CLINICAL OUTCOMES AND BIOMECHANICAL ANALYSIS OF ARTHROSCOPIC MULTI-LIGAMENT KNEE RECONSTRUCTION: A PROSPECTIVE COMPARATIVE STUDY OF SEMITENDINOSUS, GRACILIS, AND PERONEAL GRAFTS

Background: Multi-ligament knee injuries (MLKI) are complex pathologies requiring effective surgical intervention to restore joint stability and function. While autograft options such as semitendinosus (ST) and gracilis (G) are commonly used in arthroscopic multi-ligament knee reconstruction, the use of peroneal longus (PL) grafts remains underexplored in clinical literature. The biomechanical properties of PL grafts, as well as their comparative effectiveness in multi-ligament reconstructions, have not been well-studied. This gap in the literature highlights the need for a prospective comparative study to evaluate the clinical outcomes and biomechanical stability associated with PL grafts in comparison to ST and G. Methods: A prospective cohort study was conducted on 60 patients (20 per group), undergoing arthroscopic multi-ligament knee reconstruction using ST, G, or PL grafts. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner activity scores at 4, 6 & 12 months. Biomechanical analysis included KT-1000 testing, side-to-side comparison, and rotational laxity evaluation (pivot-shift grading). Data were analyzed using ANOVA with Bonferroni post-hoc tests for clinical scores, and Kaplan-Meier survival analysis for graft integrity. Results: Preliminary findings show that both ST and PL grafts provide comparable results in terms of biomechanical stability, with PL grafts demonstrating lower donor-site morbidity. However, ST grafts resulted in superior clinical outcomes (IKDC, Lysholm scores) in high-demand athletes. PL grafts showed less residual laxity on KT-1000 testing. The incidence of graft failure was similar between groups, with PL showing slightly better graft survival rates. Conclusion: This study highlights the potential of PL grafts as an effective alternative for multi-ligament knee reconstruction, especially in patients seeking to minimize hamstring donor-site morbidity. Further long-term studies are required to confirm these findings and refine graft selection criteria.