Clinical and Functional Outcomes of Peroneus Longus Versus Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction: A Prospective Interventional Comparative Study

Background: Selection of an optimal autograft for anterior cruciate ligament (ACL) reconstruction remains debatable due to concerns regarding graft adequacy and donor-site morbidity. This study compared the clinical and functional outcomes of peroneus longus tendon and hamstring tendon autografts in ACL reconstruction. Methods: In this prospective comparative study, 60 patients underwent arthroscopic single-bundle ACL reconstruction for unilateral ACL tears using autografts of either hamstring (n = 30) or peroneus longus tendons (n = 30), followed by a standardized rehabilitation protocol. Knee function was assessed using the International Knee Documentation Committee (IKDC) score, and ankle function using the Foot and Ankle Ability Measure (FAAM) preoperatively and at one, three, and six months following the intervention. Results: Baseline characteristics were comparable between groups. Graft length and tunnel dimensions were similar, while graft thickness was significantly more in the peroneus longus group (p < 0.001). Improvement in IKDC scores was significant in both groups; the hamstring group showed better scores at three months (p = 0.001), with no significant difference at six months. FAAM scores were comparable at all follow-ups, demonstrating preserved ankle function in the peroneus longus group. Conclusion: Peroneus longus tendon autograft provides comparable short-term functional outcomes to hamstring tendon autograft, with the advantage of greater graft thickness and no clinically significant ankle morbidity.