Correlation of Anthropometric Features with Peroneus Longus and Hamstring Tendons Graft Size for ACL reconstruction

Aditya Fuad Robby, Luthfi Hidayat, Rahadyan Magetsari


Background: Reconstruction of the anterior cruciate ligament (ACL) is a commonly performed surgical procedure in recent years. Surgeons have to consider several factors including patient’s anthropometric variables to harvest the best graft. The hamstring tendon has its’ limitation, such as the tendon graft size deemed unfit especially for people of small statures. The peroneus longus tendon is a relatively new choice compared to hamstring. This study was conducted to know the correlation between anthropometric features with graft parameters or graft size in patients who underwent ACL reconstruction using peroneus longus and hamstring tendons.

Materials and Methods: This cross-sectional study was performed in patients who underwent ACL reconstruction using peroneus longus or hamstring tendon autografts. We evaluated their anthropometric variables (age, gender, body mass index (BMI), height and weight) and correlated them with the graft diameter obtained during surgery. Post-operative results were assessed with Karlsson and Peterson Scoring System which represent the ankle function.

Results: Twenty-three non-athletic patients underwent ACL reconstruction surgery. Patients with hamstring graft have the average height of 170 cm and 163.6 cm for the peroneal graft group. The average body weight of the hamstring graft group was 72.917 kg and the peroneal graft group was 68.82 kg. The measured BMI of the hamstring graft group was 25.2 kg/m2 and 7.833 mm of graft diameter in average, with 25.5 kg/m2 and 7.636 mm respectively for the peroneus graft group. There were strong positive correlations between weight and BMI with hamstring tendon graft diameter, but negative weak correlations with peroneus tendon graft diameter.

Conclusion: We found that body weight and BMI correlate with the diameter of both peroneus and hamstring tendon grafts. Both autografts showed equally good functional results.


ACL reconstruction, Hamstring tendon, Peroneus longus tendon, autograft, BMI

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Thomas S, Bhattacharya R, Saltikob JB, Kramer DJ. Influence of anthropometric features on graft diameter in ACL reconstruction. Arch Orthop Trauma Surg. 2013;133:215–218.

Angthong C, Chernchujit B, Apivatgaroon A, Chaijenkit K, Nualon P, Suchao-in K. The anterior cruciate ligament reconstruction with the peroneus longus tendon: a biochemical and clinical evaluation of the donor ankle morbidity. J Med Assoc Thai. 2015;98(6):555-60.

Kerimoglu S, Aynaci O, Saracoglu M, Aydin H, Turhan AU. Anterior cruciate ligament reconstruction with the peroneus longus tendon. Acta Orthop Traumatol Turc 2008:42(1):38-43.

Phatama KY, Hidayat M, Mustamsir E, Pradana AS, Dhananjaya B, Muhammad SI. Tensile strength comparison between hamstring tendon, patellar tendon, quadriceps tendon and peroneus longus tendon: A cadaver research. Journal of Arthroscopy and Joint Surgery. 2019 May 1;6(2):114-6.

Mardani-Kivi M, Karimi-Mobarakeh M, Mirbolook A, Keyhani S, Saheb-Ekhtiari K, Hashemi- Motlagh K, et al Predicting the hamstring tendon diameter using anthropometric parameters. Arch Bone Jt Surg. 2016;4(4):314-317.

Liu CT, Lu YC, Huang CH. Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. J Orthop Sci 2015;20:854– 860.

Rhatomy S, Asikin AIZ, Wardani AE, Rukmoyo T, Lumban-Gaol I, Budhiparama NC. Peroneus longus autograft can be recommended as a superior graft to hamstring tendon in single-bundle ACL reconstruction. European Society of Sports Traumatology, Knee Surgery, Arthroscopy. 2019;27:3552–3559.

Papastergiou SG, Konstantinidis GA, Natsis K, Papathanasiou E, Koukoulias N, Papadopoulos AG. Adequacy of semitendinosus tendon alone for anterior cruciate ligament reconstruction graft and prediction of hamstring graft size by evaluating simple anthropometric parameters. Anat Res Int. 2012;2012:424158.

Pinheiro LFJr, de Andrade MA, Teixeira LE, Bicalho LAL, Lemos WG, Azeredo SAC, et al Intra- operative four stranded hamstring tendon graft diameter evaluation. Knee Surg Sports Traumatol Arthrosc 2011;19:811–5.

Treme G, Diduch DR, Billante MJ, Miller MD, Hart JM. Hamstring graft size prediction: a prospective clinical evaluation. Am J Sports Med. 2008. 36(11):2204–2209.

Chiang ER, Ma HL, Wang ST, Hung SC, Liu CL, Chen TH. Hamstring graft sizes differ between Chinese and Caucasians. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):916–921.

Song X, Li Q, Wu Z, Xu Q, Chen D, Jiang Q. Predicting the graft diameter of the peroneus longus tendon for anterior cruciate ligament reconstruction. Medicine. 2018 Nov;97(44).

Janssen RPA, van der Velden MJF, van den Besselaar M, Reijman M. Prediction of length and diameter of hamstring tendon autografts for knee ligament surgery in Caucasians. Knee Surgery, Sports Traumatology, Arthroscopy, 2015;25(4):1199–1204. 14. Xie G, Huangfu X, Zhao J. Prediction of the graft size of 4-stranded semitendinosus tendon and 4- stranded gracilis tendon for anterior cruciate ligament reconstruction: a Chinese Han patient study. Am J Sports Med. 2012;40(5):1161–1166.

Goyal T, Paul S, Das L, Choudhury AK. Correlation between anthropometric measurements and activity level on length and diameter of semitendinosus tendon autograft in knee ligament surgery: A prospective observational study. SICOT-J. 2020;6(23).

Shao X, Shi LL, Bluman EM, Wang S, Xu X, Chen X, et al Satisfactory functional and MRI outcomes at the foot and ankle following harvesting of full thickness peroneus longus tendon graft. Bone Joint J 2020;102- B(2):205–211.

Trung DT, Manh SL, Thanh LN, Dinh TC, Dinh TC. Preliminary result of arthroscopic anterior cruciate ligament reconstruction using anterior half of peroneus longus tendon autograft. Open Access Macedonian Journal of Medical Sciences. 2019 Dec 30; 7(24):4351-4356.



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