Comparative Outcomes of Hamstring Tendon versus Peroneus Longus Tendon Autograft in Arthroscopic Single-Bundle...

Graft selection remains a critical determinant of outcomes in anterior cruciate ligament (ACL) reconstruction. While hamstring tendon (HT) autografts are widely used, variable graft diameter and knee-flexor morbidity remain concerns. The peroneus longus tendon (PLT) has emerged as a promising alternative offering predictable diameter and minimal donor-site morbidity. This study compares operative, functional, and stability outcomes between HT and PLT autografts in single-bundle arthroscopic ACL reconstruction.

A prospective comparative study was conducted on 50 patients who underwent arthroscopic single-bundle ACL reconstruction at a tertiary care center. Patients were divided into two groups: Group A (n = 26) received quadrupled HT autografts, and Group B (n = 24) underwent reconstruction using PLT autografts. Outcome measures included operative duration, graft diameter, Lysholm and International Knee Documentation Committee (IKDC) scores (pre-operative, 6 months, 12 months, and 24 months), range of motion at 3 months, return to daily activities, return to sport activity, anterior knee laxity at 12 months by KT-1000 arthrometer, donor-site morbidity, graft failure, post-operative infection and overall functional outcome. Statistical analysis was performed using independent t-tests and Chi-square tests. P < 0.05 was considered statistically significant.

The peroneus longus group demonstrated significantly shorter operative duration (74.85 ± 5.13 vs. 89.20 ± 4.49 min; P < 0.001), larger graft diameter (8.39 ± 0.23 vs. 7.65 ± 0.34 mm; P < 0.001), superior Lysholm scores at 24 months (96.50 ± 2.09 vs. 90.15 ± 3.18; P < 0.001), better IKDC scores at 24 months (95.80 ± 2.67 vs. 89.10± 3.09; P < 0.001), improved early range of motion (128.55 ± 4.36° vs. 124.54 ± 3.93°; P = 0.013), earlier return to daily activities (9.07 ± 0.72 vs. 10.94 ± 0.97 weeks; P < 0.001), and earlier return to sports activity (193.1 vs. 229.6 days; P < 0.001). Moreover, lower anterior knee laxity (2.28 ± 0.26 vs. 2.94 ± 0.41 mm; P < 0.001). A significant positive correlation was identified between anterior knee laxity and delayed return to daily activities (r = 0.552, P = 0.002).

PLT demonstrated favorable functional and operative outcomes and may represent an effective alternative to hamstring autograft in ACL reconstruction with respect to operative efficiency, graft diameter, functional recovery, and knee stability. PLT represents a safe and effective alternative graft, particularly in patients where adequate graft size and preservation of knee-flexor strength are desired.