Augmentation of the Anterior Cruciate Ligament Using the Peroneus Longus: Description of the Surgical Technique

Abstract

Background: The quadruple graft from the hamstring tendons has become a widely used option in the reconstruction of the anterior cruciate ligament (ACL), however, this graft may not have the desirable diameter for the reconstruction, increasing the risk of re-rupture. In this context, the peroneus longus tendon graft appears as an option to complement other grafts, transforming a thin quadruple graft into a sextuple graft. Indications: The sextuple graft technique for ACL reconstruction is used in patients who have a quadruple graft with a diameter of less than 8 mm, and due to its length, it is not possible to make a quintuple graft, for example. Technique Description: Initially, the hamstring tendons are removed with the aid of a tenotome. After that, the anterior half of the peroneus longus tendon is identified and removed. On the back table, the definitive graft is prepared so that we have a sextuple graft with a diameter greater than 8 mm. Finally, the ACL reconstruction is performed anatomically using an adjustable loop device in the femur and an interference screw in the tibia. Results: In our experience with patients who have a hamstring graft diameter of less than 8 mm, we obtained an average increase of 1.8 mm in graft diameter when augmentation was performed with the anterior half of the peroneus longus. Discussion: Grafts less than 8 mm in diameter are at increased risk of rupturing and failure of surgical treatment of the ACL injury. The surgeon must be prepared to make a quintuple or sextuple graft, but in some patients, the tendons are short or there is no availability of a tissue bank, making this practice impossible. The use of the anterior half of the peroneus longus to perform graft augmentation is safe, causing almost no morbidity to the donor area and is easily accessible during the procedure, making it an excellent option for increasing the diameter of thin grafts. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.