Donor Ankle Sensorimotor Recovery After ACL Reconstruction With a Peroneus Longus Tendon Autograft

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Anterior Cruciate Ligament Reconstruction; Anterior Cruciate Ligament Injury; Donor Site Complication
• Intervention / Treatment: Procedure: Anterior Cruciate Ligament Reconstruction Using a Peroneus Longus Tendon Autograft

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.

• Study Type: Observational
• Enrollment (Estimated): 20

Contacts and Locations

• Study Contact: Name: Dudu Ozdemir Can, MSc; Phone Number: +90 5534448492; Email: duduozdemir@gazi.edu.tr

Study Locations

• Turkey (Türkiye)
  • Ankara
    • Çankaya, Ankara, Turkey (Türkiye), 06490
      • Gazi University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Sports Health Unit
      • Contact: Dudu Ozdemir Can, MSc; Phone Number: +90 5534448492; Email: duduozdemir@gazi.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adults aged 18 to 55 years who have undergone primary unilateral anterior cruciate ligament reconstruction using a peroneus longus tendon autograft as part of routine clinical care and are referred to the Sports Health Unit, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, for postoperative rehabilitation and functional assessment. Eligible participants will be enrolled consecutively during the study period.

Description

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.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Peroneus Longus Tendon Autograft ACLR Cohort; Adults after primary unilateral ACL reconstruction using a peroneus longus tendon autograft. Participants will undergo observational assessments at postoperative 6-8 weeks, 3 months, and 6 months. Donor-limb measures will be compared with measurements from the contralateral non-donor limb. No intervention is assigned by the study.

Procedure: Anterior 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Mean Center of Pressure Velocity During Single-Leg Balance	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.	Postoperative 6-8 weeks, 3 months, and 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in CoP Path Length During Single-Leg Balance	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.	Postoperative 6-8 weeks, 3 months, and 6 months
Change in CoP Ellipse Area During Single-Leg Balance	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.	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Mean CoP Velocity During Double-Leg Balance	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).	Postoperative 6-8 weeks, 3 months, and 6 months
Change in CoP Path Length During Double-Leg Balance	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).	Postoperative 6-8 weeks, 3 months, and 6 months
Change in CoP Ellipse Area During Double-Leg Balance	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).	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Mean Normalized Peroneus Longus RMS Amplitude During Single-Leg Heel Rise	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.	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Peak Normalized Peroneus Longus RMS Amplitude During Single-Leg Heel Rise	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.	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Mean Normalized Peroneus Longus RMS Amplitude During Incline Heel Rise	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.	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Peak Normalized Peroneus Longus RMS Amplitude During Incline Heel Rise	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.	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Ankle Joint Position Sense Absolute Error	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.	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Self-Selected Gait Speed	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).	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Gait Cadence	Cadence recorded with the G-Walk inertial sensor during self-selected walking, averaged across three trials. Unit: steps per minute.	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Step Length	Step length recorded with the G-Walk inertial sensor during self-selected walking, averaged across three trials. Unit: meters (m).	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Gait Symmetry Index	Between-limb gait symmetry index derived from G-Walk spatiotemporal data. Unit: percent (%); values closer to the device-defined symmetry reference indicate greater symmetry.	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Pelvic Tilt During Gait	Sagittal-plane pelvic tilt measured by the G-Walk inertial sensor during self-selected walking, averaged across three trials. Unit: degrees (°).	Postoperative 6-8 weeks, 3 months, and 6 months
Change in Pelvic Obliquity During Gait	Frontal-plane pelvic obliquity measured by the G-Walk inertial sensor during self-selected walking, averaged across three trials. Unit: degrees (°).	Postoperative 6-8 weeks, 3 months, and 6 months
Change in FAAM Activities of Daily Living Subscale	Foot and Ankle Ability Measure Activities of Daily Living subscale, transformed to a 0%-100% score. Higher percentages indicate better self-reported function.	Preoperative, Postoperative 6-8 weeks, 3 months, and 6 months
Change in FAAM Sports Subscale	Foot and Ankle Ability Measure Sports subscale, transformed to a 0%-100% score. Higher percentages indicate better self-reported sport-related function.	Preoperative, Postoperative 6-8 weeks, 3 months, and 6 months

Collaborators and Investigators

• Sponsor: Gazi University
• Investigators: Study Director: Nihan Karatas, Prof. Dr., Gazi University; Principal Investigator: Dudu Ozdemir Can, MSc, Gazi University

Study record dates

Study Major Dates

• Study Start (Estimated): August 22, 2026
• Primary Completion (Estimated): August 1, 2027
• Study Completion (Estimated): October 1, 2027

Study Registration Dates

• First Submitted: August 10, 2026
• First Submitted That Met QC Criteria: August 10, 2026
• First Posted (Actual): August 13, 2026

Study Record Updates

• Last Update Posted (Actual): August 13, 2026
• Last Update Submitted That Met QC Criteria: August 10, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: postural control; proprioception; gait analysis; surface electromyography; sensorimotor function; peroneus longus tendon autograft; donor ankle
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Knee Injuries; Anterior Cruciate Ligament Injuries
• Other Study ID Numbers: 2026-1435

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: No individual participant data sharing plan has been specified for this study.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No