Low to moderate risk of nerve damage during peroneus longus tendon autograft harvest

He, Jinshen; Byrne, Kevin; Ueki, Hiroko; Kanto, Ryo; Linde, Monica A.; Smolinski, Patrick; Wu, Song; Fu, Freddie H.

doi:10.1007/s00167-021-06698-2

Cited by 8 publications

(6 citation statements)

References 39 publications

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“…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…”

Section: Discussionmentioning

confidence: 99%

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

Wierer

Gwinner

Scheffler³

2023

Am J Sports Med

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Background: The anterior half of the peroneus longus tendon (AHPLT) has been reported to be a suitable autograft for ligament reconstruction with low donor-site morbidity. However, clinical data on graft size are limited. Purpose: To determine (1) if there is any difference in size between the AHPLT and semitendinosus tendon (ST) and (2) whether anthropometric measurements can predict autograft size. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 128 consecutive patients scheduled for knee ligament reconstruction were prospectively enrolled. Patients were treated with AHPLT (50%) or ST (50%). Data included anthropometric measurements and intraoperatively recorded graft size. A Student t test was used to determine differences between the groups. Bivariate correlation coefficients and multivariate regression analyses were calculated to identify relationships between graft size and anthropometric measurements. Results: The AHPLT and ST groups were equally distributed according to age, sex, height, weight, and body mass index (BMI). The quadrupled graft length for the AHPLT was 7.3 ± 0.6 cm as compared with 7.5 ± 0.7 cm for the ST ( P < .05). The quadrupled graft diameter was 7.7 ± 0.8 mm for the AHPLT and 8.0 ± 0.7 mm for the ST ( P < .05). Height had a moderate ( r = 0.57) to high ( r = 0.68) correlation with AHPLT and ST length, respectively ( P < .01). Weight had a moderate correlation ( r = 0.43) with AHPLT diameter ( P < .01) but only a weak correlation ( r = 0.19) with ST diameter ( P > .05). A significant interaction effect of BMI and thigh circumference on ST graft diameter was found, which showed that the effect of thigh circumference on ST graft diameter decreased significantly as BMI increased ( P < .05). This moderating effect of BMI could not be observed for the coefficient of shank circumference on AHPLT graft diameter ( P > .05). Conclusion: (1) The peroneus longus split tendon provides a reliable autograft size for knee ligament reconstructions. It was prone to be slightly shorter and thinner than the ST. (2) Patient height was the strongest predictor for AHPLT and ST graft length. However, predicting graft diameter based on thigh or shank circumference was more challenging, with higher BMIs affecting the ability to predict ST more than AHPLT.

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Section: Discussionmentioning

confidence: 99%

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

Wierer

Gwinner

Scheffler³

2023

Am J Sports Med

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“…However, it should be noticed that the SPN is quite close to the tendon stripper when harvesting PLT autograft based on a cadaver study. Directing the tendon stripper superficially may minimize the risk of SPN injury [13].…”

Section: Discussionmentioning

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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“…The superficial peroneal nerve was approximately 5.2 mm away from the end of the stripper and ran parallel to it. He did not find transection injuries in the 10 legs harvested [ 8 ]. Nerve injuries following tendon harvest using tendon strippers have been reported in HT and patellar tendon autografts.…”

Section: Discussionmentioning

confidence: 99%

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

Yadav¹,

Nemani²,

Devgun³

et al. 2022

Cureus

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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.

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Low to moderate risk of nerve damage during peroneus longus tendon autograft harvest

Cited by 8 publications

References 39 publications

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

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

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

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

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