Considerations In Rehabilitation Of ACL Reconstruction Surgery Using A Peroneal Tendon Autograft In A Fitness Athlete

HISTORY AND CASE DESCRIPTION: A 35-year-old male recreational fitness athlete presented to our hospital with a medical diagnosis of ruptured ACL to his left knee, which caused knee instability, effusion and pain. Treating orthopedic surgeon opted for an ACL reconstruction surgery using a Peroneal Tendon autograft (PLT). Rehabilitation following ACL reconstruction surgery is crucial for restoring knee function and enabling patients to return to their pre-injury levels of activity. The use of a peroneal tendon graft (PLT) in ACL reconstruction has been explored as an alternative to more traditional grafts like hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) grafts. TESTS AND RESULTS (pre-op): Physical exam:Pain and swelling to his left knee (non-dominant) are apparent and limiting range of motion. Lachman’s: positivePivot-shift: positiveMRI:Confirming a full rupture of the ACL, left knee. (Attached) TREATMENT/OUTCOMES (post-op): Patient-reported outcome measures included the IKDC questionnaire to monitor the return of function of the knee and for objective strength testing we will use an isokinetic dynamometer to assess comparative quadriceps/hamstrings ratio with the non-surgical side as well as ankle plantar flexion.While PLT grafts have a lower rate of donor site morbidity compared to HT grafts, and patients experience less thigh muscle atrophy, which responds better to rehabilitation, not much is known about the consequent residual effect on the ankle joint and mainly plantar flexion strength.Similarly to other graft options, rehabilitation following ACL reconstruction using a peroneal tendon graft should focus on an accelerated protocol that emphasizes early range of motion, strength training, and neuromuscular control. In addition, the main point of focus is the Triceps Surae muscle strengthening, in order not compromise on Lower Limp function, triple extension and return-to-sport. We tested our patient on a monthly basis until 6 months post-op, showing IKDC score consistently improving every month (from 14.9% to 80.7%) and isokinetic strength testing consistently showing plantar flexion average peak torque with less than 10% difference compared to contralateral side.