Peroneus Longus Autograft Harvest: Patient-Reported Donor-Ankle Morbidity at 1 Year.

Abstract

The peroneus longus (PL) tendon is increasingly used as an autograft for ligament and tendon reconstructions, particularly in populations where hamstring graft dimensions may be insufficient. However, donor-site ankle function and patient-reported outcomes measures (PROMs) after PL harvest remain underreported. This study aimed to evaluate changes in PROMs and range of motion (ROM) at the donor-site ankle 1 year after PL autograft harvest and the proportion exceeding minimal clinically important difference (MCID) thresholds. Patients who underwent PL autograft harvest from January 2021 through April 2023 were retrospectively enrolled. PROMs-including the Single Assessment Numeric Evaluation (SANE), American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and Cumberland Ankle Instability Tool (CAIT) score-were assessed preoperatively and at 1-year follow-up on the operated ankle. Ankle ROM was also measured. Donor-site morbidity was evaluated using MCID thresholds. Thirty-five patients (mean age: 43 ± 28 years) completed follow-up at a mean of 22.5 ± 10 months. Although ankle ROM was preserved with no statistically significant changes (<i>P</i> > .05), PROMs declined significantly compared with preoperative values (<i>P</i> < .05), with postoperative scores of SANE (92.3 ± 27.3), AOFAS (96.7 ± 10.7), FAOS (97.0 ± 23), and CAIT (27.4 ± 19.4). MCID thresholds were exceeded in 51.4% (SANE), 31.4% (AOFAS), 34.2% (FAOS), and 5.7% (CAIT) of patients. Two patients experienced transient sural nerve hypoesthesia, which resolved without long-term deficit. PL tendon harvest was associated with preserved ankle ROM at 1 year but demonstrated statistically significant declines in PROMs compared with preoperative baselines. A subset of patients exceeded MCID thresholds, indicating clinically meaningful donor-site morbidity in some cases. These findings underscore the importance of informed graft selection and highlight the need for further long-term evaluation.