Functional outcomes of peroneus longus tendon autograft for posterior cruciate ligament reconstruction: A meta-analysis

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, I 2 = 0%) and 31.1 (95%CI: 27.98-34.22, I 2 = 0%), respectively. Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5 (I 2 = 61.5%) and 94.5 (I 2 = 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.