Comparison of donor site morbidity in peroneus longus tendon harvest with and without peroneal tenodesis in ACL reconstruction: A Randomised control study

Introduction: The peroneus longus tendon is an effective autograft for ACL reconstruction, but concerns persist regarding donor-site ankle morbidity. Peroneal tenodesis is commonly performed to prevent eversion weakness, though its necessity remains controversial. This study compares donor-site morbidity and functional outcomes with and without tenodesis. Methods: This randomised control study included 97 patients undergoing primary ACL reconstruction using PLT autografts between 2019 and 2023. Patients were randomised into two groups: Group A (n=52) underwent PLT harvest with peroneal tenodesis, while Group B (n=45) underwent PLT harvest without tenodesis. Donor site morbidity was assessed using the Foot and Ankle Ability Measure (FAAM), American Orthopaedic Foot and Ankle Society (AOFAS) scores, and Visual Analogue Scale (VAS) pain scores at 3, 6, and 12 months. Muscle strength was evaluated using Medical Research Council (MRC) grading for ankle eversion and 1st ray plantarflexion. Results: There were no significant differences between the two groups in FAAM, AOFAS, or VAS scores at any follow-up interval (p>0.05). At 12 months, mean FAAM scores were 94.3 ± 4.8 (Group A) and 95.7 ± 3.2 (Group B); AOFAS scores were 90.1 ± 5.1 and 89.8 ± 5.3, respectively. Ankle eversion and plantarflexion strength were largely preserved in both groups, with no significant difference. Complication rates, including wound healing and sensory disturbances, were similar between groups. Conclusion: Peroneus longus tendon autograft harvest for ACL reconstruction results in minimal donor-site morbidity with preserved ankle function. This low morbidity supports the safety of sacrificing the peroneus longus tendon for graft purposes. As the tenodesis performed in this cohort was radiologically intact in only a subset of patients, this study cannot conclude that tenodesis offers no benefit compared with no tenodesis.