Earlier Return to Sports, Reduced Donor-Site Morbidity with Doubled Peroneus Longus Versus Quadrupled Hamstring Tendon Autograft in ACL Reconstruction.

IF 2.3 Q2 ORTHOPEDICS JBJS Open Access Pub Date : 2023-12-06 eCollection Date: 2023-10-01 DOI:10.2106/JBJS.OA.23.00051

Usama Bin Saeed, Asad Ramzan, Marryam Anwar, Hamza Tariq, Huzaifa Tariq, Ajmal Yasin, Tariq Mehmood

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Abstract

Background: Graft choice for anterior cruciate ligament reconstruction (ACLR) has been evolving. The peroneus longus tendon (PLT) has been seen as a suitable choice for ACLR, providing comparable results to those of hamstring tendon (HT) autograft, but its clinical relevance in terms of return to sports, to our knowledge, has not been studied.

Methods: Two hundred and thirty-two patients who sustained an isolated ACL injury were enrolled and underwent ACLR using doubled PLT autograft or quadrupled HT autograft; 158 were followed for 24 months. Functional scores (International Knee Documentation Committee [IKDC] and Tegner-Lysholm scores) were assessed preoperatively and at 3,6, 12, and 24 months postoperatively. Graft diameter and graft harvesting time were measured intraoperatively. Donor-site morbidity was evaluated using subjective evaluation. Time to return to sports in both groups was compared.

Results: The mean diameter of PLT autograft was significantly larger than that of HT autograft, and the mean graft-harvesting time was less (p < 0.001). Patients in the PLT group returned to sports a mean of 34 days earlier than those in the HT group (p < 0.001) and had a lower rate of donor-site morbidity and, at 6 months, better patient-reported outcomes at the knee (p < 0.001). There were no significant differences between the groups in the rate of graft rupture or in IKDC and Tegner-Lysholm scores at the 24-month follow-up.

Conclusions: PLT is a suitable autograft for ACLR in terms of graft diameter and graft-harvesting time and may offer athletes an earlier return to sports related to better outcomes at 6 months of follow-up. HT autograft was associated with increased thigh weakness. Both grafts, however, performed similarly at 24 months postoperatively.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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早期恢复运动，双腓骨长肌与四双腘绳肌腱自体移植在ACL重建中降低供体部位发病率。

背景:前交叉韧带重建(ACLR)的移植物选择一直在不断发展。腓骨长肌腱(PLT)被认为是ACLR的合适选择，提供与腘绳肌腱(HT)自体移植相当的结果，但据我们所知，尚未研究其在恢复运动方面的临床相关性。方法:选取了232例孤立性前交叉韧带损伤患者，采用双倍PLT自体移植或四倍HT自体移植行ACLR;其中158人随访24个月。术前、术后3、6、12和24个月分别评估功能评分(国际膝关节文献委员会[IKDC]和Tegner-Lysholm评分)。术中测量移植物直径和移植物收获时间。用主观评价法评价供体部位的发病率。比较两组恢复运动的时间。结果:PLT自体移植物的平均直径明显大于HT自体移植物，平均收获时间明显少于HT自体移植物(p < 0.001)。PLT组患者比HT组平均早34天恢复运动(p < 0.001)，供体部位发病率更低，6个月时，患者报告的膝关节预后更好(p < 0.001)。在24个月的随访中，两组间移植物破裂率、IKDC评分和Tegner-Lysholm评分均无显著差异。结论:从移植物直径和移植时间来看，PLT是一种适合ACLR的自体移植物，并且可以在6个月的随访中为运动员提供更早的恢复运动相关的更好的结果。HT自体移植物与大腿无力增加有关。然而，两种移植物在术后24个月的表现相似。证据等级:治疗性II级。有关证据水平的完整描述，请参见作者说明。

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