Comparação Entre Comprimento Total E Metade Anterior Dos Enxertos Do Tendão Do Perônio Longo Para Reconstruções Do Ligamento Do Joelho.

Comparação Entre Comprimento Total E Metade Anterior Dos Enxertos Do Tendão Do Perônio Longo Para Reconstruções Do Ligamento Do Joelho.

Diego Escudeiro, MSc, BRAZIL Juliano Malpaga, MD, BRAZIL Vitor Barion Castro De Padua, PhD, BRAZIL Sergio Marinho De Gusmão Canuto, BRAZIL Pedro Baches Jorge, PhD, BRAZIL

Santa Casa de São Paulo, São Paulo, São Paulo, BRAZIL


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Anatomic Location

Anatomic Structure

Diagnosis / Condition

Treatment / Technique

Ligaments

ACL


Summary: Ambos os enxertos de PL e AHPL são seguros para a reconstrução do ligamento do joelho sem morbidade significativa no local do doador. As semelhanças de resultados morfológicos e clínicos permitem a seleção de qualquer tipo de enxerto com base no planejamento cirúrgico, com o AHPL potencialmente minimizando as complicações do local doador a longo prazo.


Background

Graft selection for knee ligament reconstruction is crucial for clinical outcomes and patient satisfaction, with over 120,000 ACL injuries occurring annually in the United States. The peroneus longus tendon (PL) has recently emerged as a promising graft option due to its ease of harvest and minimal invasiveness. However, its role in ankle function raises concerns about donor site morbidity.

Purpose

With more than 120,000 anterior cruciate ligament (ACL) injuries annually in the United States, traditional grafts like hamstrings (HT) and patellar tendon (BTB) may be insufficient for specific complex reconstructions. The peroneus longus tendon (PL) has emerged as a promising alternative due to its ease of harvest, minimal invasiveness, and reduced impact on knee joint structures. The anterior half of the peroneus longus tendon (AHPL) offers further advantages by potentially reducing donor site morbidity while maintaining graft strength and length.
Study Design: Case Series

Methods

This retrospective observational study, conducted from April 2019 to May 2022, included patients undergoing ACL reconstruction with adjunctive grafts. Patients were divided into PL (n=75) and AHPL (n=39). Functional outcomes were assessed using the American Orthopedic Foot and Ankle Score (AOFAS) and Foot and Ankle Disability Index (FADI) at 6 and 24 months postoperatively. Graft length and width were measured, and statistical analyses were performed to compare outcomes and correlations with patient anthropometric data.

Results

The study included 114 patients with a mean age of 26.58 ± 5.94 years. Graft measurements showed PL grafts had a mean length of 24.16 ± 2.04 cm and width of 13.05 ± 2.51 mm, while AHPL grafts had a mean length of 22.86 ± 2 cm and width of 11.97 ± 2.59 mm. Both groups showed excellent functional outcomes with no significant differences between them. AOFAS and FADI scores improved significantly from 6 to 24 months in both groups. No significant correlation was found between graft size and patient height or weight.

Conclusion

Both PL and AHPL grafts are safe for knee ligament reconstruction without significant donor site morbidity. The morphological and clinical outcome similarities allow selecting either graft type based on surgical planning, with AHPL potentially minimizing long-term donor site complications.