Related Experiment Video
Updated: May 5, 2026
Harvesting of Peroneus Longus Tendon Autograft
Published on: September 2, 2025
Preoperative MRI-based prediction of autograft diameter in ACL reconstruction using hamstring and peroneus longus
Aashay Prasad Pande1, Atmananda S Hegde2,3, K Suprasanna4
1Department of Orthopaedics, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576 104, India.
Background:
To evaluate the predictive value of magnetic resonance imaging (MRI)-derived cross-sectional area (CSA) measurements of hamstring and peroneus longus tendons in estimating intraoperative autograft diameter during anterior cruciate ligament (ACL) reconstruction, and to identify clinically useful CSA cut-offs for achieving graft diameters ≥ 8 mm.
Methods:
Fifty-two patients undergoing primary ACL reconstruction were included in this prospective observational study, with 26 each in the hamstring tendon (HT) and peroneus longus tendon (PLT) autograft groups. Preoperative CSA was measured on axial MRI at specific anatomical levels. Intraoperative graft diameters were recorded post- harvest. Correlation analysis and receiver operating characteristic curves were used to assess predictive value and determine CSA thresholds for adequate graft size.
Results:
For the HT group, CSA measured at the medial femoral condyle showed the strongest correlation with intraoperative diameter (r = 0.782; p < 0.001), with an optimal CSA cut-off of ≥ 19.15 mm² (AUC 0.917, sensitivity: 85%, specificity: 100%). For the PLT group, ankle-level CSA best predicted graft diameter (cut-off: ≥12.84 mm², AUC 0.958, sensitivity: 95.8%, specificity: 100%).
Conclusion:
MRI-based CSA measurement provides a reliable, non-invasive method for predicting autograft adequacy. This study establishes clinically relevant CSA thresholds for HT and PLT tendons and is the first to report such values for PLT, aiding preoperative graft selection in ACL reconstruction.
