Harvesting of Peroneus Longus Tendon Autograft

Summary

This article provides a method for safely harvesting the full-thickness peroneus longus tendon autograft. It outlines critical steps, modifications, and troubleshooting for the procedure.

Abstract

Autografts are always used in anterior cruciate ligament (ACL) reconstruction. Traditional sources, such as hamstring tendons, bone-patellar tendon-bone, and quadriceps tendon, are popular choices but may result in muscle imbalances and dynamic differences in knee kinematics. The peroneus longus tendon (PLT) has emerged as an alternative autograft for ACL reconstruction, offering comparable functional outcomes and avoiding interference with the flexor-extensor complexes of the knee. However, concerns about donor site paresthesia and ankle dysfunction have been raised in PLT harvesting. This article presents a detailed protocol for safely and effectively obtaining this autograft. The protocol emphasizes critical steps, modifications, and potential troubleshooting methods. In this study, we assessed functional scores, donor paresthesia, and other complications in 20 patients six months after PLT harvesting. Our findings indicate that this protocol for PLT acquisition did not result in significant complications. Therefore, we confirm the effectiveness of this protocol and offer guidance on essential preoperative preparations and surgical techniques.

Introduction

Anterior cruciate ligament (ACL) injuries, often incurred by high-level athletes, pose a substantial challenge to those wishing to return to sports¹. ACL reconstruction using autografts is the prevailing treatment approach in such cases, with popular graft choices worldwide encompassing hamstring tendons, bone-patellar tendon-bone, and quadriceps tendon^2,3,4. While these autograft sources offer efficacy, they share a commonality in being integral components of the knee's flexor-extensor complexes. This interconnectedness has raised concerns regardi....

Protocol

The protocol was approved by the human ethics committee of the third Xiangya Hospital of Central South University and informed consent was obtained from the patient prior to making the video for educational purposes.

1. Inclusion/Exclusion criteria

1. Inclusion criteria:
   1. Confirm that the anterior cruciate ligament (ACL) is completely torn and that all patients are unilateral.
   2. Perform single-beam reconstruction as a type of operation.
   3. Utilize the ideal positioning method for tunnel positioning on the femur side.
   4. Employ the end button plate for fixation on the femur side a....

Results

Our previous successful experiments demonstrated this protocol's optimal graft harvest, minimal complications, and positive patient outcomes. Preoperative measurements of the PLT cross-sectional area using high-resolution ultrasound, particularly 1 cm proximal to the distal harvest incision, accurately predict the intraoperative diameter of the PLT graft (Figure 5)¹⁴. This consistency confirms the method's reliability in selecting the appropriate graft size for ligame.......

Discussion

Choosing the right graft is critical for the success of any ligament reconstruction surgery. The peroneus longus tendon (PLT) offers significant advantages over other graft options, such as semitendinosus tendons, primarily due to it's generally larger average diameter, which can provide greater strength and stability⁸. In our study, PLT grafts typically achieved a diameter of 8-10 mm after being doubled and braided¹⁴. Additionally, using PLT does not disrupt the knee j.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Ultrasound	GE LOGIQ, USA		12-13 MHz linear array transducer
General surgical instruments	Smtih & Nephew, USA
Tendon Stripper	Smtih & Nephew, USA		Closed blunt-ended tendon stripper