Recovery of Donor Ankle Sensorimotor Function Following Anterior Cruciate Ligament Reconstruction Using Peroneus Longus Tendon Autograft: A Prospective Longitudinal Study
This prospective longitudinal observational cohort study will characterize recovery of donor-ankle sensorimotor function in adults who have undergone primary anterior cruciate ligament reconstruction using a peroneus longus tendon autograft. Twenty participants aged 18 to 55 years will be evaluated at postoperative 6-8 weeks, 3 months, and 6 months. The donor limb and the contralateral non-donor limb will be compared using surface electromyography of the peroneus longus, force-platform measures of postural control, inertial-sensor gait analysis, active ankle joint-position sense testing, and clinical and patient-reported foot and ankle function measures. The study does not assign the surgical procedure or rehabilitation treatment.
Peroneus longus tendon autograft is used as an alternative graft source for anterior cruciate ligament reconstruction, but the longitudinal course of donor-site sensorimotor recovery has not been sufficiently described with objective measures. This study is designed to examine within-participant changes over time and differences between the donor and contralateral non-donor limbs. Eligible participants who underwent primary unilateral anterior cruciate ligament reconstruction with a peroneus longus tendon autograft at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital or Halil Şıvgın Çubuk State Hospital and who are referred to the Sports Health Unit of Gazi University will be followed at postoperative 6-8 weeks, 3 months, and 6 months. No graft type, surgery, or rehabilitation intervention is assigned by the investigators. At each assessment, peroneus longus activation will be recorded during single-leg heel-rise and medially inclined heel-rise tasks using surface electromyography and normalized to a session-specific maximal voluntary isometric contraction. Postural control will be assessed with KFORCE Plates during double-leg and single-leg balance tasks. Spatiotemporal gait and pelvic kinematics will be recorded with the G-Walk inertial sensor system. Active ankle joint-position sense will be assessed on a Cybex NORM dynamometer using a 15-degree eversion target. Foot and ankle function will be assessed using the Foot and Ankle Ability Measure. The primary analysis will examine time, limb, and time-by-limb effects across the three postoperative assessments. Parametric data will be analyzed using two-way repeated-measures analysis of variance, with nonparametric alternatives used when assumptions are not met. The planned enrollment is 20 participants, allowing for approximately 20% attrition from the minimum required sample of 16 completers.
Inclusion Criteria: * Age 18 to 55 years. * Unilateral primary anterior cruciate ligament tear confirmed by clinical examination and magnetic resonance imaging. * Primary anterior cruciate ligament reconstruction performed using a peroneus longus tendon autograft. * Able and willing to attend the postoperative assessments at 6-8 weeks, 3 months, and 6 months. * Written informed consent provided before study participation.
Exclusion Criteria: * Multiligament knee injury. * Previous surgery on the index knee or donor ankle. * Pre-existing ankle instability or major foot or ankle pathology. * Neurological or neuromuscular disease. * Inflammatory or systemic disease that may affect the assessments. * Major lower-extremity deformity that may affect the assessments. * Unable to complete the postoperative rehabilitation program or scheduled follow-up assessments.
[{"measure":"Change in Mean Center of Pressure Velocity During Single-Leg Balance","timeFrame":"Postoperative 6-8 weeks, 3 months, and 6 months"}]