Anterior Cruciate Ligament Injury, Anterior Cruciate Ligament Reconstruction, Donor Site Complication
Conditions
Keywords
peroneus longus tendon autograft, donor ankle, sensorimotor function, surface electromyography, postural control, proprioception, gait analysis
Brief summary
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.
Detailed description
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.
Interventions
PROCEDUREAnterior Cruciate Ligament Reconstruction Using a Peroneus Longus Tendon Autograft
Participants undergo primary anterior cruciate ligament reconstruction using a peroneus longus tendon autograft as part of their routine clinical care. The graft choice and surgical procedure are determined by the treating orthopedic surgeon independently of study participation. The study does not assign or modify the graft choice, surgical technique, or postoperative rehabilitation. Participants receive routine postoperative rehabilitation according to their clinical needs, while donor-ankle sensorimotor recovery is assessed prospectively at 6-8 weeks, 3 months, and 6 months after surgery.
Sponsors
Gazi University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Mean Center of Pressure Velocity During Single-Leg Balance | Postoperative 6-8 weeks, 3 months, and 6 months | Mean center of pressure (CoP) velocity during a 10-second single-leg stance, assessed separately with eyes open and eyes closed on KFORCE Plates. Each limb will be tested in three trials, and the mean for each condition will be used. Values are expressed in millimeters per second (mm/s); lower values indicate less postural sway. Change from the postoperative 6-8-week assessment to 3 and 6 months and donor-versus-contralateral limb differences will be evaluated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in CoP Path Length During Single-Leg Balance | Postoperative 6-8 weeks, 3 months, and 6 months | Total CoP path length during a 10-second single-leg stance with eyes open and eyes closed on KFORCE Plates, averaged across three valid trials for each limb and condition. Unit: millimeters (mm); lower values indicate less sway. |
| Change in CoP Ellipse Area During Single-Leg Balance | Postoperative 6-8 weeks, 3 months, and 6 months | Ellipse area of CoP excursion during a 10-second single-leg stance with eyes open and eyes closed on KFORCE Plates, averaged across three valid trials. Unit: square millimeters (mm²); lower values indicate less sway area. |
| Change in Mean CoP Velocity During Double-Leg Balance | Postoperative 6-8 weeks, 3 months, and 6 months | Mean CoP velocity during 30-second double-leg quiet stance with eyes open and eyes closed on KFORCE Plates, averaged across three trials per condition. Unit: millimeters per second (mm/s). |
| Change in CoP Path Length During Double-Leg Balance | Postoperative 6-8 weeks, 3 months, and 6 months | Total CoP path length during 30-second double-leg quiet stance with eyes open and eyes closed on KFORCE Plates, averaged across three trials per condition. Unit: millimeters (mm). |
| Change in CoP Ellipse Area During Double-Leg Balance | Postoperative 6-8 weeks, 3 months, and 6 months | Ellipse area of CoP excursion during 30-second double-leg quiet stance with eyes open and eyes closed on KFORCE Plates, averaged across three trials per condition. Unit: square millimeters (mm²). |
| Change in Mean Normalized Peroneus Longus RMS Amplitude During Single-Leg Heel Rise | Postoperative 6-8 weeks, 3 months, and 6 months | Mean root-mean-square surface EMG amplitude of the peroneus longus during the concentric, isometric, and eccentric phases of a metronome-paced single-leg heel rise. Each phase is reported separately as a percentage of session-specific maximal voluntary isometric contraction (%MVIC), averaged across three repetitions for each limb. |
| Change in Peak Normalized Peroneus Longus RMS Amplitude During Single-Leg Heel Rise | Postoperative 6-8 weeks, 3 months, and 6 months | Peak root-mean-square surface EMG amplitude during the concentric, isometric, and eccentric phases of a single-leg heel rise. Each phase is reported separately as %MVIC and averaged across three repetitions for each limb. |
| Change in Mean Normalized Peroneus Longus RMS Amplitude During Incline Heel Rise | Postoperative 6-8 weeks, 3 months, and 6 months | Mean root-mean-square surface EMG amplitude during the concentric, isometric, and eccentric phases of a single-leg heel rise on a rigid platform with approximately 30 degrees of medial inclination. Each phase is reported separately as %MVIC and averaged across three repetitions for each limb. |
| Change in Peak Normalized Peroneus Longus RMS Amplitude During Incline Heel Rise | Postoperative 6-8 weeks, 3 months, and 6 months | Peak root-mean-square surface EMG amplitude during the concentric, isometric, and eccentric phases of the medially inclined single-leg heel-rise task. Each phase is reported separately as %MVIC and averaged across three repetitions for each limb. |
| Change in Ankle Joint Position Sense Absolute Error | Postoperative 6-8 weeks, 3 months, and 6 months | Absolute difference between the 15-degree eversion target and the angle reproduced by the participant during active joint-position sense testing with eyes closed on a Cybex NORM dynamometer. Each limb will be evaluated separately. Unit: degrees (°); lower values indicate greater position-sense accuracy. |
| Change in Self-Selected Gait Speed | Postoperative 6-8 weeks, 3 months, and 6 months | Walking speed recorded with the G-Walk inertial sensor during self-selected walking over an approximately 10-meter walkway. The middle portion of the walk will be analyzed and three trials will be averaged. Unit: meters per second (m/s). |
| Change in Gait Cadence | Postoperative 6-8 weeks, 3 months, and 6 months | Cadence recorded with the G-Walk inertial sensor during self-selected walking, averaged across three trials. Unit: steps per minute. |
| Change in Step Length | Postoperative 6-8 weeks, 3 months, and 6 months | Step length recorded with the G-Walk inertial sensor during self-selected walking, averaged across three trials. Unit: meters (m). |
| Change in Gait Symmetry Index | Postoperative 6-8 weeks, 3 months, and 6 months | Between-limb gait symmetry index derived from G-Walk spatiotemporal data. Unit: percent (%); values closer to the device-defined symmetry reference indicate greater symmetry. |
| Change in Pelvic Tilt During Gait | Postoperative 6-8 weeks, 3 months, and 6 months | Sagittal-plane pelvic tilt measured by the G-Walk inertial sensor during self-selected walking, averaged across three trials. Unit: degrees (°). |
| Change in Pelvic Obliquity During Gait | Postoperative 6-8 weeks, 3 months, and 6 months | Frontal-plane pelvic obliquity measured by the G-Walk inertial sensor during self-selected walking, averaged across three trials. Unit: degrees (°). |
| Change in FAAM Activities of Daily Living Subscale | Preoperative, Postoperative 6-8 weeks, 3 months, and 6 months | Foot and Ankle Ability Measure Activities of Daily Living subscale, transformed to a 0%-100% score. Higher percentages indicate better self-reported function. |
| Change in FAAM Sports Subscale | Preoperative, Postoperative 6-8 weeks, 3 months, and 6 months | Foot and Ankle Ability Measure Sports subscale, transformed to a 0%-100% score. Higher percentages indicate better self-reported sport-related function. |
Countries
Turkey (Türkiye)
Contacts
CONTACTDudu Ozdemir Can, Msc
PRINCIPAL_INVESTIGATORDudu Ozdemir Can, Msc
Gazi University
STUDY_DIRECTORNihan Karatas, Prof. Dr.
Gazi University
Outcome results
None listed