 78.17 ± 4.52 post-operative, Modified Cincinnati was 48.86 ± 12.22 pre-operative; 79.00 ± 4.82 post-operative, Lysholm score was 49.26 ± 11.54 pre-operative; 80.20 ± 5.04 post-operative. FADI and AOFAS at donor site ankle was 93.00 ± 3.04 and 93.26 ± 4.20, respectively. Serial hop test showed good result. Conclusion PCL reconstruction using peroneus longus tendon autograft shows good functional outcome of the knee based on IKDC, Modified Cincinnati, Lysholm score, with preservation of ankle function based on AOFAS and FADI score at 2-years follow-up.

Background Tendon or ligament tears can decrease patients' quality of life. Many therapeutic interventions are available to treat such injuries. Mesenchymal stem cells (MSCs) have been shown to be effective in treating tendon or ligament tears; however, the use of stem cell‐conditioned medium (CM) requires further investigation. This review focused on the use of stem cell CM as treatment for tendon or ligament tears. Methods A systematic literature search was performed on PubMed (MEDLINE), OVID, EMBASE, the Cochrane Library, Scopus, Web of Science, and Science Direct with the terms conditioned media or conditioned medium or secretome or microvesicle or extracellular vesicle or exosome , and tendon or ligament as the search keywords. A total of 852 articles were reviewed. Five articles were identified as relevant for this systematic review. Results Meta‐analysis could not be performed because of the high heterogeneity of the reviewed studies; however, the results of this study support a positive effect of conditioned media in tendon and ligament treatment. Conclusion This review provides evidence of improvement in the tendon and ligament healing process with stem cell CM therapy in preclinical studies.

BackgroundAnterior Cruciate Ligament (ACL) is the most common ligament injury during sports activities that was treated with ACL reconstruction. Nowadays, peroneus longus is used in ACL reconstruction. However, it is difficult to predict the peroneus longus graft diameter for ACL reconstruction. Thus, preoperative measurements are very important to predict peroneus longus autograft for ACL reconstruction.MethodsA cohort retrospective study was conducted using consecutive sampling method from February 2016 until October 2017 in our center. We recorded patients’ characteristics include gender, age, body weight, height, and Body Mass Index (BMI) preoperatively. We measured peroneus longus graft diameter intraoperatively, and analysed data using Spearman correlation.ResultsThirty-nine patients met inclusion criteria. There were 28 males and 11 females in the peroneus group. From the patients' mean characteristics, age was 25.10 ± 9.16, body weight 71.23 ± 14.17, height 169.13 ± 8.81, and BMI 20.96 ± 3.44. Intraoperative peroneus longus diameter measurement was 8.56 ± 0.82. Spearman correlation showed significant correlation between intraoperative peroneus longus diameter with patient's height, body weight, and BMI with p < 0.05.ConclusionPatients’ characteristics including gender, height, weight, and BMI in preoperative measurements can predict peoneus longus graft diameter intraoperatively.

Background: Medial Patellofemoral Ligament (MPFL) reconstruction is a popular procedure to repair recurrent patellar dislocation. Many methods of reconstruction describe the use of hamstring tendons as the graft of choice. This study aimed to compare the functional outcome of MPFL reconstruction using quadriceps tendon graft with arthroscopic lateral release and to identify possible risks. Methods: This is a retrospective cohort study in patients with a history of recurrent dislocation trauma from 2014 to 2016 that already done MPFL reconstruction using quadriceps tendon grafts with arthroscopic lateral release. Patient reported outcomes were evaluated pre-operative and 2 years post-operatively using IKDC score, Lysholm knee score, Kujala score, KSS Score, thigh circumference size, and kneel down ability. Patellar fracture, redislocation, and other complications were also assessed 2 years post-operative. Results: Eight patients included in this study and showed significant improvement in clinical outcomes. The Lysholm score increased from 64.37 ± 8.23 to 90.87 ± 3.23 (p = 0.011), IKDC score increased from 62.93 ± 7.52 to 88.36 ± 3.64 (p < 0.001). Kujala score increased from 60.87 ± 7.94 to 88.37 ± 4.34 (p < 0.001), KSS knee score increased from 83.25 ± 11 to 93.87 ± 1.73 (p = 0.012). KSS function also increased from 57.50 ± 11.65 to 88.13 ± 3.72 (p = 0.011) with decreased in thigh circumference (1–3 cm). Five patients have full ROM, able to kneeling, while 3 patients were able to kneeling with adjustments. There were no postoperative infection, patellar fractures nor redislocations. Conclusion: MPFL reconstruction using quadriceps tendon grafts with arthroscopic lateral release can provide improved clinical results without complications of patellar fracture or stiffness of the knee, infection, and redislocation. Level of evidence: Level 3, Retrospective Cohort Study. Highlights:

Purpose This study aimed to evaluate the diferences in clinical outcome and donor site morbidity between the Peroneus Longus Tendon (PLT) and Hamstring Tendon (HT) in single-bundle Posterior Cruciate Ligament (PCL) reconstruction. Methods Patients with an isolated PCL injury underwent single-bundle PCL reconstruction using consecutive sampling. Patients were allocated into two groups (PLT and HT) and prospectively observed. The tendon graft diameter was measured intraoperatively. Functional scores (IKDC, Lysholm, and modiied Cincinnati scores) were recorded preoperatively and 2 years postoperatively. The thigh circumference and functional score according to the Foot and Ankle Disability Index (FADI) and American Orthopedic Foot and Ankle Society (AOFAS) were recorded to evaluate the morbidities in the ankle. Results Fifty-ive patients (hamstring n = 27, peroneus n = 28) met the inclusion criteria. The diameter of the PLT graft (8.2 ± 0.6 mm) was comparable to that of the HT graft (8.3 ± 0.5 mm). Both groups had excellent postoperative knee functional outcome scores. The mean AOFAS and FADI scores were excellent, with no diference in thigh circumference between the groups. Conclusion PLT is a good choice as a graft in PCL reconstruction at the 2-year follow-up, with minimal donor site morbidity. Level of evidence II.

BACKGROUND: Cartilage tear has begun to be treated with stem cells. However, stem cell oxygen level culture has not been evaluated for the best environment to enhance chondrogenesis. AIM: The purpose of this review is to focus on the hypoxic oxygen level of stem cells culture as a treatment for cartilage tear. METHODS: A literature search was systemically conducted on PubMed (MEDLINE), OVID, EMBASE, the Cochrane Library, Scopus, Web of Science, Science Direct, Wiley Online Library, Google Scholar, and bibliography of selected articles with the terms (“culture”) AND (“stem cell” OR “mesenchymal stem cell” OR “MSC”) AND (“hypoxic” OR “hypoxia”) AND (“cartilage” OR “chondro*”) as the main keywords. A total of 438 articles were reviewed. Thirty-six articles were considered relevant for this systematic review. RESULTS: The result of this review supports stimulation effects of hypoxic oxygen level stem cell culture in chondrogenesis process. Most studies used 5% oxygen concentration for culture, both of in vivo and in vitro studies. Due to the heterogeneity nature of the included studies, meta-analysis was unable to be conducted. CONCLUSION: Hypoxia state seems to play an important role in chondrocytes proliferation, differentiation, and matrix production.