Donor Ankle Morbidity Following Peroneus Longus Tendon Harvest for Anterior Cruciate Ligament Reconstruction: A Prospective Evaluation Using Gait, Isokinetic Muscle Strength, and Pedobarographic Analy

Ronak Kotian, Ajoy S M

Golden Jubilee National Hospital

Introduction: The peroneus longus tendon (PLT) has gained attention as a suitable autograft option for anterior cruciate ligament reconstruction (ACLR), offering benefits such as superior tensile strength, shorter harvest duration, increased graft diameter and length. However, existing literature lacks a comprehensive objective evaluation of ankle morbidity following its harvest. Method: In this prospective study, 52 patients who underwent ACLR using PLT autografts were assessed pre-operatively, and then at 6 months and 1 year post-operatively. Objective parameters included gait analysis via the GAITRite system, isokinetic strength testing of evertors and invertors using the HUMAC NORM dynamometer, and foot pressure analysis with the EMed pedography system. Subjective assessments included the Foot and Ankle Ability Measure (FAAM) score and the Foot and Ankle Outcome Score (FAOS). Results: The mean age was 32.61 ± 10.60 years, with a mean follow-up of 18.34 months. The PLT graft had an average length of 29.32 ± 2.26 cm and a diameter of 9.32 ± 0.92 mm. At 6 months, a significant reduction in peak torque at 60°/second velocity of both evertor and invertor muscles was observed (p<0.05). The decrease in peak torque at both 60°/second velocity and 120°/second velocity was not statistically significant at 1-year (p>0.05). Functional Ambulation Profile (FAP) score, cadence, single-leg support time, step time and walking velocity showed significant improvement over different time intervals (p<0.001). No significant changes were observed in stride length, double support time, stance and swing phases, maximum force, peak pressure, FAAM, or FAOS scores (p>0.05). Conclusion: Harvesting the PLT for ACLR may initially weaken the evertor and invertor muscles; however, targeted ankle rehabilitation can aid in strength recovery. Although gait and pedobarographic functions remained largely unaffected, further robust evidence is necessary before endorsing PLT as a first-line graft option. It may be suitable for select cases, such as multi-ligament injuries or revisions."

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