Peroneus Longus Morbidity Is More Significant Than Appreciated

The peroneus longus (PL) tendon is often used an autograft source with the belief that donor-site morbidity is minimal. However, this new study challenges that belief and causes us to pause before sacrificing the PL tendon.

Study design

The study is a retrospective review of 35 patients (mean age 43) who underwent PL autograft harvest between 2021–2023, with an average 22.5-month follow-up. Pre- and postoperative assessments included SANE, AOFAS, FAOS, CAIT scores, and ankle range of motion (ROM). Minimal clinically important difference (MCID) thresholds were used to assess donor-site morbidity.

Function preserved, but symptoms tell another story

• Ankle ROM: Preserved postoperatively (no significant change, P > .05).

• Patient-reported outcomes (PROMs): Significant declines from baseline (P < .05). Mean postoperative scores were SANE 92.3, AOFAS 96.7, FAOS 97.0, CAIT 27.4.

• Clinically meaningful declines: The proportion of patients exceeding the MCID was 51.4% for SANE, 31.4% for AOFAS, 34.2% for FAOS, and 5.7% for CAIT.

• Complications: Two cases of transient sural nerve hypoesthesia, both resolved spontaneously.

Clinical implications: donor-site morbidity is real

PL tendon harvest maintains ankle motion but leads to measurable, and sometimes clinically meaningful, declines in patient-reported outcomes at one year. Surgeons should weigh donor-site morbidity when selecting grafts and consider long-term monitoring.