Anterior cruciate ligament reconstruction using peroneus longus tendon autograft: a systematic review

Abstract

Abstract Background The anterior cruciate ligament is the most commonly injured ligament in the knee; controversy exists about the most suitable graft for anterior cruciate ligament reconstruction (ACLR). Aim This study aims to assess the efficiency of peroneus longus tendon (PLT) autograft as a good alternative graft choice for ACLR and to outline the advantages and disadvantages of its use. Methodology We searched the literature through PUBMED, Cochrane library, Medscape, direct science, JBJS, and Google scholar with publication date restricted to 10 years range from 2012 to 2022. English literature of prospective studies only were selected with strict inclusion criteria where human studies undergoing arthroscopic ACLR using PLT autograft, which commenting on clinical±imaging outcomes and repeated studies excluded. Eleven studies were included satisfying the predetermined inclusion criteria with a total of 564 patients. Four literatures compared ACLR using PLT autograft versus Hamstring tendon (HT), one literature versus semitendinosus graft, and another versus patellar tendon. After pooling collected data from the desired search studies, the relative risk of each of the intended outcome measures of interest was calculated and tabulated according to IKDC and AOFAS scores. Results In four literatures, in total, outcomes of 108 PLT versus 129 HT autografts were analyzed with mean follow-up 10.5 months, reported little difference was found between the two grafts in favor of PLT autograft, with mean score 95.58 for PLT versus 91.65 for HT. Outcomes of 15 PLT versus 15 semitendinosus autografts were analyzed. PLT autograft gave better clinical and biomechanical outcomes than semitendinosus graft as mean IKDC score was 91.58 for PLT versus 88.37 for semitendinosus graft. Outcomes of 50 PLT versus 50 patellar tendon autografts were analyzed, and reported that PLT autograft has a better IKDC score than patellar tendon autograft (96.8 vs. 95.1) and lower graft rupture rate (6 vs. 10%). In five literatures, in total, the outcomes of 189 patients had ACLR using PLT autograft, were analyzed after mean follow up 12.4 months and revealed that mean IKDC score was increased from 64.7 preoperative to 97.8 postoperative. PLT harvest does not appear to affect foot and ankle function to any clinically significant degree with slightly decreased AOFAS score (96.88 ± 4.95). Conclusion PLT autograft consider a very promising and ideal graft option for ACLR with excellent functional and biomechanical outcomes. PLT harvest is easy and causes minimal donor-site morbidity.