Peroneus Longus Research Articles

Decreased Isokinetic Strength of 1st Ray Plantar Flexion and Decreased Eversion Are Predictors of Unregenerated Peroneus Longus Tendon After 1 Year of Anterior Cruciate Ligament Reconstruction

Introduction: Anterior cruciate ligament (ACL) rupture is a sports-related knee injury that is quite often encountered. It is estimated that the annual incidence of these injuries reaches 5 to 8 per 10,000 individuals. There are various graft options for ACL reconstruction, such as hamstring tendon autograph, bone-patellar tendon-bone autograph (BPTB), and peroneus longus tendon autograft. Regeneration of the peroneus tendon can be assessed by several modalities, one of which is magnetic resonance imaging (MRI). One of the main concerns after PLT grafting is the potential for a decrease in plantar flexion strength and ankle eversion. Purpose: of this study was to assess the regeneration capabilities of the peroneus tendon after ACL reconstruction and its relation to the function of the muscle. A better understanding of this topic may provide an alternative, and possibly a better intervention to detect the presence of peroneus tendon regeneration and increase functional output in ACL reconstruction patients. Material and Methods: This study is an observational study using a case-control design. From the population of the study subjects, sampling was carried out that met the requirements of research inclusion and then data collection was carried out. An examination of the isokinetic strength of the plantar ankle flexion and eversion, then the data obtained is processed using SPSS 25. Results: Based on the results of the independent t test, it was found that the isokinetic strength of the 1st ray plantar flexion and ankle eversion is a predictor of regeneration of the peroneus longus (p < 0,05; p < 0.05). Conclusion: The isokinetic strength of the ankle plantar flexion and eversion is a predictor of regeneration of the peroneus longus tendon as a "donor site" after 1 year post ACL reconstruction. Keywords: ACL reconstruction, regeneration of peroneus longus, isokinetic strength of the ankle

The influence of local pain on balance control in patients with chronic ankle instability

BackgroundLocal pain around the ankle joint is a common symptom in patients with chronic ankle instability (CAI). However, whether the local pain would impose any influence on the balance control performance of CAI patients is still unknown.MethodsA total of twenty-six subjects were recruited and divided into the following two groups: pain-free CAI (group A) and pain-present CAI (group B). Subjects in both groups received two independent tests: the star excursion balance test and the single-leg stance test, in order to reflect their balance control ability more accurately.ResultsCompared with group A, the group B showed significantly more episodes of the history of sprains, decreased ankle maximum plantarflexion angle, and lower Cumberland scores (all p < 0.05). In the star excursion balance test, group B demonstrated a significantly reduced anterior reach distance than group A (p < 0.05). During the single leg stance test, group B showed a significant increase in the magnitude of electromyographic signals both in peroneus longus and soleus muscles than group A (each p < 0.05). Additionally, group B had a significantly more anterolaterally positioned plantar center of pressure than group A (p < 0.05).ConclusionCAI patients with local pain around the ankle joint had more episodes of sprains and lower functional scores when compared to those without pain. The balance control performance was also worse in the pain-present CAI patients than those without pain.

A comparison of functional knee outcomes post-arthroscopic anterior cruciate ligament (ACL) reconstruction using hamstring and peroneus longus (PL) autograft

Background: Hamstring autograft (HA) is the most common graft used in ACL reconstruction procedures. However, harvesting HA could weaken the secondary stabilizer of the knee joint. Peroneus longus grafts (PL) is a novel option secondary to hamstring graft with less morbidity at the knee joint. We intended to determine whether peroneus longus autograft (PL) is a comparable alternative to hamstring autograft for ACL Reconstruction. Methods: 84 patients were grouped into "hamstring" (n = 51) and "peroneus longus" (n = 33) groups, with a mean age of 26.2 ± 5.9 in the Hamstring group and a mean age of 26.4 ± 6.6 in peroneus group. We obtain secondary data from the medical records of several hospitals in Makassar. Results: There was a significant difference in Lysholm score (p&lt;0.05) in the hamstring group with peroneus at 6 months and 12 months postoperatively for IKDC score, anterior translation, Power Grading Flexi-Extension, ROM on flexion, and extension. In addition, in muscle atrophy, the Hamstring group compared to the peroneus group also showed a significant difference (p=0.001). Conclusion: The study's results did not show significant differences between the hamstring and peroneus groups other than atrophy of thigh muscles in the hamstring group. Based on the results of this study, we conclude peroneus longus graft is one of the graft options in ACL reconstruction surgery.

Feasibility and reliability of MScanFit motor unit number estimation in peroneus longus muscle.

Motor unit number estimation (MUNE) methods may be valuable to detect motor involvement earlier than compound muscle action potential (CMAP) amplitude. The most recent MUNE method, MScanFit, has been shown to have advantages compared with previously described methods. However, MScanFit has only been applied in a few lower extremity muscles. In this study we examined the feasibility and reliability of MScanFit in peroneus longus muscle. Twenty healthy controls (16 males and 4 females; mean age, 36.05 ± 2.58 years) were examined twice within a 1- to 2-week interval. Fibular nerve was stimulated at the knee and CMAP scans were recorded from peroneus longus muscle. From this, MScanFit MUNE and size parameters were calculated, as was the CMAP amplitude. The reliability was examined using coefficient of variation (CV) and intraclass correlation coefficient (ICC). MUNE was correlated with CMAP amplitude using linear regression analysis. The CV between sessions was higher for CMAP amplitude (11.63 ± 1.88%) than MScanFit MUNE (3.13 ± 0.78%). Among the size parameters, mean unit amplitude (μV) showed the lowest CV (11.46 ± 1.77%). Using ICC, CMAP amplitude exhibited good reliability (0.787), whereas that of MScanFit MUNE was excellent (0.902). Reliability was good for all size parameters. There was no significant correlation between MScanFit MUNE and CMAP amplitude (R=0.25, P > .05). MScanFit MUNE is feasible in the peroneus longus muscle, with high test-retest reliability in healthy subjects. Studies in patients are needed to examine the sensitivity of this muscle in disease.

Clinical assessments and gait analysis for patients with Trimalleolar fractures in the early postoperative period

BackgroundTrimalleolar fracture is a common ankle fracture with serious complications and costly healthcare problem. Most studies used clinical assessments to evaluate the functional status of the patients. Although clinical assessments are valid, they are static and subjective. Dynamic, objective and precise evaluations such as gait analysis are needed. Ankle biomechanics studies on gait in patients with trimalleolar fractures are still rare. This study aimed to investigate the clinical outcomes and gait biomechanics in patients with trimalleolar fractures in the early postoperative period and compared to healthy controls.MethodsThis was a cross-sectional study. 12 patients with trimalleolar fractures were recruited, and 12 healthy people served as controls. All patients underwent clinical assessments: Olerud and Molander ankle score (OMAS), ankle swelling and passive range of motion (ROM) of ankle, and completed gait biomechanical analysis when weight-bearing was allowed: temporal-spatial parameters, plantar pressure distributions, and surface electromyography (sEMG). The control group only performed gait test.ResultsPatients had poor outcomes of clinical assessments in the short-term. During gait analysis, patients presented compromised gait patterns: shorter step length, larger step width, slower walking speed and shorter single support compared to healthy controls (P < 0.001), and patients showed asymmetrical gait. Symmetry index of step width and walking speed were mainly correlated with the difference of ankle inversion ROM between two sides (R = -0.750, P = 0.005; R = -0.700, P = 0.011). During walking, patients showed abnormal dynamic plantar pressure features (mainly in the hindfoot and forefoot regions), and the IEMG (integrated electromyography) of tibial anterior muscle (TA) and peroneal longus muscle (PL) were larger than healthy controls (P = 0.002, 0.050).ConclusionsPatients with trimalleolar fractures showed physical impairments of the ankle, and presented altered gait parameters compared to healthy subjects in the short-term. The ankle stability of patients declined, and deficits in TA and PL muscle ability might contribute to it. Restoring complete muscle functions and improving passive ankle ROM are significant to promote the recovery of a normal gait pattern.

Evaluation of the Clinical Outcome of Arthroscopic Posterior Cruciate Ligament Reconstruction with Peroneus Longus Tendon

Evaluation of the Clinical Outcome of Arthroscopic Posterior Cruciate Ligament Reconstruction with Peroneus Longus Tendon

Electromyostimulation Application on Peroneus Longus Muscle Improves Balance and Strength in American Football Players

The aim of this study was to evaluate the effect of 5weeks of electromyostimulation (EMS) of the peroneus longus muscle on balance and muscle strength in American Football (AmF) players. Thirty-two healthy male athletes (4 American Football team training sessions per week, college level) were randomly divided into the EMS and control groups. The EMS applications were conducted on the dominant peroneus longus muscle 3 times per week for 5weeks, with each application lasting 25minutes. Before and after the interventions, the strength of ankle dorsiflexion-plantar flexion and foot eversion-inversion wasmeasured with isometric dynamometer and anterior-posterior sway, mediolateral sway, perimeter, and ellipse area were measured with the Technobody Balance System in unilateral stance positions, while eyes were open. Changes between initial and final tests for dorsiflexion and eversion strength, and mediolateral sway for dynamic balance in the groups were significantly different (P = .039, P = .027, P = .030, respectively). The EMS application had positive effects on muscle strength and dynamic balance of AmF players. The EMS can be used to improve isometric strength and dynamic balance in AmF players.

Addition of a Cognitive Task During Walking Alters Lower Body Muscle Activity.

This study compared electromyography of five leg muscles during a single walking task (WALK) to a dual task (walking + cognitive task; COG) in 40 individuals (20M and 20F) using a wavelet analysis technique. It was hypothesized that muscle activation during the dual task would differ significantly from the walking task with respect to both timing (H1) and frequency (H2). The mean overall intensity for the COG trials was 4.1% lower for the tibialis anterior and 5.5% higher for the gastrocnemius medialis than in the WALK trials. The changes between the WALK and COG trials were short 50ms bursts that occurred within 100ms of heel strike in the tibialis anterior, and longer activation periods during the stance phase in the gastrocnemius medialis. No changes in overall intensity were observed in the peroneus longus, gastrocnemius lateralis, or soleus. Furthermore, no clear frequency bands within the signal could further characterize the overall changes in muscle activity during the COG task. This advances our understanding of how the division of attentional resources affects muscle activity in a healthy population of adults.

Hip Abductor Muscle Fatigue Induces Different Strategies During Disrupted Postural Control.

BackgroundAnkle sprain is one of the most common injuries in sport, and hip abductor muscle weakness has recently been reported as a predisposing factor. Currently, the influence of hip abductor muscle fatigue on ankle joint control has not been elucidated during an ankle disturbed balance exercise. This study aimed to determine the influence of hip abductor muscle fatigue on ankle joint control during a disturbed balance task, and to consider inter-individual variability in the kinematic and neuromuscular reorganizations implemented.MethodsTwenty-six healthy subjects (13 males; 13 females) performed a unipedal postural balance task with eyes closed before and after a fatiguing exercise (up to a 50% decrease in strength) of the hip abductor muscles. Subjects completed balance task while equipped with an ankle destabilization device that allows inversion/eversion movements. Electromyographic (EMG) activity of the gastrocnemius lateralis (GastL), peroneus longus (PL) and brevis, tibialis anterior, and gluteus medius were recorded during task. Kinematics (e.g., frontal foot angulation) of the ankle complex were determined using inertial measurement units.ResultsIn the overall group, no significant time, sex or interaction effect was observed for kinematic and EMG variables. However, when considering individual responses to hip fatigue, 14 subjects decreased the standard deviation of frontal angulation (−30%) suggesting enhancement of ankle joint control, while 12 subjects increased it (+46%). Normalized EMG for PL and GastL muscles changed with fatigue for both these groups. However, variations were significantly different between groups (p = 0.027 for PL and p = 0.006 for GastL). Indeed, the contribution of ankle muscles increased for the enhanced-stability group while no change for the impaired-stability group.ConclusionThese results highlight that subject adopt different neuromuscular and kinematic ankle strategies to control ankle destabilization in response to hip abductor muscle fatigue. Frontal foot angulation variability seemed to be a valuable marker to detect the type of strategy employed. The strategy adopted by the impaired-stability group might have important implications when analyzing risk factors for ankle sprains. Further studies should consider individual responses to fatigue, to understand which factor could predispose athletes to use of one or other strategy.

Misencoding of ankle joint angle control system via cutaneous afferents reflex pathway in chronic ankle instability.

This study aimed to investigate how the cutaneous reflexes in the peroneus longus (PL) muscle are affected by changing the ankle joint position in patients with chronic ankle instability (CAI). We also investigated the correlation between the degree of reflex modulation and angle position sense of the ankle joint. The participants were 19 patients with CAI and 20 age-matched controls. Cutaneous reflexes were elicited by applying non-noxious electrical stimulation to the sural nerve at the ankle joint in the neutral standing and eversion/inversion standing positions. The suppressive middle latency cutaneous reflex (MLR; ~ 70-120ms) and angle position sense of the ankle joint were assessed. During neutral standing, the gain of the suppressive MLR was more prominent in the CAI patients than in controls, although no significant difference was seen during 30° inversion standing. In addition, the ratios of the suppressive MLR and background electromyography in a neutral position were significantly larger than those at the 15°, 25°, and 30° inversion positions in CAI patients. No such difference was seen in control individuals. Furthermore, the correlations between reflex modulation degree and position sense error were quite different in CAI patients compared to controls. These findings suggest that the sensory-motor system was deteriorated in CAI patients due to changes in the PL cutaneous reflex pathway excitability and position sense of the ankle joint.

A smart insole system capable of identifying proper heel raise posture for chronic ankle instability rehabilitation

Heel raise is widely prescribed to patients with chronic ankle instability in order to strengthen the Peroneus Longus muscle (PL) which supports the weakened lateral collateral ligaments. While the exercise itself is intuitive, ankle orientation is of particular importance because heel raises performed with inversion do not well recruit the PL. This implies that proper execution is imperative and a means to assess heel raise training sessions is needed. In this study we present a smart insole system capable of identifying heel raise events and its corresponding rise, hold and drop phases, which allows for a more descriptive analysis. The results from our heel raise sessions, which consist of four different variants performed by five healthy subjects, suggest that medial–lateral foot pressure distribution and foot orientation are needed to differentiate heel raises performed with ankle eversion and inversion. We go further and substantiate that proper execution, detected by our system, indeed leads to increased PL activation by analyzing the electromyography signals. We believe that the proposed system may provide clinicians with invaluable information regarding onsite as well as at-home training and possibly, with biofeedback, serve as foundation for software as a medical device.

Spinal Reflex Excitability of Lower Leg Muscles Following Acute Lateral Ankle Sprain: Bilateral Inhibition of Soleus Spinal Reflex Excitability.

Neural changes in the ankle stabilizing muscles following ankle sprains are thought to be one contributing factor to persistent ankle dysfunction. However, empirical evidence is limited. Therefore, we aimed to examine spinal reflex excitability of lower leg muscles following acute ankle sprains (AAS). We performed a case-control study with 2 groups consisting of 30 young adults with AAS and 30 aged-matched uninjured controls. Hoffmann reflex (H-reflex) testing was performed to estimate spinal reflex excitability of lower leg muscles: soleus, fibularis longus (FL), tibialis anterior (TA). Maximal H-reflex (Hmax) and motor responses (Mmax) were determined by delivering a series of electrical stimuli at the sciatic nerve. Hmax/Mmax ratios were calculated to represent normalized spinal reflex excitability. Separate group-by-limb analyses of variance (ANOVA) with repeated measures found there were no significant interactions for any of the muscles (SL: F1,56 = 0.95, p = 0.33, FL: F1,51 = 0.65, p = 0.42, TA: F1,51 = 1.87, p = 0.18), but there was a significant main effect of group in the soleus (F1,56 = 6.56, p = 0.013), indicating the Hmax/Mmax ratio of soleus in the AAS group was significantly lower bilaterally (AAS = 0.56 ± 0.19, control = 0.68 ± 0.17, p = 0.013), with no significant group differences in the other muscles (FL: F1,51 = 0.26, p = 0.61, TA: F1,51 = 0.93, p = 0.34). The bilateral inhibition of the soleus spinal reflex excitability following AAS may be significant in that it may explain bilateral sensorimotor deficits (postural control deficits) following unilateral injury, and provide insights into additional therapies aimed at the neural change.

Assessment of Functional Outcome and Donor Site Morbidity in Anterior Cruciate Ligament Reconstruction Using Peroneus Longus Autograft

Introduction: Arthroscopic ACL reconstruction is one of the most successful surgeries in sports medicine. But the donor site morbidities have been reported with bone patellar tendon bone graft and hamstring tendon graft. The objective of the study is to evaluate the functional outcome of and donor site (ankle) morbidities with full thickness peroneus longus tendon (PLT) autograft in arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods: A Prospective study was done in 30 patients with ACL injury. Knee stability and function were evaluated using the Lachman test, pivot shift test, International Knee Documentation Committee score (IKDC) and Lysholm knee score. Donor ankle was assessed using American Orthopedic Foot and Ankle Score (AOFAS) and grading muscle power by Medical Research Council scale. Data collected preoperatively and postoperatively at 6 &amp; 12 months were compared. Results: The IKDC score was normal or nearly normal in 24 patients and abnormal in 6 patients. The mean Lysholm score had excellent or good results in 24 patients. The Lachman test showed normal findings in 24 patients, 6 patients had 1+ laxity. The pivot-shift test was negative in 22 patients and 8 patients had 1+ glide. The mean AOFAS score was 100±0.0 (preoperatively) and 96.0±9.6 (at final follow up). No patient experienced ankle pain and instability. Conclusion: PLT autograft gave painless stable knee, with a good range of motion. It didn’t have any morbid effect on ankle and gait parameters. So, PLT autograft can be suitable graft with respect to its strength, safety and donor site morbidity. Keywords: ACL, Peroneus Longus Tendon, Knee Arthroscopy

The “Figure of Four” Reconstruction of the Medial Collateral Ligaments in the Setting of Anteromedial Rotatory Knee Instability Using a Single Autograft

The deep medial collateral ligament plays an important role in controlling tibial external rotation and restrain anterior translation of the medial tibial plateau. Despite being the basic lesion of anteromedial knee instability as proposed by many authors, the majority of the medial side reconstructions do not restore the anatomy and the function of the deep medial collateral ligament. In this Technical Note, we describe a technique to reconstruct both the superficial and deep medial collateral ligament in the setting of anteromedial knee instability using a single peroneus longus autograft.

Fatigue of hip abductor muscles implies neuromuscular and kinematic adaptations of the ankle during dynamic balance.

Determine whether hip abductor muscle fatigue influenced ankle kinematic and muscle activity during ankle-destabilized tasks. Cross-sectional study. Twenty-six healthy, active participants performed two tests (Star Excursion Balance Test, SEBT; Weight Bearing Inversion Test, WBIT) for assessment of dynamic balance and ability to control inversion. Participants were equipped with an ankle-destabilizing sandal in inversion and eversion to perform both tests, which were completed before and after a fatiguing exercise of hip abductor muscles (up to 50% reduction in strength). Electromyographic activity of peroneus longus (PL) and brevis (PB), tibialis anterior, gastrocnemius lateralis (GastL) and gluteus medius (GlutM) muscles were recorded. In addition, ankle kinematics were recorded using an inertial measurement unit. Hip abductor fatigue induced a significant decrease in SEBT scores in three directions (p < 0.01). During SEBT, ankle supination decreased by 3.2° in the anterior and posteromedial directions (p < 0.01). Muscle activity of GastL increased during achievement of three directions (p < 0.05) in response to hip abductor fatigue. In posteromedial direction, PL (p < 0.001) and GlutM (p < 0.01) activity increased with fatigue. During WBIT, inversion angular velocity was not impacted by fatigue while, PB and GastL activity increased after fatiguing exercise (p < 0.005). A decrease in SEBT performance and EMG adaptations with proximal fatigue attest to the importance of the hip abductor muscle in dynamic postural control. This could have important implications in building injury prevention programs. Changes in ankle supination may reflect a protective strategy of the joint in response to hip fatigue.

Peroneal longus tendon rupture after fluoroquinolone therapy: A case study

Fluoroquinolones are a class of antibiotics that are commonly used to treat gram-negative and gram-positive bacterial infections. Tendinopathies, most commonly affecting the Achilles tendon, are a possible side effect with the use of Fluoroquinolones. Tendinopathies may occur from two hours to six months upon starting a course of fluoroquinolones. This case study presents a patient who had a magnetic resonance imaging (MRI) confirmed peroneus longus tendon rupture with the presence of an os peroneum fracture after two courses of ciprofloxacin treatment, one course five months prior to the injury and the second course one month prior to the injury. Physicians and patients should monitor for tendon soreness and pain in the peroneus longus tendon in addition to the classically documented Achilles tendon following the use of fluoroquinolones.

The promotive effect of grafts with the double-stranded peroneus longus tendon and with the four-stranded hamstring tendon on reconstruction of the posterior cruciate ligament injury

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 methods: Herein, 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.

Reduced plantar-flexors extensibility but improved selective motor control associated with age in young children with unilateral cerebral palsy and equinovalgus gait

BackgroundChildren with spastic cerebral palsy gradually lose muscle extensibility but the interplay between the muscular and neurological components of the condition is unclear especially in the pathophysiology of equinovalgus gait. AimThis study aimed to quantify the muscular and neurological disorders in young children with unilateral cerebral palsy, and to investigate the role of the peroneus longus (PL) in equinovalgus gait.Design, setting and population: This was an observational study with prospective assessments of 31 children (median age: 2.9 years, range: 2–6) from outpatient clinic in a tertiary teaching hospital. MethodsClinical measures of plantar flexor extensibility (XV1), stretch response (XV3), and active ankle dorsiflexion angle (XA) were obtained as well as walking velocity and electromyography of tibialis anterior (TA), gastrocnemius medialis (GM) and PL during walking. ResultsWe found reduced extensibility of the triceps surae on the paretic side (effect size r = 0.73, p < 0.001 for soleus and r = 0.68, p < 0.001 for gastrocnemius) and a correlation between reduced triceps surae extensibility and earlier stretch response (ρ = 0.5, p = 0.004). During the swing phase, there was major co-contraction between TA and GM/PL, and significantly larger activation of PL compared to GM (r = 0.46, p = 0.011). Both GM and PL activation decreased with age. ConclusionsOur results suggest gradual deterioration of the muscular disorder and a link between the muscular and neurological disorders, although plantar flexor co-contraction improved with age. The PL was more activated than the GM and may be considered an intervention target to treat equinovalgus gait.

Surgical management of concurrent lateral ankle instability and osteochondral lesions of the talus increases dynamic sagittal ankle range of motion.

A biomechanical study, in which imaging modalities are used to strictly include patients with concurrent lateral ankle instability (LAI) and osteochondral lesions of the talus (OLT), is needed to demonstrate the static and dynamic ankle range of motion (ROM) restriction in these patients, and determine whether ankle ROM restriction can be corrected postoperatively. Eight patients with concurrent LAI and OLT treated with the arthroscopic modified Broström procedure and microfracture were recruited from June 2019 to January 2020. Patients were assessed using outcome scales, static ankle ROM, and a stair descent gait analysis for dynamic ankle ROM, a day prior to surgery and one year postoperatively. Eight healthy subjects were assessed using the same modalities upon recruitment. Operative outcomes and variables during stair descent were documented and compared among the preoperative, postoperative, and healthy groups. A curve analysis, one-dimensional statistical parametric mapping, was performed to compare the dynamic ankle kinematics and muscle activation curves over the entire normalised time series. The functional outcomes of patients with concurrent LAI and OLT were significantly worse than those of healthy subjects preoperatively, but were partially improved postoperatively. Patients had decreased static and dynamic ROM preoperatively, and static ROM did not significantly increase postoperatively (preoperative, 39.6 ± 11.3; postoperative, 44.9 ± 7.1; healthy, 52.0 ± 4.6; p = 0.021). Patients showed increased dynamic ankle flexion ROM (preoperative, 41.2 ± 11.6; postoperative, 53.6 ± 9.0; healthy, 53.9 ± 3.4; p = 0.012) postoperatively, as well as increased peroneus longus activation (preoperative, 35.8 ± 12.0; postoperative, 55.4 ± 25.1; healthy, 71.9 ± 13.4; p = 0.002) and muscle co-contraction of the tibialis anterior and peroneus longus (preoperative, 69.4 ± 23.4; postoperative, 88.4 ± 9.3; healthy, 66.2 ± 18.1; p = 0.045). Patients with concurrent LAI and OLT had decreased static and dynamic sagittal ankle ROM and altered neuromuscular activation patterns. The arthroscopic modified Broström procedure and microfracture did not significantly increase the static sagittal ankle ROM. However, the dynamic sagittal ankle ROM, peroneus longus activation and muscle co-contraction of the tibialis anterior and peroneus longus increased postoperatively. IV.

A retrospective cohort study of anterior half peroneus longus tendon vs hamstring tendon for anterior cruciate ligament reconstruction: A minimum 3-years follow-up

Background: The anterior half of the peroneus longus tendon (AHPLT) has recently gained popularity to become the alternate graft choice for anterior cruciate ligament reconstruction due to its acceptable biomechanical properties, easy and safe to harvest. Methods: A retrospective study was conducted to compare the results of anterior cruciate ligament (ACL) reconstruction with AHPLT and hamstring graft at the minimum of 3 years follow-up. Knee stability, International Knee Documentation Committee (IKDC) subjective score and Tegner activity level were collected. Results: There was no clinical significance regarding physical examination. Postoperative IKDC score was higher in the hamstring group compared with AHPLT group. Multiple regression analysis was done. The parsimonious model revealed graft types and gender were the most optimal variables explained postoperative IKDC score. Conclusion: AHPLT graft can be an alternative choice to conventional graft for single anatomic ACL reconstruction with less donor site morbidity, however there must be concern for smaller graft in short and thin female patients.