Peroneus Longus Tendon Autograft for Primary Arthroscopic Reconstruction of the Anterior Cruciate Ligament

Author(s): Nabil Zunayed Sidny, Mehreen Mustafiz, Abdullahel Wafee, Md Saddam Hossain, Arefin Iftekher Ahmed, Shoaib Talukder, Dewan Nurul Islam

Introduction: An anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee joint that is usually injured when engaging in sports activity, but non-sports injuries are not uncommon. Arthroscopic anterior cruciate ligament (ACL) reconstruction is the most accepted treatment for complete ACL injury worldwide. Peroneus longus tendon graft is not a popular first choice for ACL reconstruction. However, newer literature has shown good outcomes with its use.

Methods: This was a prospective cohort study conducted in Dept. of Orthopaedic and Trauma Surgery, Shaheed Monsur Ali Medical College, Dhaka, Bangladesh from January 2022 to December 2023. This prospective cohort study involves 50 patients who underwent arthroscopic single-bundle ACLR. 25 patients each were operated on with hamstring and peroneus longus autografts. At 2 years follow-up, functional outcome was compared between groups using International Knee Documentation Committee (IKDC), Modified Cincinnati, and Tegner-Lysholm scores. Donor site morbidity in the peroneus longus group was assessed using Foot and Ankle Disability Index (FADI) and The American Orthopaedic Foot and Ankle Society (AOFAS) scores.

Results: In our study we included 50 patients who were divided subsequently into group A (hamstring) and group B (peroneus longus) of 25 each. In the hamstring group, the mean age of the patients was 32.11 ± 9.460 years of which 92% were males and 8% were females. In the peroneus longus group, the mean age of the patients was 31.74 ± 7.744 years of which 74% were males and 26% were females. Fisher's exact test revealed no significant statistical difference in age distribution between the two groups (p=0.297). The mean length of the harvested Peroneus longus graft was 28.86 ± 1.30cm and the obtained mean diameter was 8.11 ± 0.49mm. There was no statistically significant difference in the mean IKDC (77.26 vs 80.78), Modified Cincinnati (84.41 vs 89.07), and Tegner- Ly-sholm scores (85.19 vs 88.78) between the hamstring and peroneus groups respectively. Mean FADI and AOFAS scores at 2 years follow up were 96.11 and 91.67 respectively in the peroneus group suggesting no significant donor site morbidity as compared to preoperative scores.

Conclusions: Peroneus longus performs similar to hamstring grafts and can be considered as one of the first choices for arthroscopic ACL reconstruction.