Published: 2020-02-25

Arthroscopic anterior cruciate ligament reconstruction with semitendinosus graft versus peroneus longus tendon graft

Pudari Manoj Kumar, Ishan Shevte, Mukesh Phalak, Abhishek Nair, Parth .


Background: Arthroscopic anterior cruciate ligament (ACL) reconstruction can be performed using autograft from various sources namely, bone patellar tendon graft, hamstring tendons (semitendinosus, gracilis) or peroneus longus tendon.

Methods: A prospective study of 30 patients who underwent arthroscopic ACL reconstruction using quadrupled semitendinosus tendon autograft and peroneus longus tendon autograft during the study period.

Results: Statistically, there is very little comparable difference between semitendinosus and peroneus longus when used for arthroscopic ACL reconstruction. However, peroneus longus tendon shows superior results when used in patients with grade 3 medial collateral ligament (MCL) injury combined with ACL injury.

Conclusions: Our study brings forth the superior efficacy and quality of the double stranded peroneus longus tendon especially in cases associated with complicated injuries involving the medial collateral ligament with a follow up date of about 2 years and as a healthy supplement to other choices of autografts and revision cases.


Peroneus longus tendon, Semitendinosus, Medial collateral ligament, Arthroscopy

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Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Fu FH. Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 2: clinical application of surgical technique. Am J Sports Med. 2011;39(9):2016–26.

Kondo E, Yasuda K, Azuma H, Tanabe Y, Yagi T. Prospective clinical comparisons of anatomic double-bundle versus single-bundle anterior cruciate ligament reconstruction proce-dures in 328 consecutive patients. Am J Sports Med. 2008;36(9):1675–87.

Yasuda K, van Eck CF, Hoshino Y, Fu FH, Tashman S. Anatomic single-and double-bundle anterior cruciate ligament reconstruction, part 1: basic science. Am J Sports Med. 2011;39(8):1789–99.

Giuliani JR, Kilcoyne KG, Rue JP. Anterior cruciate ligament anatomy: a review of the anteromedial and posterolateral bundles. J Knee Surg. 2009;22(2):148–54.

Tsukada S, Fujishiro H, Watanabe K, Nimura A, Mochizuki T, Mahakkanukrauh P, et al. Anatomic variations of the lateral intercondylar ridge: relationship to the anterior mar-gin of the anterior cruciate ligament. Am J Sports Med. 2014;42(5):1110–7.

Klos TV, Harman MK, Habets RJ, Devilee RJ, Banks SA. Locating femoral graft placement from lateral radiographs in anterior cruciate ligament reconstruction: a comparison of 3 methods of measuring radiographic images. Arthroscopy. 2000;16(5):499–504.

Sommer C, Friederich NF, Müller W. Improperly placed anterior cruciate ligament grafts: correlation between radiological para-meters and clinical results. Knee Surg Sports Traumatol Arthrosc. 2000;8(4):207–13.

Jaureguito JW, Paulos LE. Why grafts fail. Clin Orthop Relat Res. 1996;325:25–41.

Liu CT, Lu YC, Huang CH. Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. J Orthop Sci. 2015;20(5):854-60.

Angthong C, Chernchujit B, Apivatgaroon A, Chaijenkit K, Nualon P, Suchaoin 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(6):555–60.

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;45(4):922–8.