Long-Term Assessment of Peroneus Longus Tendon Graft Site Morbidity in Patients with Anterior Cruciate Ligament Reconstruction

Abstract

Objective: To evaluate donor-site morbidity and functional outcomes following anterior cruciate ligament reconstruction (ACLR) using the peroneus longus tendon (PLT) autograft of the ipsilateral site. The main aim of the study was to assess the ankle function, its stability, foot arch assessment, knee stability, and patient satisfaction after graft harvestion.

Methodology: A long-term observational cohort study of 42 patients (30 males and 12 females) who underwent ACLR using PLT autografts was conducted. Quantitative assessment included demographic data, ankle eversion and plantarflexion strength (measured with a handheld dynamometer), range of motion (ROM), and functional scoring using the American Orthopaedic Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Lysholm Knee Score. Foot arch assessment is checked by using wet foot printing method calculating the foot arch index. Qualitative evaluation was based on semi-structured patient interviews exploring perceived weakness, discomfort, cosmetic satisfaction, and return to activity. Statistical analysis was performed using paired t-tests with significance of p value set to be p < 0.05.

Results: The mean age of the patient was 28.9 ± 5.8 years, mean follow-up months of 36.4 ± 7.2. The mean ankle eversion and plantarflexion strength on the donor site were 94.6% ± 7.1% and 96.1% ± 6.4% of the contralateral limb, respectively, having not a  significant difference in ROM (p > 0.05). Functional outcomes were excellent (AOFAS 95.2 ± 4.1; FADI 96.5 ± 3.2; Lysholm 91.9 ± 5.3).  42 patients' arch index data showed 0.233 ± 0.018 operated vs. 0.231 ± 0.018 non-operated with no significant differences both feet arches. Qualitative analysis revealed 88.1% reported no ankle weakness, and 90.5% were cosmetically satisfied.

Conclusion: PLT autograft use in ACLR resulted in excellent functional recovery, preserved foot arch, ankle and knee performance, and minimal donor-site morbidity. It is a safe, reliable, and effective alternative graft option.

Keywords: Anterior Cruciate Ligament Reconstruction, Autograft, Donor-Site Morbidity, Functional Outcome, Knee Stability, Peroneus Longus Tendon