Magnetic resonance imagination of the peroneus longus tendon after anterior cruciate ligament reconstruction

Diagnosis and treatment of anterior cruciate ligament injuries: Consensus of Chinese experts part II: Graft selection and clinical outcome evaluation

Background

In the recent decade, there has been substantial progress in the technologies and philosophies associated with diagnosing and treating anterior cruciate ligament (ACL) injuries in China. The therapeutic efficacy of ACL reconstruction in re-establishing the stability of the knee joint has garnered widespread acknowledgment. However, the path toward standardizing diagnostic and treatment protocols remains to be further developed and refined.

Objective

In this context, the Chinese Association of Orthopaedic Surgeons (CAOS) and the Chinese Society of Sports Medicine (CSSM) collaboratively developed an expert consensus on diagnosing and treating ACL injury, aiming to enhance medical quality through refining professional standards.

Methods

The consensus drafting team invited experts across the Greater China region, including the mainland, Hong Kong, Macau, and Taiwan, to formulate and review the consensus using a modified Delphi method as a standardization approach. As members of the CSSM Lower Limb Study Group and the CAOS Arthroscopy and Sports Medicine Study Group, invited experts concentrated on two pivotal issues: "Graft Selection" and "Clinical Outcome Evaluation" during the second part of the consensus development.

Results

This focused discussion ultimately led to a strong consensus on nine specific consensus terms.

Conclusion

The consensus clearly states that ACL reconstruction has no definitive "gold standard" graft choice. Autografts have advantages in healing capability but are limited in availability and have potential donor site morbidities; allografts reduce surgical trauma but incur additional costs, and there are concerns about slow healing, quality control issues, and a higher failure rate in young athletes; synthetic ligaments allow for early rehabilitation and fast return to sport, but the surgery is technically demanding and incurs additional costs. When choosing a graft, one should comprehensively consider the graft's characteristics, the doctor's technical ability, and the patient's needs. When evaluating clinical outcomes, it is essential to ensure an adequate sample size and follow-up rate, and the research should include patient subjective scoring, joint function and stability, complications, surgical failure, and the return to sport results. Medium and long-term follow-ups should not overlook the assessment of knee osteoarthritis.

The role of peroneus longus (PL) autograft in the reconstruction of anterior cruciate ligament (ACL): A comprehensive narrative review

Background

Peroneus longus tendon (PLT) is a known graft utilised in the ligamentous reconstructions of knee. The current review was performed to analyze the available evidence regarding PLT in the arthroscopic anterior cruciate ligament (ACL) reconstruction.

Methods

A comprehensive search of literature was performed on March 1, 2023 using 5 databases (for manuscripts published between 2010 and 2023). All studies reporting ACL reconstruction with PL graft in adults ≥18 years were considered; and final studies were shortlisted based on specific exclusion criteria.

Results

The search identified 684 articles, among which 26 manuscripts were finally selected. PLT has been used in primary ACL reconstruction (ACLR), revision ACLR, ACLR in multiligamentous injuries and those at risk for anterior knee pain. The full-thickness PLT graft is variable in its dimensions with the mean size ranging between 7 and 8.8 mm (half-PLT grafts ≤8.1 mm). The ultimate strength of doubled PLT graft is significantly higher than native ACL and comparable to the quadrupled hamstring.There was statistically insignificant difference in the laxity and functional outcome of knee following ACLR with PLT, as compared with other autografts (p > 0.05). PLT harvest is associated with satisfactory clinical foot and ankle outcomes, as well as excellent regenerative ability. Overall, studies have demonstrated lower complications with PLT (p < 0.05).

Conclusion

The dimensions of harvested PLT graft are more consistent than HT. It has similar functional outcome and survival, as compared to other autografts. It also has lower risk for donor-site morbidity and lower complications than HT. PLT is a promising, alternative autograft choice in patients undergoing ACLR.

Complications of peroneus longus tendon harvesting: a retrospective review of 82 cases

OBJECTIVE

Peroneus longus tendon (PLT) has become a reliable autologous graft option for various ligament reconstructions. But there are potential risks and complications associated with its use as a graft. This retrospective study aimed to examine the complications and donor site morbidity following PLT harvesting.

PATIENTS AND METHODS

A retrospective review was performed on an institutional digital patient database, and all patients who underwent ligament reconstruction using PLT autograft were identified. Intraoperative, early, and late complications were reviewed using digital patient notes and patients underwent a complete physical examination during their final follow-up. Ankle function was assessed using the AOFAS score, and manual ankle muscle testing was performed on both sides. Sural nerve iatrogenic injury was evaluated with a dermatomal light touch examination. Cosmetic satisfaction due to incision scar and footwear complaints were also assessed.

RESULTS

82 patients (74 male, eight female) with a mean age of 31.9 ± 10.4 years (range, 16-66) were included in the final analysis. The mean follow-up time was 46.6 ± 30.3 months (range, 6-109). The mean AOFAS score for the donor side was 98.7 ± 3.3 (range, 87-100), and the contralateral side score was 100, with manual muscle testing graded as 5 in all movements and similar to the contralateral side. Fifteen patients (18.3%) had hypoesthesia over the dorsolateral aspect of the foot distal to the incision scar, two patients (2.4%) had hyperalgesia over the distal incision scar, and one patient (1.2%) had mild ankle instability. There were two cases (2.4%) of compartment syndrome, both of which were treated with fasciotomy and had complete regression of symptoms after 5 days. One patient (1.2%) had a transient peroneal nerve injury and foot drop that resolved in the sixth month.

CONCLUSIONS

The results of this retrospective study suggest that harvesting the PLT is associated with a high rate of complications and donor site morbidity. The most common complication was hypoesthesia around the lateral side of the foot, although the ankle functions were not affected significantly. Two cases of compartment syndrome and one transient peroneal nerve injury were observed. Care should be taken while harvesting PLT autograft, and it should be kept in mind that peroneal nerve injury might occur.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Peroneus longus tendon autograft has functional outcomes comparable to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis

PURPOSE

This review aimed to assess whether peroneus longus tendon (PLT) autograft would have comparable functional outcomes and graft survival rates when compared to hamstring tendon (HT) autograft for anterior cruciate ligament (ACL) reconstruction.

METHODS

PubMed, Web of Science, Cochrane Library, Ovid (MEDICINE), and EMBASE databases were queried for original articles from clinical studies including the keywords: ACL reconstruction and PLT autograft. Studies comparing PLT autograft versus HT autograft were included in this analysis and the following data were extracted from studies meeting the inclusion criteria: graft diameter, functional outcomes (Tegner activity scale, Lysholm score, and International Knee Documentation Committee (IKDC) subjective score), knee laxity (Lachman test), and complications (donor site pain or paresthesia, graft failure). Besides, the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Foot and Ankle Disability Index (FADI) pre-operation and at last follow-up were also compared among patients using PLT autograft. Meta-analysis was applied using Review Manager 5.3 and p < 0.05 was considered statistically significant.

RESULTS

Twenty-three studies including 925 patients with ACL reconstruction met inclusion criteria. Of these, 5 studies included a direct comparison of PLT autograft (164 patients) versus HT autograft (174 patients). No significant difference was observed between PLT and HT autografts for Tegner activity scale, Lachman test, donor site pain, or graft failure. However, PLT groups demonstrated better Lysholm score (mean difference between PLT and HT groups, 1.55; 95% CI 0.20-2.89; p = 0.02) and IKDC subjective score (mean difference between PLT and HT groups, 3.24; 95% CI 0.29-6.19; p = 0.03). No difference of FADI was found (n.s.) but AOFAS was slightly decreased at last post-operative follow-up for patients with PLT autograft compared with pre-operative scores (mean difference of 0.31, 95% CI 0.07-0.54, p = 0.01).

CONCLUSION

PLT autograft demonstrated comparable functional outcomes and graft survival rates compared with HT autograft for ACL reconstruction. However, a slight decrease in AOFAS score should be considered during surgical planning. Hence, the PLT is a suitable autograft harvested outside the knee for ACL reconstruction to avoid the complication of quadriceps-hamstring imbalance which can occur when harvesting autografts from the knee.

LEVEL OF EVIDENCE

Level II.

Peroneus longus tendon graft for anterior cruciate ligament reconstruction: A case report and review of literature

INTRODUCTION

The anterior cruciate ligament (ACL) is one of the most frequently injured structures of the knee joint. Anterior cruciate ligament reconstruction (ACLR) provides surgical restoration of the injured ACL using the placement of graft material. The choice of graft is principal in providing optimal knee stability after surgery. Peroneus longus tendon (PLT) is an autograft modality that offers unique benefits for ACL reconstruction cases.

PRESENTATION OF CASE

We present a case of ACL reconstruction surgery using PLT graft in a patient with a confirmed ACL rupture. Assessment of post-surgical pain, knee stability, and ankle function were performed to determine functional outcome and donor site morbidity. The follow-up results revealed favorable recovery and improvement in all objective parameters.

DISCUSSION

Post-operative biomechanical outcomes were evaluated using the International Knee Documentation Committee (IKDC) and the American Orthopedic Foot and Ankle Score (AOFAS) score. The use of PLT in ACL reconstruction established an excellent potential for its satisfactory result and comparable to other graft modalities in widely used evidence-based findings.

CONCLUSION

Peroneus longus tendon may be considered the first-option graft in ACL reconstruction as it indicated the absence of significant post-operative morbidity.

A finite element analysis of relationship between fracture, implant and tibial tunnel

The purpose of this article was to use finite element analysis (FEA) to study the relationship of tibial tunnel (TT) with fracture pattern and implants. A computed tomography scan of full-length tibia and fibula was obtained. Models were built after three-dimensional reconstruction. The corresponding plates and screws were constructed and assembled together with fracture models. FEA was performed and contourplots were output. The Von Mises stresses of nodes and displacements of elements were extracted. Student’s t test was used to compare the values of Von Mises stresses and displacements between corresponding models. Differences in Von Mises stresses and displacements of fragments and implants between models with and without TT were nearly all statistically significant. However, the displacements of fragments and implants for all models were < 2 mm. TT in fracture models had larger Von Mises stresses than TT in intact tibial model. However, displacements of TT in fracture models showed similar or even smaller results to those in intact tibial model. Although almost all the tested parameters were statistically significant, differences were small and values were all below the clinical threshold. This study could promote open reduction and internal fixation with one-stage reconstruction for treatment of tibial plateau fractures associated with anterior cruciate ligament (ACL) ruptures.

Insufficient evidence to support peroneus longus tendon over other autografts for primary anterior cruciate ligament reconstruction: a systematic review

IMPORTANCE

Graft choice for anterior cruciate ligament reconstruction (ACLR) remains a subject of interest among orthopaedic surgeons because no ideal graft has yet been found. Peroneus longus tendon (PLT) has emerged as an alternative autograft for reconstruction in kneeling populations and in simultaneous anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries.

OBJECTIVE

To evaluate the current evidence on the outcome of primary ACLR with PLT autograft in adults and donor ankle morbidity, in addition to determining the average PLT graft dimensions from published studies.

EVIDENCE REVIEW

Two independent reviewers searched PubMed, CENTRAL, EMBASE, Scopus and Virtual Health Library databases using the terms "anterior cruciate ligament," "peroneus longus" and "fibularis longus" alone and in combination with Boolean operators AND/OR. Studies evaluating clinical and stability outcomes, graft-donor ankle morbidity and graft dimensions of PLT in ACLR were included. Methodological quality was assessed using the Modified Coleman Methodology Score (mCMS). A narrative analysis is presented using frequency-weighted means wherever feasible. Publication bias was assessed using the ROBIS tool.

FINDINGS

Twelve articles with intermediate-level methodological quality were included. Eight studies assessing the clinical and stability outcomes of reconstruction with PLT showed satisfactory outcomes, similar to those of hamstring tendons (HT). No studies assessed anterior knee pain as an outcome. Six studies evaluated the graft-donor ankle morbidity using general functional foot and ankle scores and non-validated tools, showing favourable outcomes. Nine studies assessed PLT graft diameter, revealing grafts consistently larger than 7 mm among the different preparation techniques, which is comparable with reports of HT grafts.

CONCLUSIONS AND RELEVANCE

The clinical and stability outcomes of ACLR with different PLT autograft preparation techniques are comparable with those of HT during short-term follow-up; however, there is insufficient evidence to support its use in the populations that motivated its implementation. Thus, stronger evidence obtained with the use of validated tools reporting negligible donor-graft ankle morbidity after PLT harvesting is required prior to recommending its routine use, despite the consistency of its dimensions.

LEVEL OF EVIDENCE

Level III.

Tendon Regeneration After Partial-Thickness Peroneus Longus Tendon Harvesting: Magnetic Resonance Imaging Evaluation and In Vivo Animal Study

BACKGROUND

In recent years, the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft source for ligament reconstruction has gained popularity. However, no reports are available regarding tendon regeneration after harvesting of the AHPLT.

HYPOTHESIS

When half of the tendon is preserved during tendon harvesting, the quality of the regenerated tendon is better than that of the regenerated tendon after full-thickness harvesting.

STUDY DESIGN

Case series; Level of evidence, 4; controlled laboratory study.

METHODS

A total of 21 patients who underwent AHPLT harvesting for lower extremity ligament reconstruction participated in the magnetic resonance imaging (MRI) study to evaluate tendon regeneration 1 year after the harvesting. An in vivo animal study was performed to compare the quality of the regenerated tendon after partial-thickness and full-thickness tendon harvesting. A total of 30 adult female Sprague-Dawley rats were allocated to 2 groups-15 rats underwent partial-thickness Achilles tendon harvesting (partial-thickness harvesting [PTH] group), and 15 rats underwent full-thickness Achilles tendon harvesting (full-thickness harvesting [FTH] group). The quality of the regenerated tendons was compared 180 days after tendon harvesting.

RESULTS

All 21 patients showed regeneration of the peroneus longus tendon (PLT) (homogeneously dark on both T1- and T2-weighted sequences). The cross-sectional area of the regenerated tendon divided by that of the preoperative tendon was 92.6% and 84.5% at 4 cm and 9 cm proximal to the tip of the distal fibula, respectively. In the animal study, the mean histologic score was better for the PTH group compared with the FTH group (9.17 ± 1.35 vs 14.72 ± 0.74; P < .001). The ultimate strength and the stiffness of the regenerated Achilles tendon were significantly higher for the PTH group compared with the FTH group (35.5 ± 8.3 vs 22.4 ± 8.3 N, P = .004; and 31.6 ± 7.7 vs 23.5 ± 4.8 N/mm, P = .016).

CONCLUSION

The PLT was found to regenerate after partial-thickness harvesting on MRI. In the animal study, the quality of the regenerated tendon when half of the tendon was preserved during tendon harvesting was better than that after full-thickness tendon harvesting.

Satisfactory functional and MRI outcomes at the foot and ankle following harvesting of full thickness peroneus longus tendon graft

AIMS

To evaluate the donor site morbidity and tendon morphology after harvesting whole length, full-thickness peroneus longus tendon (PLT) proximal to the lateral malleolus for ligament reconstructions or tendon transfer.

METHODS

A total of 21 eligible patients (mean age 34.0 years (standard deviation (SD) 11.2); mean follow-up period 31.8 months (SD 7.7), and 12 healthy controls (mean age, 26.8 years (SD 5.9) were included. For patients, clinical evaluation of the donor ankle was performed preoperatively and postoperatively. Square hop test, ankle strength assessment, and MRI of distal calf were assessed bilaterally in the final follow-up. The morphological symmetry of peroneal tendons bilaterally was evaluated by MRI in healthy controls.

RESULTS

Among the patients, the mean pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Karlsson-Peterson score were 98.7 (SD 2.5; p = 0.480) and 98.5 (SD 2.4; p = 0.480), and 98.3 (SD 2.4; p = 0.162) and 97.9 (SD 2.5; p = 0.162), respectively. There was no significant difference between square hop test bilaterally (p = 0.109) and plantar flexion peak force bilaterally (p = 0.371). The harvested limb had significantly less eversion peak force compared to the contralateral limb (p < 0.001). Evidence of probable tendon regeneration was observed in all the patients by MRI and the total bilateral peroneal tendon index (mean ratio of harvested side cross-sectional area of peroneal tendon compared with the contralateral side) was 82.9% (SD 17.4). In 12 healthy controls, peroneal tendons (mean 99.4% (SD 4.3) were found to be morphologically symmetrical between the two sides.

CONCLUSION

The current study showed satisfactory clinical foot and ankle outcomes after full-thickness PLT harvesting and indicated the regenerative potential of PLT after its removal. Level of Evidence: Level IV, therapeutic retrospective case series. Cite this article: Bone Joint J 2020;102-B(2):205-211.

Eversion and First Ray Plantarflexion Muscle Strength in Anterior Cruciate Ligament Reconstruction Using a Peroneus Longus Tendon Graft

Background:

The peroneus longus tendon has been used as a graft in orthopaedic reconstruction surgery because of its comparable biomechanical strength with the native anterior cruciate ligament (ACL) and hamstring tendon. However, one of the considerations in choosing an autograft is donor site morbidity.

Purpose/Hypothesis:

This study aimed to compare ankle eversion and first ray plantarflexion strength between the donor site and its contralateral site after ACL reconstruction. The study hypothesis was that strength measurements will be different between the harvest site and contralateral healthy site.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients who underwent ACL reconstruction using a peroneus longus tendon autograft between March 2017 and December 2018 were included in this study. Patients followed a rehabilitation protocol from the first day after surgery. Ankle eversion and first ray plantarflexion strength were measured using a modified dynamometer 6 months after surgery. Donor site morbidity was assessed 6 months after surgery using the Foot & Ankle Disability Index (FADI) and American Orthopaedic Foot & Ankle Society (AOFAS) scoring system for the ankle and hindfoot.

Results:

A total of 31 patients (22 male, 9 female; mean age, 27.58 ± 8.69 years [range, 18.00-45.00 years]) fulfilled the inclusion criteria. There was no significant difference in ankle eversion strength at the donor site compared with the contralateral site (P = .55), with means of 65.87 ± 7.63 N and 66.96 ± 8.38 N, respectively. Also, there was no significant difference in ankle first ray plantarflexion strength at the donor site compared with the contralateral site (P = .68), with means of 150.64 ± 11.67 N and 152.10 ± 12.16 N, respectively. The mean FADI score of 99.71 ± 0.57 and mean AOFAS score of 98.71 ± 3.03 at the donor site were considered excellent results.

Conclusion:

Ankle eversion and first ray plantarflexion strength at the donor site were similar to those at the contralateral healthy site, with no donor site morbidity. This suggests that the peroneus longus tendon is a promising graft in ACL reconstruction.

Open reduction and internal fixation in a one-stage anterior cruciate ligament reconstruction surgery for the treatment of tibial plateau fractures: A case report and literature review

Treatment of tibial plateau fractures associated with anterior cruciate ligament (ACL) injuries can be challenging. Maintaining the joint surface and axis are two main principles for the management of patients with tibial plateau fractures. Herein, we describe a patient with tibial plateau fracture of Schatzker type VI associated with complete ACL rupture. Although in a two-stage reconstruction surgery for treatment of its rupture seem to be accepted by most orthopaedic surgeons in cases of ACL injuries, we treated our patient with ORIF in a one-stage ACL reconstruction surgery. At the 1-year follow-up, the patient gained full range of motion and was functioning well. We reviewed the literature on performing ORIF in a one-stage ACL reconstruction for the treatment of tibial plateau fractures, which seemed to be a reasonable management approach that supported its use for the treatment of this patient.

[Anatomic stabilization of chronic lateral instability of the ankle : Gold technique]

OBJECTIVES

Anatomical reconstruction of the lateral ligament complex in the ankle.

INDICATIONS

Chronic lateral ankle instability.

CONTRAINDICATIONS

Severe osteoarthritis, obesity, hindfoot varus, general contraindications (infection, circulatory disorders, diabetic foot syndrome).

SURGICAL TECHNIQUE

Anatomical V‑shaped reconstruction of the lateral ligament complex with half of the peroneus brevis tendon and additional retinaculum stabilization.

POSTOPERATIVE MANAGEMENT

Lower leg orthesis (e. g. protect.CAT Walker, medi GmbH, Bayreuth, Germany) for 6 weeks. Week 1-2, no weight bearing, no active pro- and supination. Starting in week 3-4, begin with partial weight bearing, pain adapted. Starting in week 7, free range of motion, begin with progressive training.

RESULTS

Between March 2014 and June 2016, 16 patients (6 female, 10 male) were treated with the above-named technique. Average age was 32.8 years (range 17.9-57.1 years). Ten patients completed the 6‑ and 12-month follow-ups. None of these 10 patients reported a feeling of instability. In the clinical examination, the lateral ligament complex was stable. Patients showed a free range of motion at the 12-month follow-up.

Donor Site Morbidity After Lateral Ankle Ligament Reconstruction Using the Anterior Half of the Peroneus Longus Tendon Autograft

BACKGROUND

The anterior half of the peroneus longus tendon (AHPLT) has been reported to be an effective autograft for ligament reconstruction with respect to strength and safety. However, there is little information regarding donor site morbidity after harvesting the AHPLT. Furthermore, to the best of our knowledge, there has not been a study on the isokinetic evaluation of ankle plantar flexion and eversion after AHPLT harvesting.

PURPOSE

To evaluate the clinical and radiographic results after lateral ankle ligament reconstruction using the AHPLT. We further investigated whether harvesting the AHPLT for lateral ankle ligament reconstruction decreases the strength of ankle plantar flexion and eversion.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Thirty consecutive patients (31 cases) were treated by anatomic lateral ligament reconstruction using the AHPLT. For the clinical assessment, visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Karlsson-Peterson scores were evaluated preoperatively and at the last follow-up. For the radiographic assessment, talar tilt angle and anterior talar displacement were measured preoperatively and at the last follow-up. The peak isokinetic torques for ankle plantar flexion at angular velocities of 30 and 120 deg/s and eversion at angular velocities of 30 and 60 deg/s were measured at a minimum of 1 year after surgery.

RESULTS

The mean VAS score improved significantly from 6.4 ± 1.7 preoperatively to 1.6 ± 1.5 at the last follow-up ( P < .001). The mean respective AOFAS and Karlsson-Peterson scores improved significantly from 57.2 ± 12.8 and 66.9 ± 13.6 preoperatively to 89.0 ± 10.0 and 93.3 ± 5.7 at the last follow-up ( P < .001). The mean talar tilt angle improved significantly from 15.3° ± 6.2° preoperatively to 3.4° ± 3.0° at the last follow-up ( P < .001), and the mean anterior talar displacement improved significantly from 10.2 ± 3.3 mm preoperatively to 6.3 ± 1.9 mm at the last follow-up ( P < .001). No significant differences were observed between the uninvolved and involved legs in the mean peak torque for plantar flexion at angular speeds of 30 deg/s ( P = .517) and 120 deg/s ( P = .347) or for eversion at angular speeds of 30 deg/s ( P = .913) and 60 deg/s ( P = .983).

CONCLUSION

Anatomic lateral ligament reconstruction using the AHPLT showed good clinical and radiographic results without a significant decrease in the peroneus longus strength. Lateral ligament reconstruction using the AHPLT may be a good surgical option for the treatment of chronic ankle instability.

The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source

BACKGROUND

The shortage of autogenous grafts has often times been a problem in knee ligament reconstruction. There are little data concerning the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft.

HYPOTHESIS

The AHPLT is a suitable graft with respect to its strength, safety, and donor site morbidity.

STUDY DESIGN

Descriptive laboratory study and case series; Level of evidence, 4.

METHODS

The safety and efficacy of using the AHPLT as an autograft source were evaluated. A cadaveric study was first done to reveal the anatomic profile of the AHPLT, to test its failure load, and to compare it with that of the semitendinosus and gracilis tendons. Then, a cadaveric harvest study was performed to show it was safe and reproducible. The space between the tendon stripper and the peroneal nerve during harvesting of the AHPLT was evaluated. Lastly, a clinical study was performed to evaluate donor site morbidity. The preoperative and postoperative foot and ankle functions of 92 patients who underwent a variety of knee ligament reconstructions with the AHPLT were followed for more than 2 years and were then evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the Foot and Ankle Disability Index (FADI) to determine the influence of tendon removal on ankle and foot function.

RESULTS

The average failure load of the AHPLT was 322.35 ± 63.18 N, accounting for 97.69% ± 19.48% and 147.94% ± 41.30% of the semitendinosus and gracilis tendons, respectively. During tendon harvesting, the distance between the head of the tendon stripper and the branching point of the deep peroneus nerve was 4.6 to 10.4 cm. The clinical study showed that the preoperative and postoperative AOFAS scores were 97.4 ± 2.0 and 97.2 ± 1.6 (P = .85), respectively, while the FADI scores preoperatively and postoperatively were 96.8 ± 2.2 and 96.9 ± 2.5 (P = .91), respectively. No signs of peroneus nerve injury, peroneus longus tendon rupture, or tendinopathy were found.

CONCLUSION

The AHPLT is acceptable for use as an autograft with respect to its strength, safety, and donor site morbidity.