Peroneus Longus Tendon Harvest for Acl Reconstruction Yields Good Functional Outcome of the Ankle: A Systematic Review and Meta-Analysis Publisher



Soleymanha M ; Soleymani Nejad A ; Keyhani S ; Vosoughi F ; Laprade RF ; Tollefson LV
Source: Knee Surgery, Sports Traumatology, Arthroscopy Published:2025

Abstract

Purpose: The peroneus longus tendon (PLT) has emerged as a promising autograft option for anterior cruciate ligament (ACL) reconstruction, but concerns persist regarding donor-site morbidity and ankle functional outcomes. This systematic review and meta-analysis aimed to evaluate ankle performance following PLT harvest for ACL reconstruction. Methods: This systematic review and meta-analysis performed by searching five databases (PubMed, Embase, Web of Science, Scopus, and the Cochrane Library) up to March 2025. Inclusion criteria included: ACL reconstruction using PLT autograft, ≥6-month follow-up, and validated ankle outcomes (American Orthopaedic Foot And Ankle Society [AOFAS]/Foot and Ankle Disability Index [FADI] scores). Pooled effect sizes were calculated using random-effects models using R software (version 4.4.3). Heterogeneity was assessed via I² statistics, and risk of bias was evaluated using JBI checklists. Results: Twenty articles (1024 patients) were identified, comprising eleven prospective cohort studies and nine randomised clinical trials (RCT), based on title, abstract, and quality assessments. Meta-analysis demonstrated excellent postoperative ankle function, with pooled AOFAS scores of 96.0 (95% confidence interval [CI]: 92.6–99.3) at 6 months, 96.1 (93.9–98.2) at 12 months, and 97.2 (93.9–100.6) at 24 months. FADI scores similarly improved to 97.4 (96.0–98.9) by 6 months and 99.4 (98.7–100.1) at 24 months. Meta-regression revealed no significant association between age and AOFAS outcomes (β = −0.23, p = 0.36). Minor complications (e.g., transient hypaesthesia) occurred in 13%–23% of patients but resolved within months. No studies reported major nerve injuries or ankle instability. Conclusion: Peroneus longus tendon harvest for ACL reconstruction yields minimal donor-site morbidity, with consistently high AOFAS/FADI scores across all age groups. These findings support the safety of PLT autografts, though heterogeneity is evident, and the predominance of male participants and the regional focus of studies, mainly Asian populations, may affect generalisability. Level of Evidence: Level II. © 2025 Elsevier B.V., All rights reserved.