Use of Peroneus Longus Tendon as Autograft for Anterior Cruciate Ligament Reconstruction: A Prospective Interventional Study

Background: The anterior cruciate ligament (ACL) is considered the main passive structure that maintains the stability of the knee with the femur and the tibia. The main function of the Anterior cruciate ligament is to limit the tibial forward movement and knee varus and valgus in the state of extension. The Anterior cruciate ligament runs anteriorly, medially, and distally to the tibia. Its length ranges from 22 to 41 mm (mean, 32 mm (, and its width from 7 to 12 mm. Objective: To assess the functional outcome and donor site morbidity of the peroneus tendon in ACL reconstruction. Patients and Methods: This Prospective Observational Study was conducted at tertiary care hospital at Misr University for Science and Technology Hospital (Souad Kafafi Hospital) from June 2022 to October 2023 and performed on a total of 20 patients who presented with unilateral anterior cruciate ligament and underwent reconstruction by using of peroneus longus tendon as autograft. Results: As regards operative characteristics, the current research study revealed that the time from injury to surgery ranged between 2 to 25 weeks with mean of 9.45 ± 7.39 weeks. The total operative time was ranged between 34.5 to 55 min with mean of 42.26 ± 4.66 min. The harvest graft time was ranged between 6.4 to 8.2 min with mean of 7.38 ± 0.53 min and the graft diameter ranged between 7.5 to 8.8 mm with mean of 8.15 ± 0.36 mm. As regards A.O.F.AS score follow-up, our study results revealed that the A.O.F.AS score was increased in the studied group after 6 weeks with a weak significant improvement of AOFAS after 6 months of treatment. As regards I.K.D.C score, our study results revealed that there was highly significant improvement of IKDC score in the study group at 6 weeks postoperatively. As regards the return to normal activity, our study result revealed that the minimum time for normal activity was 2.5 month and the maximum time was 12 months in our patients with mean of 6.05 ± 2.98 months. As regards complications, our study results revealed that few postoperative complications were recorded such as superficial infection in 2 cases (10%), hemarthrosis in 2 cases (10%) and only one case (5%) had arthro-fibrosis and one case (5%) failed. Conclusions: Peroneus longus tendon (PLT) is a promising graft in ACL reconstruction. It is considered the first-option graft in ACL reconstruction as it provided good functional results, prevented potential complications of the autograft harvested from the knee region, and did not significantly affect the ankle joint and demonstrated the absence of significant post-operative morbidity regarding biomechanical inconveniency to the ankle donor site. Given these findings, PLT autograft is a suitable alternative graft choice from outside the knee for patients undergoing ACL reconstruction.