Harvesting of Peroneus Longus Tendon Autograft

[Announcer] Welcome to this instructional video on the practical for safely harvesting the peroneus longus tendon autograft. This method, outlined by Chi Liang and Jinshen from the Department of Osteopathic Surgery at The Third Xiangya Hospital of Central South University in China, aims to provide clinicians with a reliable technique for minimizing complications in orthopedic surgeries. The protocol was approved by the Human Ethics Committee of The Third Xiangya Hospital of Central South University, and informed constant was obtained from the patient prior to making the video for educational purposes. Let's dive into the critical steps of the practical. Step one, preoperative preparation. Use ultrasound to locate the PLT graft area above the posterior lateral malleolus, and predict the diameter of the PLT autograft by measuring the cross-sectional area at the proximal ending of this incision, one centimeter away. Position the patients pan or lateral decubitus, with the operative limb appropriately exposed, disinfected, and sterilely draped. Step two, incision location and tendon isolation. To begin, a one to two-centimeter longitudinal incision is made one centimeter posterior, and two centimeter proximal, to the midpoint of the lateral malleolus. Careful dissection through the subcutaneous tissue is performed, paying close attention to the preservation of the sural nerve. Step three, harvesting the tendon. Elevate the PLT and stitch the proximal part using a whip-stitch style for subsequent autograft harvest. Mark the distal portion with another type of suture. Transversely section the PLT with tissue scissors. Finally, harvest the full thickness PLT using a standard closed blunt-ended tendon stripper. Suture the distal portion of the PLT to the peroneus brevis tendon. Remember to keep the stripper parallel and superficial to the fibula to prevent injury to the superficial peroneal nerve. Harvesting should stop five centimeter below the fibular head to avoid injury to deep peroneal nerve. Step four, postoperative care. Schedule follow-up appointments for wound assessment, suture removal, and rehabilitation progression. Now, let's discuss some representative results. In our study, we evaluated the American Orthopedic Foot and Ankle Society score and donor paresthesia in 20 patients to PLT harvest, both pre-operation and post-operation. Our findings show that harvesting the PLT with this protocol did not lead to significant complications, as shown in the table. In conclusion, this method holds great promise. It provides a reliable and customizable autograft source for a variety of orthopedic surgeries, offering advantages in terms of strength, minimal morbidity, and tissue compatibility. Its potential applications extend to ACL reconstruction, ankle stabilization, and other osteopathic procedures, ultimately enhancing patient outcomes and reducing the risk of graft-related complications.