The Clinical and Functional Outcome of Peroneus Longus Graft in Comparison to Hamstring Graft in Arthroscopic Repair of Complete Anterior Cruciate Ligament Tear

Background And Objective: Anterior cruciate ligament reconstruction (ACLR) has been recognized as the standard treatment to restore knee stability and joint function after an ACL rupture. Peroneus longus tendon has emerged as a promising alternative autograft for anterior cruciate ligament reconstruction (ACLR), offering adequate graft size, favorable biomechanical properties, and minimal impact on ankle function. However, hamstring tendon autografts remain widely used, despite concerns about donor site morbidity and potential hamstring weakness. The present study aims to compare functional outcomes, knee stability, and donor site morbidity between ACLR using peroneus longus tendon autograft and hamstring tendon autograft, to determine whether peroneus longus can serve as an equivalent or superior graft option.Methods: Forty-two patients with ACL tear were treated with ACLR using quadrupled hamstring tendon autograft and peroneus longus tendon autograft in BIMS, Belagavi from March 2024 to July 2025.Results: A total of 40 patients were included in the study, with 20 patients allocated to each group, and all completed a minimum follow-up of 6 months. There were no significant differences between the groups in terms of clinical outcomes or knee stability. However, the peroneus longus graft demonstrated a significantly greater diameter compared to the hamstring graft (P<0.001). Evaluation using AOFAS, FADI, and ankle range of motion revealed that patients in the peroneus longus tendon group did not exhibit any noticeable dysfunction of the ankle joint. However, the hamstring group should significant reduction in thigh circumference.Conclusion: Patients who underwent ACL reconstruction using the peroneus longus tendon experienced faster recovery in patients. Patients showed faster knee extension, they also showed reduced anteromedial knee pain, and patientsless thigh muscle wasting compared to hamstring graft recipients. The peroneus longus tendon serves as a strong autograft option because of its larger graft diameter and superior mechanical strength. Additionally, harvesting this tendon avoids complications typically associated with hamstring graft harvest around the knee, such as local pain and muscle weakness. These benefits, along with minimal donor site morbidity and preservation of ankle function, make the peroneus longus tendon a reliable and effective graft choice for ACL reconstruction