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Published in: Journal of Orthopaedic Surgery and Research 1/2024

Open Access 01-12-2024 | Research article

The effect of harvesting the anterior half of the peroneus longus tendon on foot morphology and gait

Authors: Zhi Zhao, Li Tang, Jing Chen, Xinwen Bai, Yu Chen, Liqi Ng, Yu Zhou, Yu Deng

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

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Abstract

Background and objectives

In anterior cruciate ligament reconstruction, the strength of the graft was found to be unsatisfactory usually the anterior half of the peroneus longus tendon was taken for supplementation, but the effect on foot and ankle function and gait in the donor area is unclear. This study aims to explore the changes in the ankle and gait after using the harvested anterior half of the peroneus longus tendon as a reconstruction graft for the anterior cruciate ligament.

Methods

A total of 20 patients, 6 males and 14 females, aged 18 to 44 years, with unilateral anterior cruciate ligament injuries, underwent reconstruction using the harvested anterior half of the peroneus longus tendon as a graft between June 2021 and December 2021. The part on which the anterior half of the peroneus longus tendon was harvested was considered the experimental group, while the contralateral foot was the control group. At the 6-month follow-up, the Lysholm knee score, AOFAS ankle score, and gait-related data (foot length, arch index, arch volume, arch volume index, and gait cycle parameters: percentage of time in each gait phase, step frequency, step length, foot strike angle, and push-off angle) were assessed using a 3D foot scanner and wearable sensors for both groups.

Results

All 20 patients completed the six-month follow-up. There were no statistically significant differences between the experimental and control groups regarding knee scores, ankle scores, foot length, arch index, arch volume, arch volume index, step frequency, and step length (P > 0.05). However, there were statistically significant differences between the experimental and control groups in terms of the gait cycle parameters, including the percentage of time in the stance, mid-stance, and push-off phases, as well as foot strike angle and push-off angle (P < 0.05).

Conclusion

Through our study of the surgical experimental group we have shown that harvesting the anterior half of the peroneus longus tendon does not affect foot morphology and gait parameters; however, it does impact the gait cycle.
Literature
2.
go back to reference Widner M, Dunleavy M, Lynch S. Outcomes following ACL reconstruction based on graft type: Are all grafts equivalent? Curr Rev Musculoskelet Med. 2019;12:460–5.PubMedPubMedCentralCrossRef Widner M, Dunleavy M, Lynch S. Outcomes following ACL reconstruction based on graft type: Are all grafts equivalent? Curr Rev Musculoskelet Med. 2019;12:460–5.PubMedPubMedCentralCrossRef
3.
go back to reference Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33:33–47.PubMedPubMedCentralCrossRef Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33:33–47.PubMedPubMedCentralCrossRef
4.
go back to reference Liu C-T, Lu Y-C, Huang C-H. Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. J Orthop Sci. 2015;20:854–60.PubMedCrossRef Liu C-T, Lu Y-C, Huang C-H. Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. J Orthop Sci. 2015;20:854–60.PubMedCrossRef
5.
go back to reference Butt UM, Khan ZA, Amin A, Shah IA, Iqbal J, Khan Z. Peroneus longus tendon harvesting for anterior cruciate ligament reconstruction. JBJS Essent Surg Tech. 2022;12:e2000053.CrossRef Butt UM, Khan ZA, Amin A, Shah IA, Iqbal J, Khan Z. Peroneus longus tendon harvesting for anterior cruciate ligament reconstruction. JBJS Essent Surg Tech. 2022;12:e2000053.CrossRef
7.
go back to reference Hallinan JTPD, Wang W, Pathria MN, Smitaman E, Huang BK. The peroneus longus muscle and tendon: a review of its anatomy and pathology. Skeletal Radiol. 2019;48:1329–44.PubMedCrossRef Hallinan JTPD, Wang W, Pathria MN, Smitaman E, Huang BK. The peroneus longus muscle and tendon: a review of its anatomy and pathology. Skeletal Radiol. 2019;48:1329–44.PubMedCrossRef
8.
go back to reference Marín Fermín T, Hovsepian JM, Symeonidis PD, Terzidis I, Papakostas ET. Insufficient evidence to support peroneus longus tendon over other autografts for primary anterior cruciate ligament reconstruction: a systematic review. J ISAKOS. 2021;6:161–9.PubMedCrossRef Marín Fermín T, Hovsepian JM, Symeonidis PD, Terzidis I, Papakostas ET. Insufficient evidence to support peroneus longus tendon over other autografts for primary anterior cruciate ligament reconstruction: a systematic review. J ISAKOS. 2021;6:161–9.PubMedCrossRef
9.
go back to reference Cicirelli G, Impedovo D, Dentamaro V, Marani R, Pirlo G, D’Orazio TR. Human gait analysis in neurodegenerative diseases: a review. IEEE J Biomed Health Inform. 2022;26:229–42.PubMedCrossRef Cicirelli G, Impedovo D, Dentamaro V, Marani R, Pirlo G, D’Orazio TR. Human gait analysis in neurodegenerative diseases: a review. IEEE J Biomed Health Inform. 2022;26:229–42.PubMedCrossRef
10.
go back to reference Worsley PR, Whatling G, Barrett D, Holt C, Stokes M, Taylor M. Assessing changes in subjective and objective function from pre- to post-knee arthroplasty using the Cardiff Dempster-Shafer theory classifier. Comput Methods Biomech Biomed Engin. 2016;19:418–27.PubMedCrossRef Worsley PR, Whatling G, Barrett D, Holt C, Stokes M, Taylor M. Assessing changes in subjective and objective function from pre- to post-knee arthroplasty using the Cardiff Dempster-Shafer theory classifier. Comput Methods Biomech Biomed Engin. 2016;19:418–27.PubMedCrossRef
11.
go back to reference Klöpfer-Krämer I, Brand A, Wackerle H, Müßig J, Kröger I, Augat P. Gait analysis - available platforms for outcome assessment. Injury. 2020;51(Suppl 2):S90–6.PubMedCrossRef Klöpfer-Krämer I, Brand A, Wackerle H, Müßig J, Kröger I, Augat P. Gait analysis - available platforms for outcome assessment. Injury. 2020;51(Suppl 2):S90–6.PubMedCrossRef
12.
go back to reference Hecht GG, Van Rysselberghe NL, Young JL, Gardner MJ. Gait analysis in orthopaedic surgery: history, limitations, and future directions. J Am Acad Orthop Surg. 2022;30:e1366–73.PubMedCrossRef Hecht GG, Van Rysselberghe NL, Young JL, Gardner MJ. Gait analysis in orthopaedic surgery: history, limitations, and future directions. J Am Acad Orthop Surg. 2022;30:e1366–73.PubMedCrossRef
13.
go back to reference Boutaayamou M, Schwartz C, Stamatakis J, Denoël V, Maquet D, Forthomme B, et al. Development and validation of an accelerometer-based method for quantifying gait events. Med Eng Phys. 2015;37:226–32.PubMedCrossRef Boutaayamou M, Schwartz C, Stamatakis J, Denoël V, Maquet D, Forthomme B, et al. Development and validation of an accelerometer-based method for quantifying gait events. Med Eng Phys. 2015;37:226–32.PubMedCrossRef
14.
go back to reference Tong K, Granat MH. A practical gait analysis system using gyroscopes. Med Eng Phys. 1999;21:87–94.PubMedCrossRef Tong K, Granat MH. A practical gait analysis system using gyroscopes. Med Eng Phys. 1999;21:87–94.PubMedCrossRef
15.
go back to reference Kotiadis D, Hermens HJ, Veltink PH. Inertial gait phase detection for control of a drop foot stimulator Inertial sensing for gait phase detection. Med Eng Phys. 2010;32:287–97.PubMedCrossRef Kotiadis D, Hermens HJ, Veltink PH. Inertial gait phase detection for control of a drop foot stimulator Inertial sensing for gait phase detection. Med Eng Phys. 2010;32:287–97.PubMedCrossRef
16.
go back to reference Gouwanda D, Gopalai AA. A robust real-time gait event detection using wireless gyroscope and its application on normal and altered gaits. Med Eng Phys. 2015;37:219–25.PubMedCrossRef Gouwanda D, Gopalai AA. A robust real-time gait event detection using wireless gyroscope and its application on normal and altered gaits. Med Eng Phys. 2015;37:219–25.PubMedCrossRef
17.
go back to reference Luning S, Jinzhong Z. Rehabilitation guide for knee arthroscopy and shoulder arthroscopy. 2nd ed. Nanjing: Jiangsu Phoenix Science and Technology Press; 2020. p. 41–4. Luning S, Jinzhong Z. Rehabilitation guide for knee arthroscopy and shoulder arthroscopy. 2nd ed. Nanjing: Jiangsu Phoenix Science and Technology Press; 2020. p. 41–4.
18.
go back to reference Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349–53.PubMedCrossRef Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349–53.PubMedCrossRef
19.
go back to reference Schneider W, Jurenitsch S. Normative data for the American orthopedic foot and ankle society ankle-hindfoot, midfoot, hallux and lesser toes clinical rating system. Int Orthop. 2016;40:301–6.PubMedCrossRef Schneider W, Jurenitsch S. Normative data for the American orthopedic foot and ankle society ankle-hindfoot, midfoot, hallux and lesser toes clinical rating system. Int Orthop. 2016;40:301–6.PubMedCrossRef
20.
go back to reference Wang J, Tang L, Tang J, Chen J, Gong X, Qin L, et al. The typically developing pediatric foot - the data of the 1744 children in China. Foot Ankle Surg. 2022;28:347–53.PubMedCrossRef Wang J, Tang L, Tang J, Chen J, Gong X, Qin L, et al. The typically developing pediatric foot - the data of the 1744 children in China. Foot Ankle Surg. 2022;28:347–53.PubMedCrossRef
21.
go back to reference Zhao C, Chen J, Deng Y, Huang W, Ma S, Su S, et al. Arch volume: a new method for medial longitudinal arch measurement. Foot Ankle Surg. 2022;28:962–7.PubMedCrossRef Zhao C, Chen J, Deng Y, Huang W, Ma S, Su S, et al. Arch volume: a new method for medial longitudinal arch measurement. Foot Ankle Surg. 2022;28:962–7.PubMedCrossRef
22.
go back to reference He J, Tang Q, Ernst S, Linde MA, Smolinski P, Wu S, et al. Peroneus longus tendon autograft has functional outcomes comparable to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2021;29:2869–79.PubMedCrossRef He J, Tang Q, Ernst S, Linde MA, Smolinski P, Wu S, et al. Peroneus longus tendon autograft has functional outcomes comparable to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2021;29:2869–79.PubMedCrossRef
23.
go back to reference Rhatomy S, Asikin AIZ, Wardani AE, Rukmoyo T, Lumban-Gaol I, Budhiparama NC. Peroneus longus autograft can be recommended as a superior graft to hamstring tendon in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27:3552–9.PubMedCrossRef Rhatomy S, Asikin AIZ, Wardani AE, Rukmoyo T, Lumban-Gaol I, Budhiparama NC. Peroneus longus autograft can be recommended as a superior graft to hamstring tendon in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27:3552–9.PubMedCrossRef
24.
go back to reference Nazem K, Barzegar M, Hosseini A, Karimi M. Can we use peroneus longus in addition to hamstring tendons for anterior cruciate ligament reconstruction? Adv Biomed Res. 2014;3:115.PubMedPubMedCentralCrossRef Nazem K, Barzegar M, Hosseini A, Karimi M. Can we use peroneus longus in addition to hamstring tendons for anterior cruciate ligament reconstruction? Adv Biomed Res. 2014;3:115.PubMedPubMedCentralCrossRef
25.
go back to reference Zhao J, Huangfu X. The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source. Am J Sports Med. 2012;40:662–71.PubMedCrossRef Zhao J, Huangfu X. The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source. Am J Sports Med. 2012;40:662–71.PubMedCrossRef
26.
go back to reference Shao X, Shi LL, Bluman EM, Wang S, Xu X, Chen X, et al. Satisfactory functional and MRI outcomes at the foot and ankle following harvesting of full thickness peroneus longus tendon graft. Bone Jt J. 2020;102-B:205–11.CrossRef Shao X, Shi LL, Bluman EM, Wang S, Xu X, Chen X, et al. Satisfactory functional and MRI outcomes at the foot and ankle following harvesting of full thickness peroneus longus tendon graft. Bone Jt J. 2020;102-B:205–11.CrossRef
27.
go back to reference Shi F-D, Hess DE, Zuo J-Z, Liu S-J, Wang X-C, Zhang Y, et al. Peroneus longus tendon autograft is a safe and effective alternative for anterior cruciate ligament reconstruction. J Knee Surg. 2019;32:804–11.PubMedCrossRef Shi F-D, Hess DE, Zuo J-Z, Liu S-J, Wang X-C, Zhang Y, et al. Peroneus longus tendon autograft is a safe and effective alternative for anterior cruciate ligament reconstruction. J Knee Surg. 2019;32:804–11.PubMedCrossRef
28.
go back to reference Sumal AS, Jarvis GE, Norrish AR, Brassett C, Whitaker RH. The role of the angle of the fibularis longus tendon in foot arch support. Clin Anat. 2021;34:651–8.PubMedCrossRef Sumal AS, Jarvis GE, Norrish AR, Brassett C, Whitaker RH. The role of the angle of the fibularis longus tendon in foot arch support. Clin Anat. 2021;34:651–8.PubMedCrossRef
29.
go back to reference Sethi D, Bharti S, Prakash C. A comprehensive survey on gait analysis: history, parameters, approaches, pose estimation, and future work. Artif Intell Med. 2022;129:102314.PubMedCrossRef Sethi D, Bharti S, Prakash C. A comprehensive survey on gait analysis: history, parameters, approaches, pose estimation, and future work. Artif Intell Med. 2022;129:102314.PubMedCrossRef
30.
go back to reference Mangone M, Marinelli E, Santilli G, Finanore N, Agostini F, Santilli V, et al. Gait analysis advancements: rehabilitation value and new perspectives from forensic application. Eur Rev Med Pharmacol Sci. 2023;27:3–12.PubMed Mangone M, Marinelli E, Santilli G, Finanore N, Agostini F, Santilli V, et al. Gait analysis advancements: rehabilitation value and new perspectives from forensic application. Eur Rev Med Pharmacol Sci. 2023;27:3–12.PubMed
31.
32.
go back to reference Mohtadi NG, Chan DS. A randomized clinical trial comparing patellar tendon, hamstring tendon, and double-bundle ACL reconstructions: patient-reported and clinical outcomes at 5-year follow-up. J Bone Jt Surg Am. 2019;101:949–60.CrossRef Mohtadi NG, Chan DS. A randomized clinical trial comparing patellar tendon, hamstring tendon, and double-bundle ACL reconstructions: patient-reported and clinical outcomes at 5-year follow-up. J Bone Jt Surg Am. 2019;101:949–60.CrossRef
33.
go back to reference Björnsson H, Samuelsson K, Sundemo D, Desai N, Sernert N, Rostgård-Christensen L, et al. A randomized controlled trial with mean 16-year follow-up comparing hamstring and patellar tendon autografts in anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44:2304–13.PubMedCrossRef Björnsson H, Samuelsson K, Sundemo D, Desai N, Sernert N, Rostgård-Christensen L, et al. A randomized controlled trial with mean 16-year follow-up comparing hamstring and patellar tendon autografts in anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44:2304–13.PubMedCrossRef
34.
go back to reference Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA. Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med. 2016;44:3083–94.PubMedCrossRef Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA. Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med. 2016;44:3083–94.PubMedCrossRef
35.
go back to reference Carollo JJ, Matthews D. Strategies for clinical motion analysis based on functional decomposition of the gait cycle. Phys Med Rehabil Clin N Am. 2002;13:949–77.PubMedCrossRef Carollo JJ, Matthews D. Strategies for clinical motion analysis based on functional decomposition of the gait cycle. Phys Med Rehabil Clin N Am. 2002;13:949–77.PubMedCrossRef
37.
go back to reference Angthong C, Chernchujit B, Apivatgaroon A, Chaijenkit K, Nualon P, Suchao-in K. The anterior cruciate ligament reconstruction with the peroneus longus tendon: a biomechanical and clinical evaluation of the donor ankle morbidity. J Med Assoc Thai. 2015;98:555–60.PubMed Angthong C, Chernchujit B, Apivatgaroon A, Chaijenkit K, Nualon P, Suchao-in K. The anterior cruciate ligament reconstruction with the peroneus longus tendon: a biomechanical and clinical evaluation of the donor ankle morbidity. J Med Assoc Thai. 2015;98:555–60.PubMed
39.
go back to reference Rademaker J, Rosenberg ZS, Beltran J, Colon E. Alterations in the distal extension of the musculus peroneus brevis with foot movement. AJR Am J Roentgenol. 1997;168:787–9.PubMedCrossRef Rademaker J, Rosenberg ZS, Beltran J, Colon E. Alterations in the distal extension of the musculus peroneus brevis with foot movement. AJR Am J Roentgenol. 1997;168:787–9.PubMedCrossRef
41.
go back to reference Johnson CH, Christensen JC. Biomechanics of the first ray. Part I. The effects of peroneus longus function: a three-dimensional kinematic study on a cadaver model. J Foot Ankle Surg. 1999;38:313–21.PubMedCrossRef Johnson CH, Christensen JC. Biomechanics of the first ray. Part I. The effects of peroneus longus function: a three-dimensional kinematic study on a cadaver model. J Foot Ankle Surg. 1999;38:313–21.PubMedCrossRef
42.
go back to reference Karimi M, Fatoye F, Mirbod SM, Omar H, Nazem K, Barzegar MR, et al. Gait analysis of anterior cruciate ligament reconstructed subjects with a combined tendon obtained from hamstring and peroneus longus. Knee. 2013;20:526–31.PubMedCrossRef Karimi M, Fatoye F, Mirbod SM, Omar H, Nazem K, Barzegar MR, et al. Gait analysis of anterior cruciate ligament reconstructed subjects with a combined tendon obtained from hamstring and peroneus longus. Knee. 2013;20:526–31.PubMedCrossRef
43.
go back to reference Bi M, Zhao C, Zhang Q, Cao L, Chen X, Kong M, et al. All-inside anterior cruciate ligament reconstruction using an anterior half of the peroneus longus tendon autograft. Orthop J Sports Med. 2021;9:2325967121991226.PubMedPubMedCentralCrossRef Bi M, Zhao C, Zhang Q, Cao L, Chen X, Kong M, et al. All-inside anterior cruciate ligament reconstruction using an anterior half of the peroneus longus tendon autograft. Orthop J Sports Med. 2021;9:2325967121991226.PubMedPubMedCentralCrossRef
44.
go back to reference Rhatomy S, Abadi MBT, Setyawan R, Asikin AIZ, Soekarno NR, Imelda L-G, et al. Posterior cruciate ligament reconstruction with peroneus longus tendon versus hamstring tendon: a comparison of functional outcome and donor site morbidity. Knee Surg Sports Traumatol Arthrosc. 2021;29:1045–51.PubMedCrossRef Rhatomy S, Abadi MBT, Setyawan R, Asikin AIZ, Soekarno NR, Imelda L-G, et al. Posterior cruciate ligament reconstruction with peroneus longus tendon versus hamstring tendon: a comparison of functional outcome and donor site morbidity. Knee Surg Sports Traumatol Arthrosc. 2021;29:1045–51.PubMedCrossRef
45.
go back to reference Kaur M, Ribeiro DC, Theis J-C, Webster KE, Sole G. Movement patterns of the knee during gait following ACL reconstruction: a systematic review and meta-analysis. Sports Med. 2016;46:1869–95.PubMedCrossRef Kaur M, Ribeiro DC, Theis J-C, Webster KE, Sole G. Movement patterns of the knee during gait following ACL reconstruction: a systematic review and meta-analysis. Sports Med. 2016;46:1869–95.PubMedCrossRef
Metadata
Title
The effect of harvesting the anterior half of the peroneus longus tendon on foot morphology and gait
Authors
Zhi Zhao
Li Tang
Jing Chen
Xinwen Bai
Yu Chen
Liqi Ng
Yu Zhou
Yu Deng
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-023-04429-6

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