Peroneus Longus Tendon Autograft: A Promising Graft for ACL Reconstruction

Abstract

Background: With the increasing use of hamstring tendon as an autograft in anterior cruciate ligament (ACL) reconstruction, some shortcomings have been found on the donor site. Therefore, an alternative autograft option with adequate strength and less donor site morbidity will be very valuable. Peroneus longus tendon has been found to be a promising option. Indication: Primary ACL reconstruction. Technique Description: Peroneus longus tendon graft is harvested with a longitudinal skin incision at 2 to 3 cm (2 finger-breadths) above and 1 cm (1 finger-breadth) behind the lateral malleolus, followed by superficial fascia incision in line with skin incision. The peroneus longus and peroneus brevis tendons were then identified. The tendon division location was marked at 2 to 3 cm above the level of the lateral malleolus. After that, an end-to-side suture was performed between the distal part of the peroneus longus tendon and peroneus brevis tendon. The peroneus longus tendon was stripped proximally with a tendon stripper to at least 5 cm from the fibular head to prevent peroneal nerve injury. Graft preparation was performed with a standard procedure to obtain the suitable graft size. In routine arthroscopic ACL reconstruction, peroneus longus tendon graft fixation can be performed with a cortical suspension device, bioabsorbable screws, or a combined technique. Results: Recent studies showed that peroneus longus autograft had a comparable outcome with hamstring tendon autograft in primary ACL reconstruction at a 1-year follow-up. The use of peroneus longus tendon autograft resulted in larger graft diameter and less thigh hypotrophy. The mean (±SD) for the AOFAS-Hindfoot Score in the peroneus longus group was 97.3 ± 4.2, while the mean FADI score was 98 ± 3.4, both of which were considered excellent results. Discussion/Conclusion: The use of peroneus longus autograft in primary ACL reconstruction is a safe procedure with an excellent outcome. Peroneus longus tendon autograft can be recommended as an alternative graft in single-bundle ACL reconstruction. Further study of the functional outcome and knee stability evaluation is recommended.

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

“…While the deep peroneal nerve may be considered to be “safe” during PLT harvest, the tendon stripper should be advanced carefully [15, 38]. Some studies have advocated for stopping the stripper 4–5 cm distal to the fibular head to avoid injury to the deep peroneal nerve [5, 11, 30]. One must keep in mind that variation in individual anatomy exists, as transection of the common peroneal nerve has even been reported in the setting of a hamstring autograft harvest [4].…”

Earlier Return to Sports, Reduced Donor-Site Morbidity with Doubled Peroneus Longus Versus Quadrupled Hamstring Tendon Autograft in ACL Reconstruction

“…The surgeries were carried out arthroscopically by the same surgeon; general or spinal anesthesia was used, depending on patients’ health profile and risk stratification. PLT autografts were harvested perioperatively using the technique described by Budhiparama et al 8 , and HT autografts were harvested perioperatively using the technique described by Vinagre et al 9 . Both (HT and PLT) grafts were prepared by stripping off excess muscle and using the following tool set: looped sutures (ACL TightRope RT and TightRope ABS; Arthrex), high-strength looped suture (no.…”

VJSM Editorial: Application of Levels of Evidence to Video Journal Publications

“…Budhiparama et al’s 1 video on the use of peroneus longus tendon in anterior cruciate ligament (ACL) reconstruction, provides an example of a Video Journal Level 2 publication.…”