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Can Full Thickness Peroneus Longus Graft Be Used For ACL Reconstruction ? – A 3 Year Prospective Study With Isokinetic Testing of and Functional Outcomes of Ankle

Can Full Thickness Peroneus Longus Graft Be Used For ACL Reconstruction ? – A 3 Year Prospective Study With Isokinetic Testing of and Functional Outcomes of Ankle

Arumugam Sivaraman, MS(Orth), AB(IM)(USA), FRCS(Glasg), INDIA Prakash Ayyadurai, MS, INDIA Suresh Perumal, MS(Orth), INDIA Parthiban Jeganathan, MS, INDIA Avinash Mahender, MBBS, D.ortho, DNB ortho, INDIA Vikram Rao, MD , INDIA Thiagarajan Alwar, MD, INDIA

Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamilnadu, INDIA

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Summary: Can full thickness Peroneus longus Graft be used for ACL reconstruction ? – A 3 year Prospective study with Isokinetic testing of and functional Outcomes of Ankle


Dearth of autograft options is a challenge faced by surgeons, for patients with thin Hamstrings, Multi-ligament Injuries and revision ACL /PCL injuries. The dilemma in using Peroneus Longus[PL] as a routine viable autograft is the concern of Ankle and foot morbidity. Though studies have come up focussing on Subjective scores for assessing ankle morbidity, the purpose of this study is to evaluate the donor Ankle and foot using functional and Isokinetic evaluation parameters.

Material & Methods
This prospective study included 53 consecutive patients with Isolated ACL tear, with no other lower limb injury in the past, who underwent ACL reconstruction with PL graft. Patients with multilligament injuries/ Ligament injuries other than ACL, and patients with generalised ligamentous laxity were excluded. Clinical assessment of all(53) Donor ankles was done preoperatively and postoperatively at 3,6 and 12 months and 3 year using VAS- FA(visual analog scale -foot and ankle) scoring. Isokinetic testing of donor ankle using Biodex dynamometer was done at one year & 3 year postoperatively. The Mean pre-op, 3 month, 6 month and 1 year post-op VAS-FA score in the study was found to be 97.64[SD 5.42], 91.74[SD 9.43], 95.21[SD 7.51] and 96.5[SD 5.85] respectively. The mean 3 year post op VAS-FA score was 97.12[SD 5.21] There was no significant difference between pre-op and post-op VAS-FA scores. At one-year and three year follow-up, the difference in peak torques of ankle movements in donor ankle were statistically insignificant when compared to contralateral ankle at both 600/sec and 1200/sec velocities.


Findings of this study showed excellent clinical outcomes and favourable objective ankle dynamics in PL harvested donor ankle. Comparison of the VAS-FA scores of the donor ankle to its pre surgery values instead of the opposite ankle provides a more accurate assessment of donor site morbidity. These findings may help to allay the apprehensions in using PL as a viable autograft alternative.

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