The Early Outcomes of Anterior Cruciate Ligament Reconstruction Using Autologous Peroneus Longus Tendon in an Egyptian Cohort

Background: Anterior cruciate ligament (ACL) reconstruction using autologous grafts continues to represent the gold standard for the management of ACL ruptures. In recent years, the autologous peroneus longus tendon (PLT) has gained significant attention as a viable graft alternative, attributed to its superior biomechanical properties, sufficient tensile strength and minimal donor-site complications making it a strong candidate for achieving optimal functional and clinical outcomes. Patients and methods: This prospective clinical study assessed the early functional and biomechanical outcomes following arthroscopic ACL reconstruction using autologous PLT in adult Egyptian males. A total of 115 patients were included and evaluated using the International Knee Documentation Committee (IKDC) and the American Orthopaedic Foot and Ankle Society (AOFAS) scoring systems at 1, 3, and 6 months postoperatively. Dynamic footprint analysis was performed preoperatively and postoperatively to detect any alterations in foot biomechanics. Results: IKDC scores demonstrated a statistically significant improvement throughout the follow-up period (p < 0.001). AOFAS scores showed an initial transient decline at one month, followed by near-baseline recovery at six months. Dynamic footprint analysis revealed no significant postoperative changes in foot biomechanics. Minor complications included localized edema (9.5%) and superficial infection (1.7%) with no recorded cases of nerve injury. Conclusion: Autologous PLT graft represented a safe, reliable and efficient option for ACL reconstruction, providing significant improvement in knee stability and functional outcomes with minimal effect on donor-site function and ankle biomechanics.