Publication:

Assessment of donor site morbidity and functional outcome in anterior cruciate ligament reconstruction using peroneus longus autograft

Background Anterior cruciate ligament (ACL) reconstruction is commonly performed using hamstring tendon or bone–patellar tendon–bone autografts; however, donor site morbidity associated with these grafts has prompted the search for alternative autografts. The peroneus longus tendon (PLT) has emerged as a potential option due to its favorable biomechanical properties and adequate graft length and strength. Concerns remain regarding donor ankle morbidity following PLT harvest. Objective of the study was to assess donor site morbidity of the ankle and functional outcomes of the knee following arthroscopic ACL reconstruction using a peroneus longus tendon autograft.

Methods This prospective observational study included 45 patients who underwent arthroscopic ACL reconstruction using an ipsilateral peroneus longus tendon autograft at a tertiary care center. Patients were followed up for a minimum of 12 months. Knee function and stability were assessed using the International Knee Documentation Committee (IKDC) score, anterior drawer test, Lachman test, and pivot shift test. Donor ankle morbidity was evaluated using the American orthopaedic foot and ankle society (AOFAS) score and muscle strength assessment of ankle eversion and first ray plantar flexion using the Medical Research Council (MRC) scale. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 20.0, with p<0.05 considered statistically significant.

Results The majority of patients were aged 26–40 years (55.6%) and were male (68.9%). Sports-related injuries were the most common mechanism (60%). At 12 months follow-up, 93.3% of patients achieved excellent or good IKDC scores, with the mean IKDC score improving significantly from 60±2.2 preoperatively to 97.5±4.8 postoperatively (p<0.01). Objective knee stability was restored, with negative anterior drawer and Lachman tests in 95.6% and 93.3% of patients, respectively, and a negative pivot shift test in 100% of patients. Donor ankle function was preserved, with a mean AOFAS score of 98.4±3 at final follow-up. Grade V muscle strength was maintained in 91.1% of patients for ankle eversion and 95.6% for first ray plantar flexion, with no patient demonstrating strength ≤grade 3.

Conclusions Arthroscopic ACL reconstruction using the peroneus longus tendon autograft provides excellent knee stability and functional outcomes with minimal donor ankle morbidity. The PLT autograft is a reliable and effective alternative to conventional autografts for ACL reconstruction.