Peroneus Longus Tendon Graft to Reconstruct the Posterolateral Corner of the Knee

Abstract

The posterolateral corner is critical to knee stability. Neglected injuries have a direct impact on the prognosis due to residual instability, chronic pain, deformities, and failure to repair other structures. Several techniques are used to reconstruct the posterolateral corner, often with autologous ischiotibial grafts or homologous grafts. An option little used for knee ligament reconstructions is the peroneus longus tendon graft. Although reported as a good alternative for anterior cruciate ligament reconstruction, we found no case using a peroneus longus tendon graft for posterolateral corner reconstruction. Here, we describe the case of a patient who underwent a non-anatomical reconstruction of the posterolateral corner using a peroneus longus tendon graft. The patient underwent surgical procedures for ligament reconstruction and correction of the deformity caused by a failed graft, but his knee remained unstable. During the preoperative planning, it was decided to reconstruct the posterolateral corner with an ipsilateral peroneus longus tendon graft. Studies have shown that the peroneus longus tendon graft does not increase ankle morbidity, and that its length and diameter favor ligament reconstruction. Thus, the present article highlights the importance of the proper diagnosis of ligament injuries in the acute phase, and describes a new technique for posterolateral corner reconstruction that must be included in the surgeon's body of knowledge, increasing the amount of technical options.

Keywords: anterior cruciate ligament injuries; anterior cruciate ligament reconstruction; autograft; joint instability.

Fig. 1

Panoramic clinical image of the lower limbs during the preoperative evaluation.

Fig. 2

Preoperative anteroposterior and lateral radiographs of the left knee.

Fig. 3

Intraoperative image. A 2-cm incision posterior to the lateral malleolus, ipsilateral to the ligament injury. Identification and isolation of the peroneus longus and brevis tendons.

Fig. 4

Intraoperative image. Graft harvest from the peroneus longus tendon.

Fig. 5

Non-anatomical posterolateral corner reconstruction under direct visualization in a lateral approach.

Fig. 1

Imagem clínica panorâmica dos membros inferiores na avaliação pré-operatória.

Fig. 2

Radiografias pré-operatórias anteroposterior e lateral do joelho esquerdo.

Fig. 3

Imagem intraoperatória. Incisão de 2 cm posterior ao maléolo lateral ipsilateral à lesão ligamentar. Identificação e isolamento dos tendões fibulares longo e curto.

Fig. 4

Imagem intraoperatória. Retirada do enxerto do tendão fibular longo.

Fig. 5

Imagem intraoperatória. Reconstrução não anatômica do canto posterolateral por via lateral e visualização direta.