Peroneus Longus Tendon Research Articles

Comparison of Functional Outcomes of an Anterior Cruciate Ligament (ACL) Reconstruction Using a Peroneus Longus Graft as an Alternative to the Hamstring Tendon Graft.

Background Ever since the arthroscopic reconstruction of the anterior cruciate ligament (ACL) has begun, the use of the peroneus longus (PL) graft for primary ACL reconstruction (ACLR) has never been thought of. There is very little literature on it. Hence, our study aims to compare the functional outcomes, knee stability, donor site morbidity, and assessment of thigh muscle wasting in patients with ACL injury managed by arthroscopic single bundle reconstruction with peroneus longus tendon (PLT) and hamstring tendons (HT), respectively. Methods All adults aged 16-50 years of either gender presenting with symptoms of symptomatic ACL deficiency were admitted for arthroscopic single-bundle ACLR and allocated into two groups (peroneus longus and hamstring tendon). Functional scores (International Knee Documentation Committee (IKDC), Lysholm score), clinical knee evaluation (anterior drawer, Lachman, and pivot shift test), donor site morbidity (American Orthopedic Foot and Ankle Society ankle hindfoot score (AOFAS)), and thigh circumference were recorded preoperatively and at six months and one year postoperatively. The same post-op rehabilitation protocol was followed in both groups. Results One hundred and ninety-four patients (hamstring n = 96, peroneus n = 98) met the inclusion criteria. There were no significant differences between the preoperative, six-month postoperative, and one-year postoperative scores between the hamstring and peroneus longus groups in the IKDC (p=0.356) and Lysholm knee score (p=0.289). The mean for the AOFAS was 99.05 ± 3.56 and 99.80 ± 0.70 in the PLT and HT groups, respectively, showing no statistical difference, with a significant improvement in thigh muscle wasting among the PLT group at final follow-up (p < 0.001). Conclusion We observed similar knee stability and functional outcomes and no obvious donor site morbidity among both groups. These patients also had better responses to physiotherapy in recovering from their thigh muscle wasting. So, we can recommend that a PL graft can be a safe, viable, and effective option for usual arthroscopic single-bundle ACL reconstruction.

Preoperative ultrasound can accurately predict the diameter of double-stranded peroneus longus tendon autografts.

This study aimed to determine the correlation between the intraoperative diameter of double-stranded peroneus longus tendon (2PLT) and length of the PLT autograft and preoperative ultrasound (US) measurements, as well as radiographic and anthropometric measurements. The hypothesis was that US can accurately predict the diameter of 2PLT autografts during operation. Twenty-six patients underwent ligament reconstruction with 2PLT autografts were included. Preoperative US was used to calculate the in situ PLT cross-sectional area (CSA) at seven levels (0, 1, 2, 3, 4, 5, 10cm proximal to the harvest start point). Femoral width, notch width, notch height, maximum patellar length, and patellar tendon length were determined on preoperative radiographs. Intraoperative measurements of PLT were made, including all fiber lengths of PLT and diameters of 2PLT using sizing tubes calibrated to 0.5mm. CSA at 1cm proximal to the harvest site had the highest correlation with the diameter of 2PLT (r = 0.84, P < 0.001). Calf length had the highest correlation with PLT length (r = 0.65, P < 0.001). The diameter of the 2PLT autografts could be predicted by the following formula: 4.6 + 0.2 × [sonographic CSA of PLT at 1cm level]; the length of PLT could be predicted by the following formula: 5.6 + 0.5 × Calf length. The diameter of 2PLT and length of PLT autografts can be accurately predicted by preoperative US and calf length measurements, respectively. Accurate preoperative prediction of the diameter and length of autologous grafts can provide the most suitable and individualized graft for patients. IV.

Cavovarus deformity of one foot with planovalgus deformity of the contralateral foot (Wind-swept heels): A case report

Normal alignment of the arches and adequate stability is essential for the foot to function correctly. Pes planus and pes cavus are fairly common foot deformities, but it is uncommon to see both in the same patient simultaneously. This study aimed to describe the clinical presentation and prognosis of an uncommon combination of bilateral foot abnormalities named “windswept heels” resembling windswept knees. A 43-year-old female employee experienced frequent pain in her right foot and swelling and pain in her left foot, mainly when walking barefoot. She had a severe cavovarus deformity of the right foot with pressure callosities on the lateral side, clawing of the toes, and a positive Coleman’s block test. With the loss of the medial arch, severe heel valgus, and forefoot abduction, the left foot developed a planovalgus deformity. The left foot’s talus-first metatarsal angle and the right foot’s calcaneal inclination angle increased on weight-bearing radiographs. The left foot underwent staged surgical treatments, including medial sliding calcaneal osteotomy, gastrocnemius recession, and cotton osteotomy. For the right foot, lateral sliding calcaneal osteotomy, plantar fasciotomy, and peroneus longus tendon transfer. The American Orthopaedics Foot and Ankle Society Score (AOFAS) was used to measure the clinical and functional outcomes. At 1 year, her AOFAS scale was 85 compared to 59 before surgery. Since this presentation resembles the windswept knee deformity, we propose calling this disorder windswept heel deformity.

A prospective study of arthroscopic primary ACL reconstruction with ipsilateral peroneus longus tendon graft: Experience of 439 cases.

Anterior cruciate ligament (ACL) tears are frequent ligamentous injuries that necessitate reconstruction in many cases. The patellar tendon and the hamstring tendon are the most frequently utilized autografts for reconstruction. However, both have certain disadvantages. We hypothesized that the peroneus longus tendon would be an acceptable graft for arthroscopic ACL reconstruction. The aim of this study is to determine whether a peroneus Longus tendon transplant is a functionally viable option for arthroscopic ACL reconstruction without compromising donor ankle activity. In this prospective study 439 individuals aged between 18 to 45 years, who underwent ACL reconstruction using ipsilateral Peroneus longus tendon autograft were observed. The injury to the ACL was initially assessed by physical examinations and further confirmed by magnetic resonance imaging (MRI). The outcome was assessed at 6, 12, and 24 months after the surgery using Modified Cincinnati, International Knee Documentation Committee (IKDC), and Tegner-Lysholm scores. The donor ankle stability was evaluated using foot and ankle disability index (FADI) and AOFAS scores, as well as hop tests. Significant (P < .001) improvement in the result of the IKDC score, Modified Cincinnati, and Tegner-Lysholm score was observed at the final follow-up. The Lachman test was mildly (1+) positive only in 7.70% of cases, the anterior drawer became negative in all cases, and the pivot shift test was negative in 97.43% of cases at 24 months after the surgery. FADI and AOFAS scores for donor's ankle functional assessment were impressive, as were single hop test, triple hop test, and cross over hop test results at 2 years. None of the patients had any neurovascular deficit. However, 6 cases of superficial wound infection were observed, 4 at the port site and 2 at the donor site. All resolved after appropriate oral antibiotic therapy. The peroneus longus tendon can be considered a safe, effective, and promising graft of choice for arthroscopic primary single-bundle ACL reconstruction because it has a good functional outcome and impressive donor ankle function after surgery.

Analysis of Postural Control following Anterior Cruciate Ligament Reconstruction with Ipsilateral Peroneus Longus Tendon Graft.

Harvesting peroneus longus for ACL reconstruction is thought to create ankle instability which could add to postural instability from an ACL injury. This apprehension prevents its use as a graft of primary choice for many surgeons. To date, there is no evidence available describing changes in postural control after its use in ACL reconstruction. The purpose of the study was to analyse the changes in postural control in the form of static and dynamic body balance after ACL reconstruction with Peroneus Longus Tendon Graft and compare it with the unaffected limb at different time intervals. Thirty-one participants with ACL injury were selected and subjected to an assessment of static and dynamic balance before and after ACL reconstruction using the HUMAC balance system. Outcome measures for Centre of Pressure (COP) assessment were average velocity, path length, stability score, and time on target. Comparison of scores was done pre-operatively as well as at three- and six-months post-reconstruction with Peroneus longus tendon graft. Static balance of the affected limb showed significant improvement with a decrease in average velocity (F=4.522, p=0.026), path length (F=4.592: p=0.024) and improvement of stability score (F=8.283, p=0.001). Dynamic balance measured by the time on the target variable also showed significant improvement at six-month follow-up (F=10.497: p=0.000). There was no significant difference between the affected and non-affected limb when compared at the different time intervals. The static and dynamic balance, which is impaired after ACL injury, improves with ACL reconstruction with PLT autologous graft. Hence PLTG can be safely used as a graft for ACL reconstruction without affecting postural control and body balance.

OUTCOME OF SIMULTANEOUS ARTHROSCOPIC ANTERIOR AND POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING AUTOGENOUS GRAFTS WITH ALL-INSIDE TECHNIQUE

Introduction: Bicruciate knee ligament injury is a lesion affecting both the posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL) simultaneously, which is one of the most severe knee joint injuries. Operative simultaneous reconstruction is the standard of treatment. Objectives: To evaluate clinical results of one-stage ACL and PCL reconstruction using autogenous tendon grafts with an all-inside technique. Material and methods: The medical records of patients operated on by a group of surgeons at the Orthopedic Center, Military Hospital 103 from March 2015 to March 2020 were retrospectively analyzed. Thirty-four patients (24 males, 10 females) with combined rupture of both ACL and PCL underwent one-stage ACL and PCL reconstruction using autogenous hamstring and peroneus longus tendon grafts with all-inside technique. Results: The mean time of follow-up was 32.09 ± 25.15 months (9 - 68 months). The mean age was 37.7 ± 9.0 years (range 23 - 56 years). At the final follow-ups, all patients were without limit extension, 5/34 patients (14.71%) with limit flexion. The Lachman test was negative in 32 patients (94.12%), the pivot shift testing in 32 patients (94.12%) was negative, 26 patients (76.47%) had a positive posterior drawer test. The Lysholm knee score preoperative and final follow-up were 46.76 ± 17.08 (range 12 - 82) and 89.29 ± 8.57 (range 50 - 99) (p &lt; 0.01), respectively. Conclusion: This study demonstrates the effectiveness and safety of simultaneous arthroscopically assisted reconstruction of both ACL and PCL using autogenous hamstring and peroneus longus tendon for restoring knee stability with an all-inside technique.

Human Muscle–Derived Cells Are Capable of Tenogenic Differentiation and Contribution to Tendon Repair

Background: It has been reported that the harvested hamstring tendon for autograft could be regenerated with well-oriented fibers and uniformly distributed spindle-shaped cells after removal. However, which cell type might participate in the repair process remains unknown. Purpose: To investigate the tenogenic differentiation potential of human muscle–derived cells (MDCs) both in vitro and in vivo. Study Design: Controlled laboratory study. Methods: Primary human MDCs and tenocytes were isolated from discarded materials during a peroneus longus tendon–harvesting procedure. Expression of tenogenic genes were evaluated and compared among MDCs, MDCs with tenogenic induction, and tenocytes. RNA sequencing was performed to evaluate the expression profile of differentiated MDCs. Human MDCs were implanted in a tendon injury model to investigate the in vivo tenogenic differentiation potential. Histologic and functional analyses were performed to evaluate the function of MDCs for tendon repair. Results: The relative expression levels (in fold change) of tenogenic genes Col I, MKX, SCX, THBS4, and TNC in MDCs were significantly upregulated 11.5 ± 1.3, 957.1 ± 63.7, 19.1 ± 2.8, 61.9 ± 4.8, and 10.2 ± 2.8 after tenogenic induction, respectively. The expression profile of tenogenically differentiated MDCs was much closer to primary tenocytes. Activation of TGF-β/Smad3 signaling significantly promoted the tenogenic differentiation ability of MDCs. Transplanted human MDCs were identified in regenerated tendon and expressed tenogenic genes. As for biomechanical properties, the failure loads in the Matrigel, transplantation, and uninjured groups were 7.2 ± 0.5, 11.6 ± 0.3, and 13.9 ± 0.7 N, while the stiffness values were 4.4 ± 1.3 × 103, 7.6 ± 0.8 × 103, and 10.9 ± 1.1 × 103 N/m. Plantarflexion force, histologic morphology, and motor function were also significantly improved after MDC transplantation in a tendon injury model. Conclusion: There exist cells with tenogenic differentiation potential in human skeletal muscles. Activation of TGF-β/Smad3 signaling plays an important role in tenogenic differentiation for human MDCs. Human MDCs contribute to structural and functional repair for the injured tendon. MDCs are a potential cell source to participate in the repair process after tendon injury. Clinical Relevance: The MDCs could be a promising cell source to repair tendon injury.

Primary anterior cruciate ligament reconstruction using full-thickness peroneus longus tendon autograft

Abstract Introduction Many grafts have been described for ACL reconstruction; however, disagreements regarding globally accepted gold standard graft choice persist. Recently, the peroneus longus tendon (PLT) Autograft has been used in the field of ACL reconstruction as an alternative autograft. This study aimed to evaluate the efficacy of the peroneus longus tendon as a graft for primary ACL reconstruction and to study its possible effects on foot and ankle function. Patients and methods This was a prospective study that included patients who underwent ACL reconstruction using Peroneus longus tendon autograft. Results were assessed via physical examination. Donor site morbidity of the foot and ankle was assessed using Medical American Orthopedic Foot &amp; Ankle Society (AOFAS) score and Foot and Ankle Disability Index (FADI). Postoperative knee function was evaluated by the International Knee Documentation Committee (IKDC) and Tegner-Lysholm score. Results Thirty patients were included in the study with a mean age of 28 years old. Peroneus longus graft diameter was 8.5 ± 0.7 mm. There was a significant difference between pre and postoperative functional scores in IKDC and Tegner-Lysholm score. Ankle scores were excellent. The mean of AOFAS was 97.7 ± 3.1 and FADI was 98.5 ± 0.5. Conclusion The peroneus longus tendon is an appropriate autograft source for ACL reconstruction. Its use in primary ACL reconstruction is very encouraging with minimal donor site morbidity.

Peroneous Longus Tendon Versus Hamstring Tendon Autograft On Anterior Cruciate Ligament Reconstruction: A Meta-Analysis and Systematic Review

Introduction: Anterior Cruciate Ligament (ACL) injury is one of the most common knee injuries. ACL reconstruction is the current gold standard to restore functional of the knee. Graft selection is important for satisfactory outcomes. Currently, most used autograft are hamstring tendon (HT) and bone patellar tendon bone (BPTB) grafts. This study aims to thoroughly evaluate and review an alternative autograft for ACL reconstruction, which is peroneus longus tendon (PLT). Method: Systematic review and meta-analysis was conducted using PRISMA guidelines. Literature was searched through PubMed, Google Scholar, Science Direct and Cochrane Library using Boolean operators. This study included original articles reporting on (1) clinical studies of ACL reconstruction (single-bundle or double-bundle) using PLT autograft (anterior-half, posterior half, or full-thickness); and (2) studies directly comparing outcomes of PLT versus HT. All procedures were primary ligament reconstructions performed for symptomatic acute or chronic ACL injury, with or without meniscal injury. The outcomes assessed included clinical and functional outcome, namely IKDC score, AOFAS scale and FADI. Results: From 247 studies obtained, after full-text review, 4 studies met all eligibility criteria. A total of 259 patients were included in this study. No significant differences was found in IKDC score (p = 0.99) and FADI score (p = 0.11) but significant differences was found in the mean of AOFAS score in favor of HT autograft (p = 0.03). Conclusion: PLT autograft is a suitable alternative graft choice from the others for the knee of patients undergoing ACL reconstruction.

Prevalence of Abnormal Ultrasonographic Findings in Asymptomatic Peroneal Tendons

The peroneus longus (PL) and peroneus brevis (PB) tendons comprise the lateral compartment of the leg and stabilize the foot during weightbearing. Peroneal tendinopathy can precipitate lateral ankle pain and induce functional disability. The progression of peroneal pathology to lateral ankle dysfunction is thought to stem from asymptomatic, subclinical peroneal tendinopathy. There may be clinical benefit to identifying asymptomatic patients with this condition before progression to disability. Various ultrasonographic characteristics have been observed in peroneal tendinopathy. The purpose of this study is to identify the frequency of subclinical tendinopathic characteristics in asymptomatic peroneal tendons. One hundred seventy participants underwent bilateral foot and ankle ultrasonographic examination. Images were assessed for abnormalities of the PL and PB tendons by a group of physicians who recorded frequencies of abnormalities. This team consisted of an orthopaedic surgeon specializing in foot and ankle surgery, a fifth-year orthopaedic surgery resident, and a family medicine physician with musculoskeletal sonographer certification. A total of 340 PL and 340 PB tendons were assessed. Sixty-eight (20%) PL and 41 (12.1%) PB tendons had abnormal traits. Twenty-four PLs and 22 PBs had circumferential fluid, 16 PLs and 9 PBs had noncircumferential fluid, 27 PLs and 6 PBs had thickening, 36 PLs and 12 PBs had heterogenicity, 10 PLs and 2 PBs had hyperemia, and 1 PL had calcification. In Caucasian participants, male gender was associated with increased frequency of abnormal findings, but there were no other significant differences based on age, body mass index, or ethnicity. In our studied population of 170 patients who had no complaints of associated symptoms, we found that 20% of PLs and 12% of PBs displayed ultrasonographic abnormalities. When we included all unusual findings within and around the tendons, prevalence rates of ultrasonographic abnormalities were 34% for PLs and 22% for PBs. Level II, prospective cohort study.

Peroneus Longus Tendon Autograft for Anterior Cruciate Ligament Reconstruction: A Safe and Effective Alternative in Nonathletic Patients

Background: The Anterior Cruciate Ligament (ACL) is one of the most vital parts for sustaining knee joint stability. But, the frequency of ACL injuries is increasing alarmingly. The Peroneus Longus Tendon (PLT) is now considered to be a promising graft which is a safe and efficient alternative to other grafting methods.

Holy Grail of ACL Reconstruction Grafts

Selection of the appropriate graft for ACL (anterior cruciate ligament) reconstruction is very important. The right choice of graft will determine the success of the surgery. For professional athletes, the primary choice remains the bone patellar tendon graft. However, sometimes there are complaints of anterior knee pain. The patellar tendon bone remains the strongest graft source for ACL reconstruction. Currently, the most popular graft used is the hamstring tendon, which consists of the semitendinosus and gracillis. The small incision makes this tendon very popular in reconstructive surgery. However, it is not uncommon for the acquired hamstring tendon size to be unpredictable and sometimes too small. The quadriceps tendon is also a good tendon of choice in the ACL reconstruction surgery. Several studies have shown the results of reconstruction with a balanced force with the patellar tendon bone. The portion of bone obtained from the superior pole of the patella, allows bone-to-bone healing. Currently, several surgeons use the peroneus longus tendon as an alternative graft option in ACL reconstructive surgery. The small incision and the relatively easy process of taking the graft, make more and more surgeons interested in using it. However, the use of the peroneus tendon should be reserved in cases of multiple ligament injury or revision cases. Further studies are needed to evaluate the long-term effects on the involved ankle. In many countries, allografts can also be used for ACL reconstruction surgery. Its preparation requires strict conditions, so that the graft condition remains good when used.

Peroneal Tendon Dislocation Treated with Arthroscopic Approach: A Case Report

Peroneal tendon dislocation is usually manifested as ankle instability and pain. Peroneal tendon dislocation is caused by ruptured of superior peroneal retinaculum (SPR) due to anatomical abnormality. SPR can be damaged due to excessive contraction force of dorsiflexion of the foot. The epidemiology of this pathology is also uncertain, because peroneal tendon dislocation is often mistaken for lateral ankle ligament sprain. The treatment should include conservative treatment and surgical treatment if it fails. A 20-year-old Indonesian Male attended orthopedic consultation with pain and snapping of the lateral side of left foot from 2 years ago after twisting his ankle during a recreational sport. Snapping was felt when doing sport exercise and in certain position. The tendon dislocation can be seen after that. On examination, he felt pain on palpation and snapping on lateral side of the ankle. The left ankle was snapped in a dorsiflexion and plantarflexion positions and can return into normal position. After conservative therapy, the condition did not improve. Then surgical intervention was suggested. Patient was operated on June 21st 2022 on a operating room with lateral decubitus position under subarachnoid anesthesia. The surgery was done with arthroscopic approach. During operation we found a SPR disruption, peroneus longus tendon longitudinal tear, low lying peroneus brevis muscle belly and shallow retromaleolar groove. These finding may increase the risk of dislocation. We performed a peroneus longus debridement, peroneal brevis muscle excision, retromaleolar groove deepening, and SPR repair are our best choice of treatment. Short leg splint and physiotherapy exercise were applied after surgery. Presented case of peroneal dislocation is very low. Usually for this case is best treated with surgical intervention. By using arthroscopy, we can detect abnormality and treat them at once. SPR repair and groove deepening with arthroscopic approach can offers a satisfactory outcome.

Stability of the knee after posterior cruciate ligament reconstruction using peroneus longus tendon graft with three femoral insertion sites. A cadaveric study

IntroductionMany kinds of grafts were used for single-bundle reconstruction of the posterior cruciate ligament (PCL). Recently, the peroneus longus tendon (PLT) was used in some clinical reports. This study aimed to test the best position of the femoral insertion in the case of using PLT for PCL reconstruction. MethodsSeventeen fresh frozen cadaveric knees were randomized into three groups. Group AL (6 knees): the femoral insertion in PCL reconstruction was at the footprint center of the anterolateral bundle (ALB). Group PM (5 knees): at the footprint center of the posteromedial bundle (PMB). And group MC (6 knees) was at the midpoint of the center of the anterolateral bundle and posteromedial bundle. The PCL of all knees was cut and a PCL reconstruction procedure was performed with autologous peroneus longus tendon (PLT). The stability of each knee was tested in three conditions: PCL was intact, PCL was resected, and PCL was reconstructed. The KT-1000 machine was used to measure the maximum posterior displacement of the tibia under force with the knees at 0, 30, 60, 90, and 120 degrees of flexion. ResultsAverage posterior displacement of the tibia under force for intact PCL of group AL was 1.6 mm, group MC was 1.2 mm, and group PM was 1.3 mm. After PCL was resected, the knee laxity was increased remarkably: posterior displacement of the tibia of group AL was 8.9 mm, group MC was 9.4 mm, and group PM was 13.6 mm. After PCL was reconstructed, group AL was 1.5 mm, group MC was 2.0 mm, and group PM was 5.6 mm. The results showed that after PCL reconstruction the group AL and group MC give better stability to the knee (p < 0.05, except knee at 120 degrees of flexion). Group AL got more stability than group MC, but the difference was not significant (p ≥ 0.164) ConclusionIn a single-bundle reconstruction of the PCL with the graft PLT, the femoral insertion at the footprint center of the ALB and the midpoint of the center of the ALB and PMB showed better stability than that at PMB.

FUNCTIONAL OUTCOMES OF PERONEUS LONGUS TENDON AUTOGRAFT ARTHROSCOPIC RESTORATION OF AN ANTERIOR CRUCIATE LIGAMENT TEAR

The study was conducted to assess the functional outcome of arthroscopic reconstruction of anterior cruciate ligament tear by using peroneus longus tendon autograft. A prospective study was conducted in the Orthopaedics Department of Bakhtawar Amin Memorial Trust, Multan from 22 June 2021-22 June 2022. A total of 24 patients from the out-patient department were included in the study. Patients were clinically examined, and MRI was performed to confirm the presence of tear. Arthroscopic reconstruction was done. IKDC was used to assess the final outcome after 6 months, MRC was used to evaluate ankle stability with normal side as control. IKDC was normal in 22 patients (91.6%) and abnormal in only 2 patients (20%). The average IKDC score was 82.44. Lachman test showed normal results in 17 (70.8%)patients, 1+ laxity in 4 (16.6%), 2+laxity in (8.3%) and 3+laxity in 1 (4.1%)patient. 14 (58.3%) patients had negative pivot shift and 10 (41.6%)had positive glide. Peroneus longus tendon autograft is an effective option for anterior cruciate ligament reconstruction with less complications and maintains ankle function.

Intérêt des greffes au tendon peroneus longus deux brins et aux ischio jambiers quatre brins dans la reconstruction du ligament croisé postérieur

IntroductionPosterior cruciate ligament (PCL) injury hampers the rotational stability and stability front to back of the knee joint, seriously affecting the quality of life of patients. Some studies have reported that the peroneus longus tendon (PLT) has sufficient length and strength. HypothesisWe hypothesized that the PLT can be used as a novel appropriate material for PCL reconstruction therapy. Materials and methodsHerein, we systematically analysed the clinical effect of the double-stranded PLT and the four-stranded hamstring tendon in the reconstruction of the PCL and compared the effectiveness and safety of these two surgical approaches in the reconstruction of PCL injury. A total of 48 patients with complete rupture of the PCL were divided into Group A (reconstructed with the double-stranded PLT, 25 cases) and Group B (reconstructed with the four-stranded hamstring tendon, 23 cases). ResultsThe patients were followed up for more than 1 year. The intraoperative time for tendon extraction was significantly shorter in Group A than Group B. Twenty-four months after operation, patients in the two groups showed the alleviated tibial posterior displacement and the increased IKDC score, Lysholm score and Tegner score. Nevertheless, these scores showed no significant differences between the two groups. Additionally, compared with the therapy using the four-stranded hamstring tendon, therapy using the double-stranded PLT is simpler and safer. DiscussionBoth surgical methods are effective in the treatment of PCL injury. The PLT could be a good choice for PCL injury reconstruction material, especially when the four-stranded hamstring tendon is accidentally damaged or ineffective. Our study may provide guidance for the clinical treatment of PCL injury. Level of EvidenceIII, retrospective study.

Peroneus longus tendon transfer; prospective study of treatment outcome of recurrent fixed clubfoot deformities in children after failed surgical treatment

BackgroundIn childhood, for flexible clubfoot deformity, the transfer of the tendon of the tibialis anterior muscle is widely used. In contrast, extensive surgical procedures are required for fixed clubfoot deformities. MethodsWe describe the peroneus longus tendon transfer to the peroneus brevis tendon, additionally to full surgical release, in cases of recurrent fixed clubfoot deformities. The purpose of this surgical technique was to restore and maintain the dynamic balance of foot inversion-eversion during the gait cycle by augmenting the muscular strength of the weak peroneus brevis tendon. We report the prospective study of treatment outcome of twenty recurrent fixed clubfoot deformities in twelve children (20 feet) after failed surgical treatment they had. Anteroposterior and lateral radiographs under full-body weight-bearing and the AOFAS score pre-and postoperatively were used in all patients. For the estimation of the severity of the recurrent clubfoot deformity in each child and to increase the credibility of the AOFAS rating scale, we additionally used a clubfoot sheet score preoperatively and postoperatively (maximum score 100 points for normal foot appearance clinically and radiologically). ResultsThe mean age at surgery was 6,85 (±1,81; 5–11) years. The mean follow-up time was 5,4 (±1,7; 2–8) years. The mean AOFAS ankle-hindfoot rating score increased from 69,85 (±9,51; 53–82) points preoperatively to 94,4 (±2,43; 91–97) points postoperatively. The mean clubfoot sheet rating score increased from 43,00 (±12,18; 15–55) points, preoperatively to 90,0 (±4,58; 80–95) points postoperatively. The two-tailed p-value was < 0,0001. ConclusionsThe transfer of the peroneus longus tendon to the peroneus brevis tendon is a minimal surgical procedure that acts collaboratively in maintaining the correction of foot deformity, achieved by the complete surgical release. Level of Evidence: IV.

Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions.

To evaluate the distances using ultrasound between the superficial peroneal nerve (SPN) and sural nerve along the peroneus longus tendon (PLT) autograft harvest path at different ankle or knee positions in order to minimize risk of iatrogenic nerve injury during PLT autograft harvest. Twenty-four fresh-frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft with a tendon stripper. Four specimens were utilized to validate correct identification of nerves under ultrasound. Sonographically guided perineural injections were performed at the start point and end point of the PLT harvest path using coloured latex, followed by dissection with gross inspection. Using ultrasound, the distance from the peroneus brevis muscle to the sural nerve at different ankle positions (20° dorsiflexion, neutral, and 20° plantarflexion) was measured, and the distance from the end of the tendon stripper to the SPN at different knee positions (full extension and 90° flexion) was also measured. Measurements were performed by two separate observers using ImageJ software. Cadaveric dissection showed the presence of latex around nerves in all four specimens. The average distance from the brevis muscle to the sural nerve increased significantly from dorsiflexion to plantarflexion. The shortest distance from the tenodesis site to the sural nerve was 5.8 ± 1.7mm. There was no significant difference from the end of the tendon stripper to the SPN between full extension or 90° flexion of the knee. When harvesting the PLT, it is recommended to place the ankle at plantarflexion. The knee at full extension or 90° flexion had no effect. Joint positions at the time of graft harvest should be monitored to reduce risks of iatrogenic nerve injury.

A Study of the Functional Outcome of Supplementation of Hamstring Graft With Anterior Half of the Peroneus Longus Tendon in Arthroscopic Anterior Cruciate Ligament Reconstruction

The present study was done to analyze the functional outcome, donor site morbidities, and associated parameters when using the anterior half of the peroneus longus for augmentation of an inadequate hamstring graft when performing arthroscopic anterior cruciate ligament (ACL) reconstruction. Thirty patients with complete ACL tears were operated on. In all these patients, the thickness or length of the hamstring graft takenwas found to be inadequate (less than 8 mm and 7.5 cm, respectively). So, additionally, the anterior half of the peroneus longus tendon (AHPLT) graft was harvested to reach an optimum size of the final graft. Functional outcome was assessed using the International Knee Documentation Committee (IKDC) score at six weeks, three months, and six months. The Foot and Ankle Disability Index (FADI) score at six months was used to assess ankle stability. The mean age in our study was 28.8 years with male predominance (73.33%). The mean operative time was 86.4 minutes. The mean hamstring graft thickness in our study was 6.5 mm, which improved to 9.12 mm after augmentation. The mean graft length after AHPLT augmentation was 9.38 cm. The mean IKDC score at six months was 87.35. At the end of six months, FADI scores were found within normal limits(range: 135-136) in all the patients. No complications were noted in any of the patients. The AHPLT graft was always found to be sufficient enough for augmenting the hamstring graft to reach an acceptable thickness and length. There was no graft site morbidity and the ankle functional levels remained the same as preoperative levels, making it an excellent choice for augmentation of inadequate hamstring grafts.

Ultrasound Imaging and Prevalence of Intrasheath Peroneal Tendon Subluxation in Asymptomatic Volunteers

Category: Ankle; Other Introduction/Purpose: Intrasheath peroneal tendon subluxation is typically an incidental finding in athletes with sports-related injuries and is characterized by a temporary reversal in the anteroposterior positions of the peroneus longus (pL) and peroneus brevis (pB) tendons within their common tendon sheath. It is currently unclear whether intrasheath subluxation represents normal physiologic or pathologic tendon motion. This study aims to determine the normal variation in motion of supramalleolar pB and pL tendons in multiple ankle positions and to determine the overall prevalence of intrasheath tendon subluxation in asymptomatic volunteers. Methods: Static sonographic images of the peroneal tendons in 22 asymptomatic volunteers were collected in the neutral position, in eight fixed ankle positions (active and passive pronation, dorsiflexion, supination, and plantarflexion), and during dynamic ankle circumduction. The center of each tendon in relation to the lateral fibular cortex and in relation to each other was measured in each position and used to calculate absolute and percentage displacement. Two-way ANOVA was used to determine the significance of passive versus active motion and two-tailed paired sample t-test was used to compare the mean displacement of pL and pB in active and passive positions. Results: Intrasheath subluxation was not visualized in any static position but was visualized in 33% of patients during active ankle circumduction, regardless of direction or laterality. Percent displacement was greatest in active ankle plantarflexion (55%) for pB and in active pronation (34%) for pL. A statistically significant difference in the tendon positions in relation to each other was found in the anteroposterior direction (p=0.026), but there were no statistically significant differences between active and passive motions or with ankle positioning. A non-painful ankle 'snap' was palpated by the sonographer in all cases of intrasheath subluxation. Conclusion: Intrasheath subluxation is a fairly common occurrence seen in one third of our volunteers. Our results suggest that a snapping ankle in otherwise asymptomatic patients is highly suggestive of intrasheath peroneal tendon subluxation and can be well-documented with dynamic ultrasound. Establishing the normal ranges of motion of supramalleolar peroneal tendons may assist in the evaluation of patients with lateral ankle pain.