Low to moderate risk of nerve damage during peroneus longus tendon autograft harvest.

Abstract

This study aims to evaluate the proximity of the tendon stripper to both the peroneal and sural nerves during peroneus longus tendon (PLT) autograft harvesting. Ten fresh-frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft using a standard closed blunt-ended tendon stripper. The distance to the sural nerve from the PLT (at 0, 1, 2 and 3cm proximal to lateral malleolus (LM), and the distance to the peroneal nerve and its branches from the end of the tendon stripper were measured by two separate observers using ImageJ software. The average distance from the PLT to the sural nerve increased significantly from 0 to 2cm proximal to LM. The average distance to the sural nerve at the LM was 4.9 ± 1.5mm and increased to 10.8 ± 2.4mm (2cm proximal to LM). The average distance from the tendon stripper to the deep peroneal nerve was 52.9 ± 11.4mm. The average distance to the PLT branch of peroneal nerve was 29.3 ± 4.2mm. The superficial peroneal nerve, which coursed parallel and deep to the tendon stripper, was on average 5.2 ± 0.7mm from the end of the stripper. No transection injuries of the nerves were observed in any of the ten legs after harvesting. This cadaver study found during a full-thickness PLT harvest, the distances between the tendon stripper and the nerves were greater than 5mm with an initial incision at 2cm proximal to LM which is recommended.