Peroneus Longus Tendon Autograft versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Comparative Study with a Mean Follow-up of Two Years

Document Type : RESEARCH PAPER

Authors

1 Bone, Joint and Related Tissues Research Center, Akhtar Orthopedic Training and Research Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Faculty of Sciences, University of Guilan, Rasht, Iran

3 Poursina Hospital Orthopaedic Research center, Guilan University of medical sciences, Rasht, Iran

Abstract

Background: Peroneus longus tendon can be a suitable alternative autograft for anterior cruciate ligament reconstruction 
(ACLR). The present study aimed to compare the clinical outcome and donor site morbidity in ACLR using peroneus 
longus tendon autograft versus hamstring tendon autograft. 
Methods: In a comparative cross-sectional study, ACLR was performed with quadrupled hamstring tendon autograft in 
65 patients between 2017 and 2018, and in another group, peroneus longus tendon autograft was used for ACLR in 65 
patients between 2018 and 2019. The same surgical technique, fixation method, and postoperative protocol were used 
in both groups. The knee functional outcomes were assessed according to the Lysholm score and the International 
Knee Documentation Committee scale at preoperative and at the end of at least 2 years after the procedure. Moreover, 
graft diameter was measured intraoperatively. Thigh circumference, the American Orthopedic Foot and Ankle Score 
(AOFAS), The Foot & Ankle Disability Index (FADI), and ankle range of motion (ROM) were used to evaluate ankle 
donor site morbidities.
Results: A total of 130 patients (65 patients in each group) were evaluated with a minimum follow-up of 2 years (range 
24–31 months). Both groups showed no significant differences in clinical outcomes and knee stability. The peroneus 
longus graft diameter was significantly larger than the hamstring diameter (P<0.001). Assessment of AOFAS, FADI, and 
ankle ROM showed no apparent ankle joint dysfunction in the peroneus longus tendon group.
Conclusion: Faster knee extensions, less anteromedial knee pain, and thigh hypotrophy were observed in peroneus 
longus tendon patients. Peroneus longus tendon autograft can be an appropriate autograft for ACLR due to its strength, 
larger graft diameter, and avoiding potential complications of hamstring autograft obtained from the knee region.
Level of evidence: IV

Keywords

References

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reconstruction: A case report and review of literature. 
International Journal of Surgery Case Reports. 
2021:38:106028.
15.He J, Tang Q, Ernst S, Linde M, Smolinski P, Wu 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 Sport 
Traumatol Arthrosc 2020; Sep27.
16.Park SK, Oh H, Park S, Lee J, Lee S, Yoon K. Factors 
predicting hamstring tendon autograft diameters and 
resulting failure rates after anterior cruciate ligament 
reconstruction. Knee Surg Sports Traumatol Arthrosc 
2013; 21(5):1111-8.
17.Conte EJ, Hyatt AE, Gatt CJ, Dhawan A. Hamstring 
autograft size can be predicted and is a potential risk 
factor for anterior cruciate ligament reconstruction 
failure. Arthroscopy 2014; 30(7):882-90.
18.Mariscalco M, Flanigan D, Mitchell J, Pedroza A, 
Jones M, Andrish J, et al. The influence of hamstring 
autograft size on patient-reported outcomes and 
risk of revision after anterior cruciate ligament 
reconstruction: a Multicenter Orthopaedic Outcomes 
Network (MOON) Cohort Study. Arthroscopy 2013; 
29(12):1948-53.
19.Bi M, Zhao C, Zhang S, Yao B, Hong Z, Bi Q. 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
20.Snaebjörnsson T, Hamrin Senorski E, Ayeni OR, 
Alentorn-Geli Eduard, Krupic F, Norberg F, et al. 
Graft Diameter as a Predictor for Revision Anterior 
Cruciate Ligament Reconstruction and KOOS and 
EQ-5D Values: A Cohort Study From the Swedish 
National Knee Ligament Register Based on 2240 
Patients. Am J Sport Med 2017; 45(9):2092-2097.
21.Kjaergaard J, Faunø LZ, Faunø P. Sensibility Loss after 
ACL Reconstruction with Hamstring Graft. Int J Sports 
Med 2008; 29:507-11.
22.Rhatomy S, Hartoko L, Setyawan R, Soekarno NR, 
Zainal Asikin AI, Pridianto D, et al. Single bundle 
ACL reconstruction with peroneus longus tendon 
graft: 2-years follow-up. J Clin Orthop Trauma 2020; 
11(Suppl 3):S332-S336.
23.Marí�n Fermí�n T, Hovsepian JM, Symeonidis PD, 
Terzidis I, Papakostas ET. 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.
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Reconstruction Using an Anterior Half of the 
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The Archives of Bone and Joint Surgery
Volume 10, Issue 8
August 2022
Pages 695-701

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History

  • Receive Date: 11 August 2021
  • Revise Date: 23 October 2021
  • Accept Date: 02 February 2022

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