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Peroneus longus autograft can be recommended as a superior graft to hamstring tendon in single-bundle ACL reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A peroneus longus tendon autograft is used in many orthopaedic procedures and it is biomechanically comparable to a hamstring tendon autograft. Despite its potential, there are few studies that have evaluated the use of the peroneus longus tendon in ACL reconstruction. The aim of this study was to compare the clinical outcome and donor site morbidity of ACL reconstruction with hamstring tendon autografts versus peroneus longus tendon autografts in patients with an isolated ACL injury.

Methods

Patients who underwent isolated single-bundle ACL reconstruction were allocated to two groups (hamstring and peroneus longus) and observed prospectively. Graft diameter was measured intraoperatively. Functional scores (IKDC, modified Cincinnati and Lysholm scores) were recorded preoperatively and 1 year after surgery. Donor site morbidities were assessed with thigh circumference measurements and ankle scoring with the AOFAS and FADI.

Results

Fifty-two patients (hamstring n = 28, peroneus n = 24) met the inclusion criteria. The peroneus longus graft diameter (8.8 ± 0.7 mm) was significantly larger than the hamstring diameter (8.2 ± 0.8 mm) (p = 0.012). There were no significant differences between the pre- and 1-year postoperative score between the hamstring and peroneus longus groups in the IKDC (n.s), modified Cincinnati (n.s), and Lysholm (n.s). The mean for the AOFAS was 97.3 ± 4.2 and for the FADI 98 ± 3.4 in the peroneus longus group, with a significant decrease in thigh circumference in the hamstring group (p = 0.002).

Conclusion

Anterior cruciate ligament reconstruction with peroneus longus autografts produces a functional score (IKDC, modified Cincinnati, Lysholm) comparable to that of hamstring autografts at a 1-year follow-up, with the advantages of larger graft diameter, less thigh hypotrophy and excellent ankle function based on AOFAS and FADI scores.

Level of evidence

Prospective cohort study, Level II.

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Abbreviations

ACL:

Anterior cruciate ligament

BPTB:

Bone–patellar tendon–bone

MPFL:

Medial patellofemoral ligament

IKDC:

International Knee Documentation Committee

MCL:

Medial collateral ligament

AOFAS:

American Orthopedic Foot and Ankle Score

FADI:

Foot and Ankle Disability Index

KOOS:

Knee injury and Osteoarthritis Outcome Score

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Acknowledgements

We would like to thank Dadang R. Sasetyo, MD, for his assistance with patient selection, history taking and obtaining patient consent, and Shinta Primasara, MD, for her help with postoperative functional data collection during patient rehabilitation.

Funding

No external funding was used.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia

    Sholahuddin Rhatomy & Anggun E. Wardani

  2. Department of Orthopaedics and Traumatology, Dr Sardjito General Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia

    Asa Ibrahim Zainal Asikin & Tedjo Rukmoyo

  3. Nicolaas Institute of Constructive Orthopaedics Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jl. Jendral Gatot Subroto Kav. 59, 6th floor, Jakarta, 12950, DKI Jakarta, Indonesia

    Imelda Lumban-Gaol & Nicolaas C. Budhiparama

  4. RSUP dr. Soeradji Tirtonegoro, Jln. KRT. dr Soeradji Tirtonegoro No. 1, Klaten, Indonesia

    Sholahuddin Rhatomy & Anggun E. Wardani

  5. RSUP dr. Sardjito, Jalan Kesehatan No. 1, Sinduadi, Mlati, Sinduadi, Mlati, Kabupaten Sleman, Daerah Istimewa Yogyakarta, 55281, Indonesia

    Asa Ibrahim Zainal Asikin & Tedjo Rukmoyo

  6. Department of Radiology, Dr Soeradji Tirtonegoro General Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia

    Anggun E. Wardani

Authors
  1. Sholahuddin Rhatomy
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  2. Asa Ibrahim Zainal Asikin
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  3. Anggun E. Wardani
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  4. Tedjo Rukmoyo
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  5. Imelda Lumban-Gaol
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  6. Nicolaas C. Budhiparama
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Contributions

NCB conceived the study, participated in its design, reviewed, edited and finalised the manuscript. SR carried out patient selection consisting of history taking, physical examination and MRI evaluation, explained the study to the patients and obtained the patients’ informed consent, performed all the ACL reconstruction surgery, collected intraoperative study data, reviewed and edited the paper. AIZA collected preoperative data including demographic data, preoperative functional scores and postoperative data, including functional scores and thigh circumference measurements, performed statistical analyses, wrote the paper and prepared the manuscript. AEW performed statistical analyses, wrote the paper and prepared the manuscript. ILG performed statistical analyses and interpretations, reference review, manuscript review and edits. TR co-ordinated the study design with all the authors and reviewed the manuscript. All the authors have read and approved the final manuscript.

Corresponding author

Correspondence to Nicolaas C. Budhiparama.

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The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants.

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Rhatomy, S., Asikin, A.I.Z., Wardani, A.E. et al. Peroneus longus autograft can be recommended as a superior graft to hamstring tendon in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 3552–3559 (2019). https://doi.org/10.1007/s00167-019-05455-w

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  • DOI: https://doi.org/10.1007/s00167-019-05455-w

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