The Anterior Cruciate Ligament Reconstruction with the Peroneus Longus Tendon: A Biomechanical and Clinical Evaluation of the Donor Ankle Morbidity

Chayanin Angthong MD*, Bancha Chernchujit MD*, Adinun Apivatgaroon MD*, Kornkit Chaijenkit MD**, Poonyanat Nualon PT***, Kanoknan Suchao-in PT***

Affiliation : * Department of Orthopedic Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Department of Orthopedic Surgery, Kanchanaphisek Medical Center, Mahidol University, Nakhon Pathom, Thailand *** Department of Physical Therapy, Faculty of Allied Health Science, Thammasat University, Pathumthani, Thailand

Background : The purpose of this study was to report on ankle and foot functions via the holistic evaluations using clinical examination, functional scores assessment and isokinetic tests after harvesting autogenous peroneus longus tendons for anterior cruciate ligament (ACL) reconstruction focusing on the donor site morbidity with a minimum 1-year follow-up period. Material and Method: The study included 24 patients who underwent ACL reconstruction using peroneus longus autograft and endobutton fixation. Results of ACL reconstruction were assessed via physical examination. Donor site morbidity of the foot and ankle after tendon-harvesting was assessed using American Orthopedic Foot-and-Ankle Society (AOFAS) for ankle-hindfoot score and Visual Analogue Score-Foot Ankle (VAS-FA). Isokinetic testing for the ankle was performed in 10 voluntary patients after surgery.
Results : Mean follow-up time was 12.8 months. Regarding the latest follow-up, anterior drawer tests of ankle showed normal findings in 83.3%, and 1+ anterior laxity in 16.7% of all patients. Mean pre- and postoperative AOFAS scores were 100.00.0 and 96.09.6, respectively at 6-month follow-up (p = 0.06). Mean pre- and postoperative VAS-FA scores were 99.71.1 and 95.412.0, respectively at ~13-month follow-up (p = 0.09). At 7-month follow-up by isokinetic testing, peak torques of eversion and inversion were significantly lower on the harvested ankle compared with the contralateral ankle at both velocities (60°/second and 120°/second, p<0.05).
Conclusion : Based on overall findings in the present study, the authors could not recommend the peroneus longus tendon as the first option of donor graft for ACL reconstruction due to the several morbidities particularly in the first 12 months after the operation. However, the peroneus longus tendon may be the option after other graft harvestings for the ligament reconstruction, which needs several tendon grafts in a patient with multi-directional instability of the knee due to some specific situation such as a traumatic knee dislocation.

Keywords : Anterior cruciate ligament, Peroneus longus, Ankle, Morbidity

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