Functional outcomes of anterior cruciate ligament reconstruction with peroneus longus autograft: a cohort study

Background: Injuries to the anterior cruciate ligament (ACL) are a frequent cause of functional limitation in active individuals. Reconstruction using autografts is the standard surgical approach. While hamstring and bone-patellar tendon-bone (BPTB) grafts are commonly used, each is associated with donor-site morbidity. The peroneus longus tendon (PLT) has emerged as a viable option with biomechanical properties comparable to the native ACL and fewer donor-site complications. Objectives were to assess the functional outcomes of ACL reconstruction with PLT autograft, focusing on knee stability, ankle function, and donor-site morbidity. Methods: A prospective cohort of 35 patients underwent arthroscopic ACL reconstruction with PLT autograft between July 2019 and August 2021. Functional outcomes were evaluated preoperatively and at 3, 6, and 9 months using international knee documentation committee (IKDC) score, Lysholm score, foot and ankle disability index (FADI), and American orthopaedic foot and ankle society (AOFAS) score. Data were analyzed with Wilcoxon signed-rank test (p<0.05). Results: Mean IKDC scores rose from 65.8 preoperatively to 92.6 at 9 months (p<0.001). FADI scores showed minimal change, from 99.3 preoperatively to 97.6 at 9 months, with no significant ankle morbidity. The average AOFAS score was 98.4 at 9 months. Ninety-six percent of patients expressed satisfaction with their results, with no neurovascular complications noted. Conclusions: ACL reconstruction using PLT autograft provides excellent short-term outcomes with minimal donor-site morbidity, supporting its role as a safe and effective alternative to conventional grafts.