Iatrogenic Foot Drop After Anterior Cruciate Ligament Reconstruction With Peroneus Longus Tendon Autograft: Report of a Rare Case

Abstract

Reconstruction of the anterior cruciate ligament using autografts is a common procedure performed in the modern era. The peroneus longus tendon is an upcoming graft with several advantages over traditional autografts. It has minimal donor site morbidity in relation to biomechanical properties of the ankle. Common peroneal nerve injury during harvest is a theoretical concern while harvesting the peroneus longus tendon. The following case highlights the importance of careful surgical technique and timely intervention while dealing with such complications. A 25-year-old male suffered an anterior cruciate ligament rupture while wrestling. He had an unstable knee and difficulty performing daily activities. He underwent an arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft. Following surgery, the patient reported a foot drop and decreased sensations over the dorsum of the foot. The patient was advised of a foot drop splint and neuroprotective medications. Neurophysiological studies were not performed since they cannot differentiate between partial and complete nerve injury in the first week after injury. A surgical exploration of the nerve was done. An intraneural hematoma was found with contusions over the peroneus longus tendon. Neurolysis was performed to decompress the nerve. The functioning of the anterior cruciate ligament was satisfactory during follow-up. An advancing Tinel's sign was noted on followup. The patient finally recovered after a 3-month follow-up.

Peroneus Longus Split Versus Semitendinosus Tendon Autograft Size: A Cross-sectional Study

“…However, only 1 case of intraneural hematoma at the level of bifurcation of the common peroneal nerve has been reported so far. 20,68 Ongoing studies are quantifying the possible differences between standard ''knee'' autografts and the AHPLT. 21…”