Donor-site morbidity following arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft

Abstract

Introduction: Peroneus longus has proved to be a promising graft for ACL reconstruction due to its high tensile strength, and ease of harvesting. While multiple studies have assessed the functional outcomes of the knee after ACL reconstruction using peroneus longus autograft, we aimed to evaluated donor site morbidity among the Indian population.

Matreials and methods: This was a prospective, longitudinal, descriptive study conducted at a tertiary care hospital. Preoperative AOFAS and Karlsson-Peterson scores were obtained, and patients were followed up after surgery for a period of 6-months using the same scoring systems and strength testing with a hand-held Chatillon MSE-100-M dynamometer. Pedobarographs were done using Diers Pedoscan Plantar Pressure Measurement System on a subset of seven patients.

Results: 20 patients participated in the study. Mean AOFAS and Karlsson-Peterson scores pre-operatively were 99.7 ± 1.34 and 98.5 ± 4.62 respectively. On completing 6- months of follow-up these scores were found to be 95.6 ± 9.43 and 88.75 ± 18.42 respectively. Deterioration of mean evertor strength was noted at all follow-ups compared to the opposite side. Static pedobarographs showed significant decreased in total surface area of contact and pressure over the posterior aspect of the operated side by 3-months which improved later at 6-months. Dynamic pedobarographs showed decreased mean average plantar pressure while walking on the operated side and significant increase in mean surface area of contact of the operated side (191.886±22.678 cm²) at 6-months of follow-up compared to the opposite side (184.471 ± 22.218 cm²). Five patients showed deviation of the point of maximum pressure while walking on the operated foot making it lateral to the COP with increased lateral plantar/ medial plantar pressure ratio.

Conclusion: While the use of peroneus longus tendon autografts in arthroscopic ACL reconstruction does not seem problematic on short-term subjective assessment, there is objective evidence in keeping with evertor weakness, weakness of first ray plantar flexion and possible ankle instability.

Level of evidence: Level lll.

Keywords: ACL reconstruction; Donor site morbidity; Pedobarography; Peroneus longus; Planar pressure measurement.