Peroneus longus tendon autograft for arthroscopic anterior cruciate ligament reconstruction: A prospective interventional study of eighty cases

Background: Anterior cruciate ligament (ACL) is a common injury conventionally managed by various graft reconstruction using either bone patellar tendon bone (BPTB) or quadruple hamstring tendon (HT) autograft. However, both these grafts options are associated with many limitations and complications. Peroneus longus tendon (PLT) autograft resembles hamstring tendon's biomechanical strength and is a potential substitute for HT. Aim: This study aimed to quantify the clinical outcome in terms of knee functionality and donor site morbidity using PLT autograft. Methods: ACL injury patients underwent single bundle ACL reconstruction using PLT autograft harvested from ipsilateral ankle. Functional score for knee (IKDC and Modified Cincinnati score) were assessed at pre-operative, 6 monthly interval and 2-years after surgery. Donor site morbidities were assessed with thigh circumference measurement and ankle scoring using AOFAS, FADI and hop test. Results: Eighty patients fulfilled inclusion criteria. Peroneus longus graft diameter was 8.50±0.65 mm. Mean graft harvest time was 7.20 minutes. There was significant difference between pre and 2-years post-operative knee functional score in IKDC and Modified Cincinnati. Mean of AOFAS was 98.53±3.60 and FADI was 99.74±0.52 with no significant decrease of thigh circumference (p>0.05). Conclusion: ACL reconstruction with PLT autograft has excellent knee functional score in IKDC and Modified Cincinnati score at 2-years follow up, excellent ankle function based on AOFAS and FADI score. Specific advantages of PLT graft over HT are greater and more consistent graft diameter and length, less thigh hypotrophy, preserved Qudriceps-Hamstrings functions resulting in better knee kinematics.