Posts

Translate this page into:

To Assess the Functional Outcome of the Fibularis Longus Sinew Autograft Versus the Hamstring Sinew Autograft for ACL Reconstruction

/in /by

Original Article | Journal of Clinical Orthopaedics | Vol 10 | Issue 2 | July-December 2025 | page: 105-110| Pankaj Kumar Singh, Avinash Kumar Singh, Dinesh Kumar Chaturvedi, Sachin Kale

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.792

Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 11 Jul 2025, Review Date: 08 Aug 2025, Accepted Date: 10 Sep 2025 & Published Date: 10 Dec 2025

Author: Pankaj Kumar Singh [1], Avinash Kumar Singh [1], Dinesh Kumar Chaturvedi [1], Sachin Kale [2]

[1] Department of Orthopaedic, Heritage Institute of Medical Sciences, Varanasi, U.P., India.
[2] Department of Orthopaedic, Dr. D Y Patil School of Medicine, Nerul, Navi Mumbai, Maharashtra, India

Address of Correspondence
Dr. Avinash Kumar Singh,
Department of Orthopaedic, Heritage Institute of Medical Sciences, Varanasi, U.P., India.
E-mail: avinashsingha@gmail.com

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction is widely performed to restore knee stability following ligament rupture. The choice of autograft remains pivotal in determining long-term functional outcomes. While hamstring tendon (HT) autografts are commonly used, they are associated with donor site morbidity and variable graft diameter. Fibularis longus tendon (PLT) has emerged as a promising alternative due to its favourable biomechanical properties and potential to preserve hamstring function.
Objectives: To assess and compare the functional outcomes, knee stability, and donor site morbidity associated with PLT versus HT autografts in patients undergoing ACL reconstruction.
Methods: A prospective comparative clinical study was conducted between August 2023 and March 2025 at a tertiary care institute in Varanasi. Fifty patients with isolated ACL tears were randomly assigned to undergo reconstruction using either HT or PLT autografts (25 per group). All underwent standardized arthroscopic techniques and a uniform rehabilitation protocol. Functional outcomes were assessed using IKDC, Lysholm, and Cincinnati scores; donor site morbidity using AOFAS and FADI scores; and knee stability via Lachman, pivot shift, and anterior drawer tests.
Results: Both groups showed significant improvement in IKDC scores postoperatively. The PLT group had a slightly higher mean IKDC at 1 year (90.90 vs 89.52; p=0.068), greater graft diameter, and better preservation of thigh muscle mass. No significant differences in knee stability tests or major complications were observed.
Conclusion: PLT is a reliable and effective autograft, showing comparable if not slightly superior functional outcomes to HT in ACL reconstruction, with minimal donor site morbidity.
Keywords: Anterior Cruciate Ligament, Autografts, Fibularis Longus Tendon, Hamstring Tendon, Functional Outcome.

References

1. Chia L, De Oliveira Silva D, Whalan M, McKay MJ, Sullivan J, Fuller CW, Pappas E. Non-contact anterior cruciate ligament injury epidemiology in team-ball sports: a systematic review with meta-analysis by sex, age, sport, participation level, and exposure type. Sports medicine. 2022 Oct;52(10):2447-67.
2. Mlv SK, Mahmood A, Vatsya P, Garika SS, Mittal R, Nagar M. Demographic characteristics of patients who underwent anterior cruciate ligament reconstruction at a tertiary care hospital in India. World Journal of Clinical Cases. 2023 May 26;11(15):3464.
3. Gokeler A, Grassi A, Hoogeslag R, van Houten A, Lehman T, Bolling C, Buckthorpe M, Norte G, Benjaminse A, Heuvelmans P, Di Paolo S. Return to sports after ACL injury 5 years from now: 10 things we must do. Journal of experimental orthopaedics. 2022 Jul 30;9(1):73.
4. Rovere G, Stramazzo L, Romeo M, D’Arienzo A, Maccauro G, Camarda L. Hamstring graft preparation for ACL reconstruction. Orthopedic Reviews. 2022 Dec 17;14(5):38408.
5. Giusti S, Susca M, Cerulli S, De Fenu E, Adriani E. Donor‐Site Morbidity in Anterior Cruciate Ligament (ACL) Reconstruction With All‐Soft Tissue Quadriceps Tendon Autograft vs. Hamstring Tendon Autograft: A Retrospective Monocentric Observational Study. Advances in Orthopedics. 2025;2025(1):8833546.
6. Keyhani S, Qoreishi M, Mousavi M, Ronaghi H, Soleymanha M. Peroneus longus tendon autograft versus hamstring tendon autograft in anterior cruciate ligament reconstruction: a comparative study with a mean follow-up of two years. Archives of Bone and Joint Surgery. 2022 Aug;10(8):695.
7. Gök B, Kanar M, Tutak Y. Peroneus longus vs hamstring tendon autografts in ACL reconstruction: A comparative study of 106 patients’ outcomes. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2024 Oct 26;30:e945626.
8. Rhatomy S, Hartoko L, Setyawan R, Soekarno NR, Asikin AI, Pridianto D, Mustamsir E. Single bundle ACL reconstruction with peroneus longus tendon graft: 2-years follow-up. Journal of clinical orthopaedics and trauma. 2020 May 1;11:S332-6.
9. Liu CT, Lu YC, Huang CH. Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. Journal of Orthopaedic Science. 2015 Sep;20(5):854-60.
10. 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 Jun 1;98(6):555-60.
11. Wiradiputra AE, Aryana GN. Peroneus longus tendon graft for anterior cruciate ligament reconstruction: a case report and review of literature. International Journal of Surgery Case Reports. 2021 Jun 1;83:106028.
12. Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M. A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. The American journal of sports medicine. 2005 Sep;33(9):1337-45.
13. Park SY, Oh H, Park S, Lee JH, Lee SH, Yoon KH. Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2013 May;21(5):1111-8.
14. Feller JA, Webster KE. A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. The American journal of sports medicine. 2003 Jul;31(4):564-73.
15. He J, Tang Q, Ernst S, Linde MA, Smolinski P, Wu S, Fu F. Peroneus longus tendon autograft has functional outcomes comparable to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2021 Sep;29(9):2869-79.
16. Khalil MH, Zawam SH. Comparative study of Peroneus longus tendon autograft versus Hamstring tendon autograft in arthroscopic anterior cruciate ligament reconstruction. International Orthopaedics. 2025 Jun;49(6):1365-72.
17. Kerimoglu S, Aynaci O, Saracoglu M, Aydin H, Turhan A. Anterior cruciate ligament reconstruction with the peroneus longus tendon. Acta orthopaedica et traumatologica turcica. 2008 Jan 1;42(1):38-43.

How to Cite this Article: Singh PK, Singh AK, Chaturvedi DK, Kale S. To Assess the Functional Outcome of the Fibularis Longus Sinew Autograft Versus the Hamstring Sinew Autograft for ACL Reconstruction. Journal of Clinical Orthopaedics. July-December 2025;10(2):105-110.

 (Article Text HTML)  (Download PDF)

Translate this page into:

An Observational Study of Clinical, Radiological, and Functional Outcome in Tibial Plateau Fractures Operated with Open Reduction Internal Fixation in Adults

/in , /by

Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 52-57 | Piyush Madhukar Jadhao, Ashish Phadnis

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.664

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 28 Sep 2024, Review Date: 26 Oct 2024, Accepted Date: 02 Nov 2024 & Published Date: 10 Dec 2024

Author: Piyush Madhukar Jadhao [1], Ashish Phadnis [1]

[1] Department of Orthopaedics, Jupiter Hospital – Eastern Express Highway, Thane, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Piyush Madhukar Jadhao,
Senior Registrar, Jupiter Hospital – Eastern Express Highway, Thane, Mumbai, Maharashtra, India.
E-mail: piyushoasis@gmail.com

Abstract

Background: Tibial plateau fractures are among some of the most challenging fractures to treat, associated with a high incidence of posttraumatic osteoarthritis later in life. The most commonly used surgical treatment is open reduction and fixation (ORIF) with plates and screws.
Objectives: This study was conducted to determine the radiological, clinical, and functional outcomes of patients with tibial plateau fractures treated by ORIF.
Materials and Methods: This retroprospective observational study included adult patients operated on for tibial plateau fractures using ORIF. Functional outcome was assessed by patient-reported outcome measures using Short Musculoskeletal Function Assessment, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form-36 Quality of Life questionnaires. Clinical and radiological outcomes were assessed using Modified Rasmussen’s clinical and radiological criteria.
Results: The majority of our patients had type 6 fractures (43.59%). We found a statistically significant negative correlation between the type of fracture and the KOOS total score. Clinical assessment using the Modified Rasmussen Criteria showed excellent results in 33.33% of patients, good results in 51.28% of patients, and fair and poor results in 7.69% of patients each, with an overall satisfactory clinical result in 84.61% of patients. The radiological assessment noted excellent results in 23.08% of patients, good results in 56.41% of patients, fair results in 12.82% of patients, and poor results in 7.69% of patients.
Conclusions: The preferred treatment of choice for tibial plateau fractures is open reduction internal fixation, with most patients demonstrating satisfactory (excellent to good) clinical and radiological outcomes. Operatively treated tibial plateau fractures result in improved functional outcomes, as it offers excellent anatomical reduction and rigid fixation to restore early movement and articular congruity, in addition to preventing stiffness of the knee.
Keywords: Proximal tibia fracture, ORIF, Quality of life, functional outcome, KOOS, SF-36, SMFA.

References

1. Stevens DG, Beharry R, McKee MD, Waddell JP, Schemitsch EH. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001;15:312-20.
2. Wood AM, Aitken SA, Hipps D, Heil K, Court-Brown C. The epidemiology and changing face of tibial plateau fractures and other intra-articular proximal tibial fractures: The Edinburgh experience. Orthop Proc 2015;97:23.
3. He QF, Sun H, Shu LY, Zhan Y, He CY, Zhu Y, et al. Tibial plateau fractures in elderly people: An institutional retrospective study. J Orthop Surg Res 2018;13:276.
4. Millar SC, Arnold JB, Thewlis D, Fraysse F, Solomon LB. A systematic literature review of tibial plateau fractures: What classifications are used and how reliable and useful are they? Injury 2018;49:473-90.
5. Roberts D, Bryanton M, et al. Radiopaedia. Schatzker Classification of Tibial Plateau Fractures. Available from: https://radio paedia.org/articles/schatzker-classification-of-tibial-plateau-fractures-1 [Last accessed on 2020 Jun 18].
6. Rüedi TP, Murphy WM. AO Principles of Fracture Management. 1st ed. Stuttgart: Thieme; 2007.
7. Manidakis N, Dosani A, Dimitriou R, Stengel D, Matthews S, Giannoudis P. Tibial plateau fractures: Functional outcome and incidence of osteoarthritis in 125 cases. Int Orthop 2010;34:565-70.
8. Timmers TK, van der Ven DJ, de Vries LS, van Olden GD. Functional outcome after tibial plateau fracture osteosynthesis: A mean follow-up of 6 years. Knee 2014;21:1210-5.
9. Raza H, Hashmi P, Abbas K, Hafeez K. Minimally invasive plate osteosynthesis for tibial plateau fractures. J Orthop Surg (Hong Kong) 2012;20:42-7.
10. Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am 2006;88:1713-21.
11. Ebraheim NA, Sabry FF, Haman SP. Open reduction and internal fixation of 117 tibial plateau fractures. Orthopedics 2004;27:1281-7.
12. Rademakers MV, Kerkhoffs GM, Sierevelt IN, Raaymakers EL, Marti RK. Operative treatment of 109 tibial plateau fractures: Five- to 27-year follow-up results. J Orthop Trauma 2007;21:5-10.
13. Dattani R, Slobogean GP, O’Brien PJ, Broekhuyse HM, Blachut PA, Guy P, et al. Psychometric analysis of measuring functional outcomes in tibial plateau fractures using the Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA) and the Western Ontario McMaster Osteoarthritis (WOMAC) questionnaires. Injury 2013;44:825-9.
14. Van Dreumel RL, Van Wunnik BP, Janssen L, Simons PC, Janzing HM. Mid-to long term functional outcome after open reduction and internal fixation of tibial plateau fractures. Injury 2015;46:1608-12.
15. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010;24:683-92.

How to Cite this article: Jadhao PM, Phadnis A. An Observational Study of Clinical, Radiological, and Functional Outcome in Tibial Plateau Fractures Operated with Open Reduction Internal Fixation in Adults. Journal of Clinical Orthopaedics July-December 2024;9(2):52-57.

 (Article Text HTML)       (Download PDF)