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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Functional outcomes of peroneus longus tendon autograft for posterior cruciate ligament reconstruction: A meta-analysis
Ahmed Mohamed Yousif Mohamed, Monzir Salih, Mugahid Mohamed, Ayman E Abbas, Maysara Elsiddig, Mazin Abdelsalam, Basil Elhag, Nujud Mohamed, Souzan Ahmed, Deena Omar, Samah Ahmed, Duaa Mohamed
Ahmed Mohamed Yousif Mohamed, Nujud Mohamed, Department of Orthopaedic, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Monzir Salih, Saint Luke’s Radiation Oncology Network, St Luke’s Hospital, Dublin D06 HH36, Ireland
Mugahid Mohamed, Maysara Elsiddig, Mazin Abdelsalam, Basil Elhag, Department of General Surgery, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Ayman E Abbas, Department of Plastic Surgery, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Souzan Ahmed, Deena Omar, Department of Emergency, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Samah Ahmed, Duaa Mohamed, Faculty of Medicine, Gezira University, Wad Medani 9GQH+GWW, Sudan
Author contributions: Yousif Mohamed AM and Salih M jointly led the meta-analysis, participated in conceptualization, research design, development of the search strategy, and defining inclusion/exclusion criteria, oversaw the systematic review process, data extraction, quality assessment, data synthesis, and manuscript preparation; Mohamed M, Abbas AE, Elsiddig M, Abdelsalam M, and Ahmed S conducted the comprehensive literature search, screened and selected studies, performed data extraction, and cross-verified the extracted data for accuracy; Elhag B and Mohamed N managed references, manuscript formatting, and the preparation of figures and tables, contributed to quality assessment; Omar D, Ahmed S, and Mohamed D handled the statistical analysis, interpreted the results, and provided critical methodological revisions, drafted the introduction and discussion sections; all authors participated in reviewing and editing the manuscript, read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ahmed Mohamed Yousif Mohamed, Department of Orthopaedic, Burjeel Medical City, 28
th Street, Abu Dhabi 92510, United Arab Emirates.
ahmedtom11@hotmail.com
Received: September 28, 2024
Revised: February 10, 2025
Accepted: February 17, 2025
Published online: March 18, 2025
Processing time: 164 Days and 21.4 Hours
BACKGROUND
The posterior cruciate ligament (PCL) is vital for regulating posterior tibial translation in relation to the femur, which is critical for knee stability. PCL tears are infrequently isolated in knee injuries; however, the absence of the PCL results in abnormal knee kinematics, which may cause injuries to other ligaments. The ideal tendon source for PCL reconstruction is still a subject of debate.
AIM
To evaluate the results of employing the peroneus longus tendon (PLT) in PCL reconstruction.
METHODS
A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction. Studies published up to August 2024 were searched across multiple databases, including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar. Full texts of the selected articles were retrieved, reviewed, and independently assessed by the investigators. Discrepancies were resolved by consensus, with any remaining disagreements being arbitrated by a third author.
RESULTS
This meta-analysis included five studies on PLT use for PCL reconstruction: (1) Four prospective studies with 104 patients; and (2) One retrospective study with 18 patients. Most studies followed up participants for 24 months, while one had a shorter follow-up of 18 months. Lysholm and modified cincinnati scores improved by pooled means of 32.2 (95%CI: 29.3-35.1, I2 = 0%) and 31.1 (95%CI: 27.98-34.22, I2 = 0%), respectively. Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5 (I2 = 61.5%) and 94.5 (I2 = 80.09%), respectively. Single-hop and triple-hop test scores averaged 95.5 (95%CI: 94.5-96.5) and 92.4 (95%CI: 91.9-92.9) respectively. No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.
CONCLUSION
Evidence supports PLT autografts for PCL reconstruction, improving knee function and patient outcomes. Larger randomized trials are needed to confirm efficacy and compare graft options.
Core Tip: This meta-analysis demonstrates that the peroneus longus tendon autograft is a viable and effective option for posterior cruciate ligament reconstruction, with evidence supporting improved knee stability and functional outcomes. Favourable muscle preservation is a key advantage. However, further high-quality studies are needed to confirm its long-term efficacy and safety across diverse populations.
