Long-term outcomes of anterior cruciate ligament reconstruction: Peroneus longus versus hamstring tendons

Objectives Management of anterior cruciate ligament (ACL) injuries evolved over the years, and the standard of care is arthroscopic ACL reconstruction (ACLR) with various graft options. The purpose of our study is to evaluate how good an alternative peroneus longus tendon (PLT) can be when used as a graft in primary ACLR by comparing the functional outcomes of patients undergoing ACLR with PLT versus Hamstring tendon (HT). Materials and Methods Quasi-experimental study involving 40 patients each in the PLT group and HT group was performed. The knee functional outcomes were compared using the International Knee Documentation Committee (IKDC) score and Tegner Lysholm (TL) knee score measured preoperatively, at 3-, 6-, and 24-month post-surgery. Ankle site morbidity was measured by the foot and ankle disability index (FADI) score and the American Orthopedic Foot and Ankle Society score. Results IKDC score in PLT group and HT group was 59.3 ± 16.08 and 48.25 ± 15.81 preoperatively, and it improved to 97.5 ± 2.58 and 92.8 ± 5.12 at 24 months, respectively. The median TL scores were 68.5 (Interquartile range [IQR] 42.3-80) and 71.5 (IQR 62.3-77) and improved to 100 (IQR 96-100) and 100 (IQR 98-100) at 24 months in PLT and HT groups, respectively. FADI and AOSFA scores for the ankle were 100 preoperatively. They dropped to 98.05 ± 1.96 and 98.05 ± 2.24 at 3 months after PLT harvest. Both the scores improved to 100 by 6 months. Graft diameter averaged at 8.78 ± 0.95 mm in the PLT group and 8.12 ± 1.10 mm in the HT group. Conclusion Harvesting PLT is relatively easier and faster, yielding sufficient-sized tendons consistently compared to HTs. Both performed similarly in regard to patient-reported outcome measures measured and followed over 2 years. No graft failures were there in both the groups. We conclude that PLTs perform similar to HT autografts when used for primary ACLR without any associated ankle site morbidity.