Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction Using Hemi-Peroneus Longus Tendon Graft: A Prospective One-Year Follow-Up Study

BackgroundThe hemi-peroneus longus tendon (HPLT) is an alternative autograft for anterior cruciate ligament (ACL) reconstruction intended to preserve part of the donor tendon.This study evaluated knee function, donorsite morbidity, and objective limb recovery during the first postoperative year. MethodsThis prospective single-arm, single-center cohort included only 23 patients aged 18-45 years with isolated ACL rupture in whom the HPLT alone provided an adequate graft construct.The International Knee Documentation Committee (IKDC) score, Lysholm, Tegner, knee and ankle visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Foot and Ankle Disability Index (FADI), single-leg hop distance, limb symmetry index (LSI), and calf circumference were evaluated.Longitudinal outcomes were analyzed with Friedman tests, followed by Holm-adjusted Wilcoxon signedrank comparisons.All patients were retained in the primary analysis. ResultsMean IKDC increased from 30.39 ± 3.93 preoperatively to 91.57 ± 5.03 at 12 months, and Lysholm increased from 39.52 ± 5.12 to 93.70 ± 6.46 (both overall p < 0.001).Tegner improved from 1.04 ± 0.82 preoperatively to 6.57 ± 1.20 at 12 months; 18 patients (78.3%) regained or exceeded their pre-injury level.AOFAS decreased from 95.65 ± 2.19 preoperatively to 67.91 ± 4.76 at three months and recovered to 92.30 ± 3.36 at 12 months.FADI followed a similar pattern, decreasing from 97.91% ± 1.47% to 73.00% ± 2.17% and recovering to 96.52% ± 2.09%.Mean LSI improved from 48.12% ± 4.88% at six months to 89.01% ± 7.44% at 12 months; 13 of 23 patients (56.5%) achieved LSI of ≥90%.One patient sustained an MRI-confirmed traumatic graft rerupture seven months postoperatively after a slip and fall on stairs. ConclusionIn selected patients in whom an adequate isolated HPLT graft was obtained, ACL reconstruction was associated with substantial improvement in knee-reported outcomes and the recovery of donor-ankle function toward baseline at one year.Objective hop symmetry recovered more slowly, and 43.5% of patients remained below 90% LSI.The small selected cohort, absence of a comparator, and short follow-up limit generalizability.