Summary

PL also provides longer harvested tendon length, thicker graft diameter, a longer graft and better functional outcomes after preparation for AI-ACLR, as compared to ST.

Abstract

Introduction

The AI-ACLR has been studied by many authors using various graft options e.g. STG, ST, allograft, synthetic graft etc. Peroneus longus has not been assessed till now in AI-ACLR. We designed this study to assess the feasibility of PL tendon in AI- ACLR, compare various intraoperative and postoperative parameters with AI-ACLR done using ST graft. We have also described our modified technique of graft preparation which is more reproducible and does not require to adjust the tibial tunnel drilling depth.

Material And Methods

The study was conducted from January 2021 to December 2022. It was a prospective case control study with patients followed up for minimum 18 months. Patients having clinically and MRI proven ACL tears, aged between 18 to 50 years were included in the study. Patients having multiligament injuries, any fracture, meniscal injuries, pre-existing osteoarthritis of knee or BMI 30 kg/m2 were excluded from study. 57 patients were enrolled for the study. Patients were non-randomly divided into two groups according to the graft source. Group 1: operated with peroneus longus (PL) tendon graft; Group 2: operated using the semitendinosus (ST) tendon graft. All patients underwent AI-ACLR using our modified technique. 46 patients completed the followup and were included in final analysis (Group 1, n= 35; Group 2, n= 11).

Results

Mean Age was 28 (17 - 36) years. Preoperative clinical examination was done in all the patients. Lachmann test was positive grade 2 in 10 (21.7%) patients and grade 3 in 36 (78.3%) patients. Anterior drawer was positive grade 2 in 14 (30.4%) patients and grade 3 in 32 (69.6%) patients. Pivot shift was grade 2 positive in 15 (32.6 %) patients and grade 3 in 31 (67.4 %) patients. The average time since injury till the surgery was 9.26 15.83 months (range 1–70 months). The mean graft length was 69.371.91 mm (65-75 mm). Mean surgical time was 60.3 8.75 minutes (range 47 – 75 minutes). Average followup duration was 24 4.8 months (range 18-29).
The harvested tendon length was significantly longer in Group 1 (31.51 ± 2.41mm vs 29.0 ± 2.49mm) (P=0.005). Group 1 also had significantly thicker graft diameter (P=0.021) (8.87±1.16mm vs 8.09 ± 0.30mm), better followup KOOS score (P<0.001; 68.86 ± 6.1 vs 60.09 ± 5.65), Lysholm score (P=0.038; 69.46 ± 4.62 vs 65.73 ± 6.25) and IKDC score (P=0.045; 59.26 ± 3.81 vs 56.18 ± 5.65). The followup VAS score was better in Group 2 (1.34 ± 0.54 vs 1.36 ± 0.51) but the difference was not statistically significant (P=0.910). The mean surgical time was slightly less in Group 1 (59.89 ± 9.32min vs 61.64 ± 6.82min) but the difference was not statistically significant (P=0.506).

Conclusion

Our modified technique of AI-ACLR using PL autograft provides significantly better functional scores with no loosening of graft and with no major complications, at minimum 18 months followup as compared to ST autograft. Use of PL also provides longer harvested tendon length, thicker graft diameter, a longer graft after preparation for AI-ACLR.