Budhiparama Nicolaas C, Rhatomy Sholahuddin, Phatama Krisna Yuarno, Chandra William, Santoso Asep, Lumban-Gaol Imelda
Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty & Sports Medicine, Medistra Hospital, Jakarta, Indonesia.
Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.
Video J Sports Med. 2021 Jul 13;1(4):26350254211009888. doi: 10.1177/26350254211009888. eCollection 2021 Jul-Aug.
With the increasing use of hamstring tendon as an autograft in anterior cruciate ligament (ACL) reconstruction, some shortcomings have been found on the donor site. Therefore, an alternative autograft option with adequate strength and less donor site morbidity will be very valuable. Peroneus longus tendon has been found to be a promising option.
Primary ACL reconstruction.
Peroneus longus tendon graft is harvested with a longitudinal skin incision at 2 to 3 cm (2 finger-breadths) above and 1 cm (1 finger-breadth) behind the lateral malleolus, followed by superficial fascia incision in line with skin incision. The peroneus longus and peroneus brevis tendons were then identified. The tendon division location was marked at 2 to 3 cm above the level of the lateral malleolus. After that, an end-to-side suture was performed between the distal part of the peroneus longus tendon and peroneus brevis tendon. The peroneus longus tendon was stripped proximally with a tendon stripper to at least 5 cm from the fibular head to prevent peroneal nerve injury. Graft preparation was performed with a standard procedure to obtain the suitable graft size. In routine arthroscopic ACL reconstruction, peroneus longus tendon graft fixation can be performed with a cortical suspension device, bioabsorbable screws, or a combined technique.
Recent studies showed that peroneus longus autograft had a comparable outcome with hamstring tendon autograft in primary ACL reconstruction at a 1-year follow-up. The use of peroneus longus tendon autograft resulted in larger graft diameter and less thigh hypotrophy. The mean (±SD) for the AOFAS-Hindfoot Score in the peroneus longus group was 97.3 ± 4.2, while the mean FADI score was 98 ± 3.4, both of which were considered excellent results.
DISCUSSION/CONCLUSION: The use of peroneus longus autograft in primary ACL reconstruction is a safe procedure with an excellent outcome. Peroneus longus tendon autograft can be recommended as an alternative graft in single-bundle ACL reconstruction. Further study of the functional outcome and knee stability evaluation is recommended.
随着腘绳肌腱在 anterior cruciate ligament (ACL) 重建中作为自体移植物的使用日益增加，在供区发现了一些缺点。因此，一种具有足够强度且供区并发症较少的替代自体移植物选择将非常有价值。已发现腓骨长肌腱是一个有前景的选择。
初次 ACL 重建。
在距外踝上方 2 至 3 厘米（2 指宽）和后方 1 厘米（1 指宽）处做一纵向皮肤切口，然后沿皮肤切口切开浅筋膜，以此方式获取腓骨长肌腱移植物。随后识别出腓骨长肌和腓骨短肌腱。在距外踝水平上方 2 至 3 厘米处标记肌腱切断位置。之后，在腓骨长肌腱远端与腓骨短肌腱之间进行端侧缝合。用肌腱剥离器将腓骨长肌腱向近端剥离至距腓骨头至少 5 厘米处，以防止腓总神经损伤。采用标准程序进行移植物制备以获得合适的移植物尺寸。在常规关节镜下 ACL 重建中，腓骨长肌腱移植物固定可采用皮质悬吊装置、可吸收螺钉或联合技术。
近期研究表明，在初次 ACL 重建术后 1 年的随访中，腓骨长肌自体移植物与腘绳肌腱自体移植物的效果相当。使用腓骨长肌腱自体移植物导致移植物直径更大且大腿肌肉萎缩更少。腓骨长肌组的美国足踝外科协会（AOFAS）后足评分的平均值（±标准差）为 97.3 ± 4.2，而功能活动与残疾指数（FADI）评分的平均值为 98 ± 3.4，两者均被认为是优异结果。
讨论/结论：在初次 ACL 重建中使用腓骨长肌自体移植物是一种安全的手术，效果良好。腓骨长肌腱自体移植物可被推荐作为单束 ACL 重建中的替代移植物。建议进一步研究其功能结果和膝关节稳定性评估。
