Functional Assessment of Anterior Cruciate Ligament Reconstruction Using Peroneus Longus vs. Hamstring Tendon at 6, 12, And 24 Months Follow Up: A Meta-Analysis

Background: Anterior cruciate ligament (ACL) tear occurs between 29 to 38 cases per 100.000 people annually with more than half of cases requiring an ACL reconstruction. Peroneus longus tendon (PLT) has growing popularity as an autograft for ACL reconstruction providing comparable outcomes with proper graft diameter size, lack of donor site morbidity and uncomplicated harvesting technique. Unfortunately, certain studies did not agree with the superiority of PLT to the standard hamstring tendon (HT). Objective: The aim of study is to compare the knee functional outcome of an ACL reconstruction using peroneus longus and hamstring tendon according to recent publications. Methods: This study conducted a thorough systematic search for relevant scientific reports on multiple medical databases, including PubMed, Embase, and Google Scholar, using a combination of keywords such as "peroneus longus," “hamstring tendon,” "ACL reconstruction," “IKDC,” and “Lysholm”. The search was performed in April 2013-2023, resulting in 1567 studies. Two reviewers (RR, WA) independently screened the abstracts and reference lists, with any discrepancies resolved through consensus, concluding 5 included studies. Results: Five studies are included with a total of 538 patients consisting of 267 patients who underwent ACL reconstruction with PLT and 271 patients who underwent ACL reconstruction with HT. Up to 24 months follow-up, there are equally balanced satisfactory functional outcomes between ACL reconstruction using peroneus longus and hamstring tendon, in terms of IKDC (I2 = 74%; SMD = 0.08 95%CI, -0.21 to 0.38; p = 0.57) and Lysholm score (I2 = 75%; SMD = 0.06 95%CI, -0.27 to 0.39; p = 0.73). Conclusion: ACL reconstruction using the peroneus longus tendon is a safe and effective procedure with excellent short to long term functional outcome of the knee. Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon.