The Association Between Duration Of Injury And Peroneus Longus Tendon Diameter And Secondary Meniscal And Chondral Damage

Background Anterior cruciate ligament(ACL)is one of the most important structures in knee joint to maintain knee stability.However,the injuries to ACL are increasing.Anterior cruciate ligament reconstruction(ACLR)is the most common procedure used to restore knee stability.Multiple factors could influence the revision rate of this procedure,especially the diameter of graft.However,studies predicting the graft diameter are few and most of existed articles are hamstring tendon related.After ACL injury,the incidence of meniscus tear and cartilage lesion increased.Multiple factors were associated with the presence of secondary injury,such as age,gender,and especially the duration from injury to surgery.Purpose To investigate the relationship between anthropometric data and peroneus longus tendon(PLT)diameter and to explore the factors associated with secondary meniscal and chondral injuries after anterior cruciate ligament injury.Methods We retrospectively analyzed the data of patients who underwent anterior cruciate ligament reconstruction(ACLR)with the PLT graft at our institution between April 2015 and March 2017.Anthropometric parameters including height,weight,gender,age,duration of injury,pre-injury activity levels,gender,and age as well as the incidence of meniscal and chondral injuries were collected from medical recorded or telephone follow-up survey.Results The mean PLT graft diameter was 8.3 mm,and 21 patients(13.5%)had a diameter less than 8mm;85 patients(54.5%)had a diameter between 8 and 9mm,and 50 patients(32.0%)had a diameter greater than or equal to 9mm.The correlation analysis showed that height(r=0.44,p<0.01),weight(r=0.41,p<0.01),and duration of injury(p=0.02)were significantly related to graft diameter.Based on these three predictors,the following regression equation was obtained:Diameter=2.28+0.028*height(cm)+0.012*weight(kg)+injury-to-surgery intervals*0.289.232(38.2%)patients suffered medial meniscus tears,299(49.3%)suffered lateral meniscal injuries,and 117(19.3%)suffered intra-articular cartilage lesions.After multivariable analysis,we found that gender was independently associated with the incidence of lateral meniscal injuries(P<0.01;OR 0.50;CI 0.34-0.73).Medial meniscal tears was associated with the injury-to-surgery intervals and gender(P<0.01;OR 1.63;CI 1.16-2.28;P=0.03;OR 0.64;CI 0.43-0.96).Severity of cartilage injury was significantly associated with injury-to-surgery intervals(P<0.01;OR 0.54;CI 0.34-0.86).The occurrence of cartilage lesions was only associated the duration from injury to surgery(P<0.01;OR 2.22;CI 1.39-3.55).Conclusion Height,weight and injury-to-surgery intervals were associated with the diameter of PLT.They are important preoperative information for surgeon about the size of PLT and can be used for alternative graft source planning and patient counselling.In addition,ACL reconstruction should be performed within one month after injury to reduce the risk for secondary meniscal and chondral injuries,as well as the severity of cartilage lesions,particularly for adult males.