SLR - May 2017 - Benjamin M. Saviet

Donor Site Morbidity After Lateral Ankle Ligament Reconstruction Using Anterior Half of the Peroneus Longus Tendon Autograft

Reference: Park CH, Lee WC. Donor Site Morbidity After Lateral Ankle Ligament Reconstruction Using the Anterior Half of the Peroneus Longus Tendon Autograft. Am J Sports Med. 2017 Mar;45(4):922–928.

Reviewed By: Benjamin M. Saviet, DPM
Residency: Steward-St. Elizabeth’s Medical Center, Brighton MA

Podiatric Relevance: Ankle sprains are the most common orthopaedic injury to the foot and ankle. Up to 20 percent of those individuals will go on to chronic ankle instability, which may require surgical correction. This article hypothesizes that an autologous graft harvested from the anterior half of the peroneus longus tendon can be successfully utilized for anatomic reconstruction of the lateral ankle ligaments with good surgical correction and low morbidity resulting from the graft harvesting.

Methods: The authors retrospectively evaluated 30 consecutive patients with chronic ankle instability who underwent anatomic ankle ligament reconstruction with graft composed of autologous ipsilateral anterior half of the peroneus longus tendon. Pre- and postintervention, patients were evaluated with visual analog scales, AOFAS and Karlsson-Peterson scoring, radiographic assessment and peak isokinetic torque assessments of eversion and plantarflexion. Patients were evaluated postoperatively at a minimum of 12 months. Average patient age was about 24 years old. Additionally, the patients underwent ankle arthroscopy prior to lateral ligament reconstruction to treat any accompanying lesions of the tibio-talar joint.

Results: The authors found significant improvement in VAS (pain decreased from 6.4 to 1.6), AOFAS (function increased from 57.2 to 89) and KP (function increased from 66.9 to 93.3) scoring systems following surgical intervention. The radiographic parameters showed marked decrease in talar tilt and anterior talar displacement as would be expected. Peak torque measurements were not found to be significantly different on the operative and nonoperative legs for plantarflexion or eversion. There were no complications associated with rupture of the remaining peroneus longus tendon. One patient required removal of a talar interference screw.

Conclusions: The authors concluded that, in the case of chronic ankle instability that has failed to improve with physical therapy or bracing for three months, anatomic reconstruction with use of autologous graft harvested from the anterior half of the peroneus longus tendon can achieve good radiographic and functional outcomes of the ankle and donor tendon with low morbidity. It is important to note they harvested tendon above the lateral malleolus to avoid the avascular area, which likely decreased complications like rupture of the residual PL tendon. The patients who undergo nonanatomic repair often complain of limitation of subtalar joint motion, and not all patients are candidates for direct repair of lateral ankle ligaments after injury. This technique is important for the foot and ankle surgical community as it can negate the need for allograft tendon, which carries a risk of infection and higher failure rate, as well as the need for harvesting of remote autografts, like gracilis or semitendinosis. This surgical procedure adds to the numerous techniques reported for treating chronic ankle instability. 

Educational Opportunities