Incidence of flatfoot after peroneuslongus ACL grafting

Investigators found few cases of postoperative arch collapse, but alternative footprint measurements classified substantially more cases of flatfoot.

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Among 130 patients undergoing primary ACL reconstruction with peroneus longus autografts, 2 developed new flatfoot by Arch Index criteria, an incidence of 1.5%.
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Both cases occurred in the operated foot, and neither patient reported pain, instability, or limitations in daily activities or sports.
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Flatfoot classification varied by measure: the Chippaux-Smirak Index identified 2 patients, the Staheli Index 24, and the Clarke angle 61.
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Exploratory analyses found no significant associations with Beighton score, body mass index, weight, or height; the 2 cases were older than other participants.
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The single-center study had no alternative-graft comparison group, and its small number of cases limited risk-factor analyses and generalizability.

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