取腓骨长肌腱用于前交叉韧带重建后，尽管外翻和第一跖列跖屈力量增强，但踝关节动态控制可能受损：一项观察性研究
简介
该研究纳入42例平均年龄31.7岁的患者，采用全厚腓骨长肌腱（PLT）自体移植物联合腓骨短肌腱固定术进行前交叉韧带重建（ACLR），术前及术后3、6个月评估踝关节动态稳定性、外翻及第一序列跖屈肌力、足踝功能及影像学参数。关键发现：踝关节跖屈活动度随时间显著增加（p=0.014），外翻活动度小幅但有统计学意义的下降（p<0.001）；第一序列跖屈肌力显著改善（…
英文摘要
BACKGROUND: The peroneus longus tendon (PLT) has emerged as a promising graft option for anterior cruciate ligament reconstruction (ACLR), with acceptable outcomes; however, concerns have been raised about potential donor-site morbidity, particularly affecting ankle and foot function. AIM: To evaluate ankle dynamic stability, eversion, and first-ray plantarflexion strength after harvesting PLT for ACLR, besides reporting the effect on foot and ankle functional outcomes and radiological foot parameters. METHODS: Forty-two patients having a mean age of 31.7 ± 9.95 years who underwent ACLR using a full-thickness PLT autograft with peroneus brevis tenodesis were evaluated preoperatively and at three and six months of follow up. Functional and clinical outcomes were assessed using the AOFAS score, ankle range of motion (ROM), and muscle strength; ankle dynamic stability was evaluated using the Eccentric-Concentric Bodyweight Power Test (ECBPT). In contrast, radiological outcomes included evaluating the Talonavicular Coverage Angle (TNCA), the Calcaneal Pitch angle (CPA), the lateral Talo-first metatarsal angle (lateral Meary's angle), and the Hindfoot Alignment Angle (HFAA). RESULTS: The Ankle plantarflexion increased significantly over time (p = 0.014). Eversion ROM demonstrated a small but statistically significant decline over time (p < 0.001). Ankle dorsiflexion and inversion remained stable throughout follow-up (p = 0.55 and 0.65, respectively). Strength of the first ray plantarflexion improved significantly over time (p < 0.001). Eversion power improved but did not reach statistical significance (p = 0.125). ECBPT decreased significantly over time (p < 0.001). Median values decreased from median 9.5 (IQR 6.0-12.0) preoperatively to 7.0 (IQR 4.2-9.8) at three months and 6.5 (IQR 4.2-9.0) at six months (p < 0.001). AOFAS scores were at the ceiling at all time points (median 100 [IQR 100-100] preoperatively, at 3 months, and at 6 months) with a statistically significant, yet clinically meaningless decline over time p < 0.001), which was noticed comparing preoperative to three and six months of follow up, p = 0.005 and 0.008, respectively, and no difference between three and six months, p = 0.157. The CPA showed a slight but statistically significant decline over time (p < 0.001). No changes were noted in TNCA (p = 0.297), lateral Meary's angle (p = 0.913), and HFAA (p = 0.629). CONCLUSION: Overall foot and ankle function, strength, and range of motion did not show clinically relevant deterioration after PLT harvesting; however, we observed potential alteration in dynamic ankle stability and possible decline in the foot longitudinal arch. Further investigation focused mainly on evaluating the PL muscle's primary functions, and longer follow up studies are warranted to reach conclusive evidence regarding the safety and efficacy of PLT for ACLR.