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

Background: 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.

Methods: 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.

Results: 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 (P > .05), PROMs declined significantly compared with preoperative values (P < .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.

Conclusion: 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.