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Mirza K, Menezes RJ, Acharya PU, Austine J, d'Almeida VR, Kamath A. Donor-site morbidity following arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04046-x. [PMID: 39039170 DOI: 10.1007/s00590-024-04046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Peroneus longus has proved to be a promising graft for ACL reconstruction due to its high tensile strength, and ease of harvesting. While multiple studies have assessed the functional outcomes of the knee after ACL reconstruction using peroneus longus autograft, we aimed to evaluated donor site morbidity among the Indian population. MATREIALS AND METHODS This was a prospective, longitudinal, descriptive study conducted at a tertiary care hospital. Preoperative AOFAS and Karlsson-Peterson scores were obtained, and patients were followed up after surgery for a period of 6-months using the same scoring systems and strength testing with a hand-held Chatillon MSE-100-M dynamometer. Pedobarographs were done using Diers Pedoscan Plantar Pressure Measurement System on a subset of seven patients. RESULTS 20 patients participated in the study. Mean AOFAS and Karlsson-Peterson scores pre-operatively were 99.7 ± 1.34 and 98.5 ± 4.62 respectively. On completing 6- months of follow-up these scores were found to be 95.6 ± 9.43 and 88.75 ± 18.42 respectively. Deterioration of mean evertor strength was noted at all follow-ups compared to the opposite side. Static pedobarographs showed significant decreased in total surface area of contact and pressure over the posterior aspect of the operated side by 3-months which improved later at 6-months. Dynamic pedobarographs showed decreased mean average plantar pressure while walking on the operated side and significant increase in mean surface area of contact of the operated side (191.886±22.678 cm2) at 6-months of follow-up compared to the opposite side (184.471 ± 22.218 cm2). Five patients showed deviation of the point of maximum pressure while walking on the operated foot making it lateral to the COP with increased lateral plantar/ medial plantar pressure ratio. CONCLUSION While the use of peroneus longus tendon autografts in arthroscopic ACL reconstruction does not seem problematic on short-term subjective assessment, there is objective evidence in keeping with evertor weakness, weakness of first ray plantar flexion and possible ankle instability. LEVEL OF EVIDENCE Level lll.
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Affiliation(s)
- Kiyana Mirza
- Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
| | - Ronald Joseph Menezes
- Department of Orthopaedic Surgery, Father Muller Medical College, Mangalore, 575002, India
| | | | - Jose Austine
- Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
| | | | - Ashwin Kamath
- Department of Orthopaedic Surgery, Father Muller Medical College, Mangalore, 575002, India
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Quinn M, Byrne RA, Albright JA, Testa E, Ahn B, Lemme N, Petit L, Blankenhorn B, Owens BD. Peroneus Longus Tendon Autograft May Present a Viable Alternative for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024; 40:1366-1376.e1. [PMID: 37898307 DOI: 10.1016/j.arthro.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE To examine the available literature to better understand the objective and patient-reported outcomes using peroneus longus tendon (PLT) autograft compared with more commonly used autografts, such as the quadrupled hamstring tendons (HT), in patients undergoing primary for anterior cruciate ligament reconstruction (ACLR). METHODS A comprehensive search of published literature in PubMed, Web of Science, Cochrane Library, Ovid, and EMBASE databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included patients undergoing ACLR with PLT autograft, inclusion of patient-recorded outcome measures, and availability in English language. Publications that included only biomechanical analysis or ACLR with use of allograft or combination grafts were excluded. RESULTS A total of 16 studies (Level of Evidence range: I-IV) met inclusion criteria, with follow-up ranging from 3 months to 5 years. In the available case series, patient-reported outcomes ranged from Lysholm = 80.7 to 95.1, International Knee Documentation Committee 78.1 to 95.7. In prospective cohorts and randomized controlled trials, PLT performance was comparable with HT autografts (PLT/HT: Lysholm = 88.3-95.1/86.5-94.9, International Knee Documentation Committee = 78.2-92.5/87.4-93.4). The majority of PLT grafts diameters were equal or greater than HT counterparts with a mean of >8 mm (PLT/HT: 7.0-9.0 mm/7.65-8.5 mm). There was minimal donor-site morbidity associated with PLT harvest. CONCLUSIONS Although limitations exist within the available literature, existing evidence suggests that PLT autograft routinely produces adequately sized grafts with comparable early outcomes to HT autograft and low risk of donor-site morbidity. However, the PLT autograft is yet to demonstrate superiority to any of the more-traditional autograft selections. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Matthew Quinn
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A..
| | - Rory A Byrne
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - J Alex Albright
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Edward Testa
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Benjamin Ahn
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Nicholas Lemme
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Logan Petit
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Brad Blankenhorn
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Brett D Owens
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
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Sritharan P, Milantoni V, Abdel Khalik H, Kay J, Slawaska-Eng D, Johnson J, de Sa D. Evaluating the quality of systematic reviews of comparative studies in autograft-based anterior cruciate ligament reconstruction using the AMSTAR-2 tool: A systematic umbrella review. Knee Surg Sports Traumatol Arthrosc 2024; 32:583-598. [PMID: 38372015 DOI: 10.1002/ksa.12062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE There remains a lack of consensus around autograft selection in anterior cruciate ligament reconstruction (ACLR), though there is a large body of overlapping systematic reviews and meta-analyses. Systematic reviews and their methodological quality were aimed to be further assessed, using a validated tool known as assessing the methodological quality of systematic reviews (AMSTAR-2). METHODS MEDLINE, Embase and CENTRAL were searched from inception to 23 April 2023 for systematic reviews (with/without meta-analysis) comparing primary ACLR autografts. A final quality rating from AMSTAR-2 was provided for each study ('critically low', 'low', 'moderate' or 'high' quality). Correlational analyses were conducted for ratings in relation to study characteristics. RESULTS Two thousand five hundred and ninety-eight studies were screened, and 50 studies were ultimately included. Twenty-four studies (48%) were rated as 'critically low', 17 (34%) as 'low', seven (14%) as 'moderate' and two (4%) as 'high' quality. The least followed domains were reporting on sources of funding (1/50 studies), the impact of risk of bias on results of meta-analyses (11/36 studies) and publication bias (17/36 studies). There was a significant increase in the frequency of studies graded as 'moderate' compared to 'low' or 'critically low' quality over time (p = 0.020). CONCLUSION The methodological quality of systematic reviews comparing autografts in ACLR is low, with many studies being rated lower due to commonly absent aspects of systematic review methodology such as investigating sources of funding and publication bias. More recent studies were generally more likely to be of higher quality. Authors are advised to consult AMSTAR-2 prior to conducting systematic reviews in ACLR. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Praveen Sritharan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Milantoni
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan Abdel Khalik
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jansen Johnson
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Viswanathan VK, Iyengar KP, Jain VK. The role of peroneus longus (PL) autograft in the reconstruction of anterior cruciate ligament (ACL): A comprehensive narrative review. J Clin Orthop Trauma 2024; 49:102352. [PMID: 38356688 PMCID: PMC10862405 DOI: 10.1016/j.jcot.2024.102352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
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.
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Affiliation(s)
| | | | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
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Zhao Z, Tang L, Chen J, Bai X, Chen Y, Ng L, Zhou Y, Deng Y. The effect of harvesting the anterior half of the peroneus longus tendon on foot morphology and gait. J Orthop Surg Res 2024; 19:69. [PMID: 38225652 PMCID: PMC10790475 DOI: 10.1186/s13018-023-04429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In anterior cruciate ligament reconstruction, the strength of the graft was found to be unsatisfactory usually the anterior half of the peroneus longus tendon was taken for supplementation, but the effect on foot and ankle function and gait in the donor area is unclear. This study aims to explore the changes in the ankle and gait after using the harvested anterior half of the peroneus longus tendon as a reconstruction graft for the anterior cruciate ligament. METHODS A total of 20 patients, 6 males and 14 females, aged 18 to 44 years, with unilateral anterior cruciate ligament injuries, underwent reconstruction using the harvested anterior half of the peroneus longus tendon as a graft between June 2021 and December 2021. The part on which the anterior half of the peroneus longus tendon was harvested was considered the experimental group, while the contralateral foot was the control group. At the 6-month follow-up, the Lysholm knee score, AOFAS ankle score, and gait-related data (foot length, arch index, arch volume, arch volume index, and gait cycle parameters: percentage of time in each gait phase, step frequency, step length, foot strike angle, and push-off angle) were assessed using a 3D foot scanner and wearable sensors for both groups. RESULTS All 20 patients completed the six-month follow-up. There were no statistically significant differences between the experimental and control groups regarding knee scores, ankle scores, foot length, arch index, arch volume, arch volume index, step frequency, and step length (P > 0.05). However, there were statistically significant differences between the experimental and control groups in terms of the gait cycle parameters, including the percentage of time in the stance, mid-stance, and push-off phases, as well as foot strike angle and push-off angle (P < 0.05). CONCLUSION Through our study of the surgical experimental group we have shown that harvesting the anterior half of the peroneus longus tendon does not affect foot morphology and gait parameters; however, it does impact the gait cycle.
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Affiliation(s)
- Zhi Zhao
- Department of Sport Medicine, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China
| | - Li Tang
- Chongqing Rongzhi Biotechnology Company Limited, Chongqing, 400012, China
| | - Jing Chen
- Chongqing Rongzhi Biotechnology Company Limited, Chongqing, 400012, China
| | - Xinwen Bai
- Department of Sport Medicine, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China
| | - Yu Chen
- Department of Sport Medicine, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China
| | - Liqi Ng
- Institute of Orthopaedic and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK
| | - Yu Zhou
- Postdoctoral Research Workstation, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China.
| | - Yu Deng
- Department of Sport Medicine, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China.
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ANDREZ TÁSSIONAVAJAS, CHAGAS JÚLIABEZERRAMARTINS, D’OLIVEIRA LÍVIABAPTISTA. GRAFTS FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: SYSTEMATIC REVIEW AND META-ANALYSIS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e256048. [PMID: 36561474 PMCID: PMC9757723 DOI: 10.1590/1413-785220223006e256048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/01/2021] [Indexed: 12/23/2022]
Abstract
Objective This study proposes to systematically review the literature and compare data on (1) function, (2) pain, (3) return to sport, and (4) complications after anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft (QT) and hamstring tendon autograft (HT). Methods In June 2021, a systematic review of the EMBASE, MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, and LILACS databases was performed, based on PRISMA guidelines. The search strategy included the keywords: "Previous Cruciate Ligament Reconstruction," "ACL reconstruction," "quadriceps tendon autograft," "quadriceps graft," "Hamstring-Tendon Autografts." Meta-analyses were performed using Review Manager software (RevMan Web). Results There were no significant differences between the two groups regarding function according to Lysholm score (MD 3.01; CI-0.30, 6.33, p = 0.08), the presence of pain (RR 0.89; CI-0.57, 1.39, p = 0.60), and re-rupture (RR 0.60; IC-0.19, 1.88, p = 0.38). Conclusion QT and HT autografts show comparatively good results in ACL reconstruction without significant differences regarding function, pain, and rupture after surgical intervention. Level of Evidence II, Systematic Review of Level II Studies.
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