ACL Reconstruction with Peroneus Longus Tendon Autograft Does Not Compromise Ankle Function: A Retrospective Study of...

The goal of this study was to assess whether harvesting the peroneus longus tendon (PLT) for anterior cruciate ligament reconstruction (ACLR) affects ankle function over time, using data from a large group of patients with at least 2 yrs of follow-up.

We retrospectively reviewed 327 patients who underwent ACLR using a quadrupled PLT graft without distal tenodesis after harvest. Ankle function was evaluated before surgery and at 6 and 24 months postoperatively using three validated tools: the AOFAS Ankle Hindfoot Score, the Foot and Ankle Disability Index (FADI), and the Visual Analogue Scale (VAS) for pain. Activity levels before injury were recorded using the Tegner Activity Scale. Changes in scores over time were analysed using the Friedman test.

Patients were followed for an average of 42.17 months. Preoperative Tegner scores suggested most patients had low to moderate activity levels. Ankle pain remained minimal across all time points, with no significant changes in VAS scores (p = 0.097). Both AOFAS and FADI scores remained consistently high from before surgery to two years after, with no significant decline. These findings suggest that harvesting the peroneus longus tendon does not result in clinically significant donor-site ankle morbidity over long-term follow-up.

Use of the peroneus longus tendon for anterior cruciate ligament reconstruction appears to be a safe and effective option that does not compromise clinical ankle function in low- to moderate-activity individuals. Our findings, based on a large cohort with minimum 2 year follow up, support PLT autograft as a reliable alternative with minimal donor site morbidity.

Level IV.