Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 11 , ISSUE 1 ( January-March, 2024 ) > List of Articles

REVIEW ARTICLE

Harvesting Peroneus Longus Tendon for ACL Reconstruction: Impact on Ankle Functions and Biomechanics?

Ajoy S Manik, Rahul Panduranga, Prasoon Kumar, Ronak N Kotian, Ramesh Debur, Sushruth Jagadish, Vishal Patil

Keywords : Anterior cruciate ligament reconstruction, Ankle function, Biomechanics, Peroneus longus tendon

Citation Information : Manik AS, Panduranga R, Kumar P, Kotian RN, Debur R, Jagadish S, Patil V. Harvesting Peroneus Longus Tendon for ACL Reconstruction: Impact on Ankle Functions and Biomechanics?. J Foot Ankle Surg Asia-Pacific 2024; 11 (1):8-12.

DOI: 10.5005/jp-journals-10040-1320

License: CC BY-NC 4.0

Published Online: 30-12-2023

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim and background: The purpose of this review was to evaluate the available evidence on the effect of harvesting the peroneus longus tendon (PLT) for anterior cruciate ligament (ACL) reconstruction on ankle functions and biomechanics. Materials and methods: A total of 17 studies of interest were included in this narrative review. There were two systematic reviews, and the remaining 15 were either case series or comparative studies. Results: Current literature does not strongly recommend the usage of PLT as a primary graft choice, which is evident from the many conflicting conclusions noted among them. Conclusion: There is a need to build the evidence with long-term studies that evaluate the objective assessment of ankle function, such as gait analysis, isokinetic muscle strength testing, and foot pressure studies after PLT harvest for ACL reconstruction. Alternatively, a multicentric study is required to recruit a large number of subjects to come to a true conclusion. Clinical significance: The effect of harvesting PLT on the foot biomechanics has to be evaluated before it becomes a norm to utilize it as an autograft for ACL reconstruction. This review provides information regarding the current trend and discusses evidence behind the same.


HTML PDF Share
  1. Mall NA, Chalmers PN, Moric M, et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 2014;42(10):2363–2370. DOI: 10.1177/0363546514542796
  2. Zhu Y, Hsueh P, Zeng B, et al. A prospective study of coracoclavicular ligament reconstruction with autogenous peroneus longus tendon for acromioclavicular joint dislocations. J Shoulder Elbow Surg 2018;27(6):e178–e188. DOI: 10.1016/j.jse.2017.12.009
  3. Ellis SJ, Williams BR, Wagshul AD, et al. Deltoid ligament reconstruction with peroneus longus autograft in flatfoot deformity. Foot Ankle Int 2010;31(9):781–789. DOI: 10.3113/FAI.2010.0781
  4. Williams BR, Ellis SJ, Deyer TW, et al. Reconstruction of the spring ligament using a peroneus longus autograft tendon transfer. Foot Ankle Int 2010;31(7):567–577. DOI: 10.3113/FAI.2010.0567
  5. Xu C, Zhao J, Xie G. Medial patella-femoral ligament reconstruction using the anterior half of the peroneus longus tendon as a combined procedure for recurrent patellar instability. Asia Pac J Sports Med Arthrosc Rehabil Technol 2016;4:21–26. DOI: 10.1016/j.asmart.2016.03.001
  6. Shao X, Shi LL, Bluman EM, et al. Satisfactory functional and MRI outcomes at the foot and ankle following harvesting of full thickness peroneus longus tendon graft. Bone Joint J 2020;102-B(2):205–211. DOI: 10.1302/0301-620X.102B2.BJJ-2019-0949.R1
  7. Hossain GMJ, Islam MS, Rahman Khan MM, et al. A prospective study of arthroscopic primary ACL reconstruction with ipsilateral peroneus longus tendon graft: experience of 439 cases. Medicine (Baltimore) 2023;102(9):e32943. DOI: 10.1097/MD.0000000000032943
  8. Singh H, Agarwal KK, Tyagi S, et al. A study of the functional outcome of supplementation of hamstring graft with anterior half of the peroneus longus tendon in arthroscopic anterior cruciate ligament reconstruction. Cureus 2022;14(10):e30138. DOI: 10.7759/cureus.30138
  9. Liu CT, Lu YC, Huang CH. Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. J Orthop Sci 2015;20(5):854–860. DOI: 10.1007/s00776-015-0744-2
  10. Sharma D, Agarwal A, Shah K, et al. Peroneus longus: most promising autograft for arthroscopic ACL reconstruction. Indian J Orthop Surg 2019;5(3):172–175. DOI: 10.18231/j.ijos.2019.033
  11. Keyhani S, Qoreishi M, Mousavi M, et al. Peroneus longus tendon autograft versus hamstring tendon autograft in anterior cruciate ligament reconstruction: a comparative study with a mean follow-up of two years. Arch Bone Jt Surg 2022;10(8):695–701. DOI: 10.22038/ABJS.2022.59568.2938
  12. Rajani AM, Shah UA, Mittal AR, et al. Functional and clinical outcome of anterior cruciate ligament reconstruction with peroneus longus autograft and correlation with MRI after 3 years. J Orthop 2022;34:215–220. DOI: 10.1016/j.jor.2022.08.027
  13. Marín Fermín T, Hovsepian JM, Symeonidis PD, et al. Insufficient evidence to support peroneus longus tendon over other autografts for primary anterior cruciate ligament reconstruction: a systematic review. J ISAKOS 2021;6(3):161–169. DOI: 10.1136/jisakos-2020-000501
  14. Bi M, Zhao C, Zhang S, et al. All-inside single-bundle reconstruction of the anterior cruciate ligament with the anterior half of the peroneus longus tendon compared to the semitendinosus tendon: a two-year follow-up study. J Knee Surg 2018;31(10):1022–1030. DOI: 10.1055/s-0038-1627466
  15. Agarwal A, Singh S, Singh A, et al. Comparison of functional outcomes of an anterior cruciate ligament (ACL) reconstruction using a peroneus longus graft as an alternative to the hamstring tendon graft. Cureus 2023;15(4):e37273. DOI: 10.7759/cureus.37273
  16. Joshi S, Shetty UC, Salim MD, et al. Peroneus longus tendon autograft for anterior cruciate ligament reconstruction: a safe and effective alternative in nonathletic patients. Niger J Surg 2021;27(1):42–47. DOI: 10.4103/njs.NJS_22_20
  17. He J, Tang Q, Ernst S, et al. Peroneus longus tendon autograft has functional outcomes comparable to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021;29(9):2869–2879. DOI: 10.1007/s00167-020-06279-9
  18. Rhatomy S, Wicaksono FH, Soekarno NR, et al. Eversion and first ray plantarflexion muscle strength in anterior cruciate ligament reconstruction using a peroneus longus tendon graft. Orthop J Sports Med 2019;7(9):2325967119872462. DOI: 10.1177/2325967119872462
  19. Goyal T, Paul S, Choudhury AK, et al. Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity. Eur J Orthop Surg Traumatol 2023;33(1):21–27. DOI: 10.1007/s00590-021-03145-3
  20. Shi FD, Hess DE, Zuo JZ, et al. Peroneus longus tendon autograft is a safe and effective alternative for anterior cruciate ligament reconstruction. J Knee Surg 2019;32(8):804–811. DOI: 10.1055/s-0038-1669951
  21. Angthong C, Chernchujit B, Apivatgaroon A, et al. The anterior cruciate ligament reconstruction with the peroneus longus tendon: a biomechanical and clinical evaluation of the donor ankle morbidity. J Med Assoc Thai 2015;98(6):555–560.
  22. Nazem K, Barzegar M, Hosseini A, et al. Can we use peroneus longus in addition to hamstring tendons for anterior cruciate ligament reconstruction? Adv Biomed Res 2014;3:115. DOI: 10.4103/2277-9175.132696
  23. Zhao J, Huangfu X. The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source. Am J Sports Med 2012;40(3):662–671. DOI: 10.1177/0363546511428782
  24. Cao HB, Liang J, Xin JY. Treatment of anterior cruciate ligament injury with peroneus longus tendon. Zhonghua Yi Xue Za Zhi 2012;92(35):2460–2462.
  25. Kim HN, Jeon JY, Dong Q, et al. Lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon. Knee Surg Sports Traumatol Arthrosc 2015;23(6):1877–1885. DOI: 10.1007/s00167-014-3072-8
  26. Caplan N, Kader DF. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. Classic Papers Orthop 2014;145–147. DOI: 10.1007/978-1-4471-5451-8_35
  27. Kerimoğlu S, Koşucu P, Livaoğlu M, et al. Magnetic resonance imagination of the peroneus longus tendon after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2009;17(1):35–39. DOI: 10.1007/s00167-008-0626-7
  28. Mustamsir E, Phatama KY. Tensile strength comparison between peroneus longus and hamstring tendons: a biomechanical study. Int J Surg Open 2017;9:41–44. DOI: 10.1016/j.ijso.2017.10.002
  29. Jacob HA. Forces acting in the forefoot during normal gait–an estimate. Clin Biomech (Bristol, Avon) 2001;16(9):783–792. DOI: 10.1016/s0268-0033(01)00070-5
  30. Ferris L, Sharkey NA, Smith TS, et al. Influence of extrinsic plantar flexors on forefoot loading during heel rise. Foot Ankle Int 1995;16(8):464–473. DOI: 10.1177/107110079501600802
  31. O'Connor KM, Hamill J. The role of selected extrinsic foot muscles during running. Clin Biomech (Bristol, Avon) 2004;19(1):71–77. DOI: 10.1016/j.clinbiomech.2003.09.001
  32. Maffulli N, Ferran NA. Management of acute and chronic ankle instability. J Am Acad Orthop Surg 2008;16(10):608–615. DOI: 10.5435/00124635-200810000-00006
  33. Arnold BL, Linens SW, De La Motte SJ, et al. Concentric evertor strength differences and functional ankle instability: a meta-analysis. J Athletic Training 2009;44(6):653–662. DOI: 10.4085/1062-6050-44.6.653
  34. Donnelly L, Donovan L, Hart JM, et al. Eversion strength and surface electromyography measures with and without chronic ankle instability measured in 2 positions. Foot Ankle Int 2017;38(7):769–778. DOI: 10.1177/1071100717701231
  35. Selmani E, Gjata V, Gjika E. Current concepts review: peroneal tendon disorders. Foot Ankle Int 2006;27(3):221–228. DOI: 10.1177/107110070602700314
  36. Perry J. Anatomy and biomechanics of the hindfoot. Clin Orthop Relat Res 1983(177):9–15.
  37. Ferretti A, Conteduca F, Morelli F, et al. Regeneration of the semitendinosus tendon after its use in anterior cruciate ligament reconstruction: a histologic study of three cases. Am J Sports Med 2002;30(2):204–207. DOI: 10.1177/03635465020300021001
  38. Lu CC, Zhang T, Reisdorf RL, et al. Biological analysis of flexor tendon repair-failure stump tissue: A potential recycling of tissue for tendon regeneration. Bone Joint Res 2019;8(6):232–245. DOI: 10.1302/2046-3758.86.BJR-2018-0239.R1
  39. Konrath JM, Vertullo CJ, Kennedy BA, et al. Morphologic characteristics and strength of the hamstring muscles remain altered at 2 years after use of a hamstring tendon graft in anterior cruciate ligament reconstruction. Am J Sports Med 2016;44(10):2589–2598. DOI: 10.1177/0363546516651441
  40. Choi JY, Ha JK, Kim YW, et al. Relationships among tendon regeneration on MRI, flexor strength, and functional performance after anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 2012;40(1):152–162. DOI: 10.1177/0363546511424134
  41. Rispoli DM, Sanders TG, Miller MD, et al. Magnetic resonance imaging at different time periods following hamstring harvest for anterior cruciate ligament reconstruction. Arthroscopy 2001;17(1):2–8. DOI: 10.1053/jars.2001.19460
  42. Burks RT, Crim J, Fink BP, et al. The effects of semitendinosus and gracilis harvest in anterior cruciate ligament reconstruction. Arthroscopy 2005;21(10):1177–1185. DOI: 10.1016/j.arthro.2005.07.005
  43. Klatte-Schulz F, Pauly S, Scheibel M, et al. Influence of age on the cell biological characteristics and the stimulation potential of male human tenocyte-like cells. Eur Cell Mater 2012;24:74–89. DOI: 10.22203/ecm.v024a06
  44. Zhou Z, Akinbiyi T, Xu L, et al. Tendon-derived stem/progenitor cell aging: defective self-renewal and altered fate. Aging Cell 2010;9(5):911–915. DOI: 10.1111/j.1474-9726.2010.00598.x
  45. Kokubo T, Hashimoto T, Nagura T, et al. Effect of the posterior tibial and peroneal longus on the mechanical properties of the foot arch. Foot Ankle Int 2012;33(4):320–5. DOI: 10.3113/FAI.2012.0320
  46. Dullaert K, Hagen J, Klos K, et al. The influence of the peroneus longus muscle on the foot under axial loading: a CT evaluated dynamic cadaveric model study. Clin Biomech (Bristol, Avon) 2016;34:7–11. DOI: 10.1016/j.clinbiomech.2016.03.001
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.