Peroneus Longus Tendon Versus Hamstring Tendon Autograft In Arthroscopic Acl Reconstruction: A Prospective Randomized Study Of Knee Function, Stability, And Donor-Site Morbidity

Abstract

Background: Arthroscopic anterior cruciate ligament reconstruction (ACLR) with hamstring tendon (HT) autografts is very popular, and could result in knee flexion weakness and harvest-related morbidity. An alternative of constant diameter, with arguably reduced donor-site morbidity, has developed in the form of the peroneus longus tendon (PLT) at the expense of ankle function.

Methods: It was a prospective randomized self-controlled study that was undertaken in a tertiary orthopaedic unit (2023-2025). The participants were randomly divided into 30 individuals with isolated unilateral ACL rupture who received ACLR with either PLT autograft (n=15) or quadrupled HT autograft (n=15). The measurement of functional outcomes was preoperative, 1.5, 3, 6 months using Modified Cincinnati Score (MCS), Lysholm score, and Subjective IKDC 2000. Donor-site complications were measured using AOFAS (PLT group), thigh circumference deficit, sensory symptoms, pain, ankle range of motion, and handheld dynamometry-based strength. Knee stability was evaluated using Anterior Drawer, Lachman, Pivot Shift and KT-1000 arthrometer at the follow-up. Independent t-tests/Mann-Whitney U tests and chi-square tests were conducted in groups (due to the independent test, 1=0.05).

Results: PLT had more mean graft diameter than HT (8.68±0.23 mm; and 7.65±0.59 mm, respectively, p<0.001). Both groups had also improved but at 12 months, PLT had better MCS (90.1±2.9 vs 86.8±2.7), Lysholm (89.9±3.8 vs 86.3±2.1) and IKDC (92.4±4.3 vs 89.1±5.2) (all p<0.05). With enduring effects, recovering the stance favoring PLT actions and dynamics with time of 3 months and above, there was less KT-1000 side-to-side difference in final follow-up (1.2±0.5 vs 1.8±0.6 mm, p<0.01). PLT had a reduced donor-site morbidity (thigh deficit 0.520.2 cm vs 1.22.04 cm, p=0.001), and comparable outcomes of the ankle near outcome normalcy at 12 months (AOFAS 97.62.4).

Conclusion: Even though PLT autograft ACLR yielded thicker grafts, faster mobilization, better 12-month stability and less donor-site morbidity and ankle functionality, it helps to support the idea that PLT is a strong alternative to HT in primary ACLR.