Peroneus longus graft in arthroscopic ACL ligament reconstruction surgeries

Abstract

Background: Different kind of grafts has been described in the literature in detail for ACL reconstruction. They are mostly bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. In this study we evaluated the possible advantage of peroneus longus tendon (PLT) graft over other grafts for anterior cruciate ligament (ACL) reconstruction. Materials and Methods: The study included in total of 24 patients, out of which 20 were males, and 4 were females. The mean age was 28 years; range 22 to 37 years who underwent ACL reconstruction using a PLT autograft. Eight patients have torn meniscus for which repair/debridement were done depending on the condition. The results were assessed according to the clinical examination and functional score at the end of at least 6 months of follow-up. Results: No difference were noted in the movement of operated and non-operated ankles. There was good antero-posterior stability noticed in the operated knee post reconstruction, which was assessed by lachman test and normal range of motion post-surgery. According to Lysholm score 15 had excellent or good results. One patient developed foot drop due to peroneal nerve neuropraxia. Conclusion: Our study concluded that harvesting the peroneus longus tendon has no effect on gait of the patient and does not lead to instability of the ankle. So, it can be used as an autogenous graft in orthopedic surgeries. Compared to other graft peroneus longus size is sufficient, graft harvesting is easy, thickness is appropriate, can be used in multi-ligament injury and no fear of graft loss while harvesting. Results of ACL reconstruction by PLT was comparable to any other graft reconstruction. Introduction Anterior cruciate ligament injuries have become common now a days [1]. Correction of the antero-posterior stability is the purpose of ACL reconstruction. The functionally stable reconstructed ACL is good in both resisting rotational or antero-posterior translation. A variety of technique as well as different kinds of grafts are now available for ACL reconstruction. Patient's degree of symptoms, activity level and participation in pivoting sports are few of the factors which determine the need of surgery in these individuals [2]. Proprioceptive rehabilitation helps a lot of patient with ACL injuries to become asymptomatic after a while [3]. ACL reconstruction should be done after acutely injured knee gets settled, giving time for resolution of effusion, recovery from of concomitant ligamentous injuries and restoration of range of motion [4]. Every surgeon has their own choice of graft depending on their training, comfort of harvesting, severity of injury and the profile of the patient. Hamstrings, bone patella bone, quadriceps tendon, peroneus longus tendon and allograft. Bone patellar tendon has their advantages like bone to bone union, early recovery and better rehabilitation in sports person due to no loss of hamstring strength [2-6]. On the other side hamstring tendon grafts have greater mechanical strength than a bone-patellar tendon-bone complex, patients treated with hamstring tendon grafts are less likely to suffer patellofemoral pain and extension loss [6]. Hamstring muscle counters the forward pull of the quadriceps and thus is necessary for the protection of the graft post operatively. Allograft are shorter operation and anesthetic time and good cosmetic results, however high costs, delayed corporation, disease transmission and immunological reaction represent disadvantages [7] .