Return-to-sport outcomes and donor-site impact assessment following anterior cruciate ligament reconstruction: A randomized trial comparing peroneus longus and hamstring autografts

Objectives: Anterior cruciate ligament (ACL) injuries are common knee traumas among athletes that often require surgical reconstruction to restore stability. This study compares the functional outcomes, graft characteristics, and donor-site morbidity of peroneus longus tendon (PLT) versus hamstring tendon (HT) autografts to determine whether PLT is a reliable alternative that does not impair ankle function. Materials and Methods: A prospective randomized clinical trial involved 120 athletes aged 16–45 years with isolated ACL injuries. And were randomly assigned to either a PLT ( n = 60) or HT ( n = 60) autograft. Assessments were conducted preoperatively and at 6 weeks, 3 months, and 6 months postoperatively, utilizing the International Knee Documentation Committee (IKDC) score, Lysholm knee score, the American Orthopaedic Foot and Ankle Society score, range of motion, and thigh circumference. Data analysis was performed, considering P < 0.05 as statistically significant. Results: The PLT group exhibited a notably larger graft diameter (9.1 ± 0.79 mm compared to 8.35 ± 0.49 mm; P = 0.0009). Improvements in IKDC and Lysholm scores occurred earlier in the PLT group ( P < 0.05), with both groups showing comparable results by 6 months. Early ankle weakness observed postoperatively in the PLT group resolved within 6 months. In addition, the PLT group demonstrated significantly better recovery in thigh circumference ( P < 0.001). Conclusion: Both grafts yield excellent functional outcomes, offering comparable knee stability and recovery. The peroneus longus graft showed advantages in graft size, lower donor-site complications, and early functional gains, all without affecting ankle function. Therefore, the PLT could be a dependable alternative to the hamstring graft, especially for high-demand sports personnel.