The Role of Peroneus Longus (PL) Autograft in the Reconstruction of Anterior Cruciate Ligament (ACL): A Comprehensive Narrative Review

Overview

Journal J Clin Orthop Trauma

Specialty Orthopedics

Date 2024 Feb 15

PMID 38356688

Authors

Vibhu Krishnan Viswanathan

Karthikeyan P Iyengar

Vijay Kumar Jain

Affiliations

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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.

Citing Articles

Complications in anterior cruciate ligament reconstruction.

Figueroa D, Gonzalez W, Figueroa L, Figueroa F, Vaisman A J Clin Orthop Trauma. 2025; 61():102876.

PMID: 39816721 PMC: 11731265. DOI: 10.1016/j.jcot.2024.102876.

Comparative effectiveness of peroneus longus tendon (PLT) autografts versus hamstring tendon (HT) autografts in anterior cruciate ligament reconstruction: a comprehensive systematic review and meta analysis.

Park J, Fernandes A, Park S, Lim H, Sayudo I, Leibovitch L Eur J Orthop Surg Traumatol. 2024; 34(5):2691-2699.

PMID: 38755499 PMC: 11291530. DOI: 10.1007/s00590-024-03984-w.

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