Comparative Evaluation of Peroneus Longus Tendon and Hamstring Tendon Autografts in Primary Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

Introduction: Anterior cruciate ligament (ACL) injury remains one of the most common causes of functional knee instability among young and active individuals. Autografts, especially hamstring tendon (HT) grafts, have long been considered the standard of care; however, concerns regarding variable graft diameter, harvest-related muscle weakness, and donor-site morbidity have led to interest in alternative grafts. The peroneus longus tendon (PLT) has gained attention due to its adequate length, favorable biomechanical strength, and minimal functional deficit at the donor site. This randomized controlled trial compared the clinical, functional, and stability outcomes of PLT autografts with HT autografts in primary ACL reconstruction. Materials and Methods: A prospective randomized controlled trial was conducted on 50 patients undergoing primary ACL reconstruction. Participants were randomized into two equal groups: Group A received PLT autograft (n = 25), and Group B received HT autograft (n = 25). Baseline characteristics, intraoperative parameters, post-operative pain, knee stability, donor-site morbidity, and functional outcomes were assessed using International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores at 3 and 6 months. KT-1000 arthrometer measurements, Lachman and pivot-shift tests were used for objective stability assessment. Data were analyzed using the Statistical Package for the Social Sciences, with P < 0.05 considered statistically significant. Results: Baseline demographic variables were comparable between groups. PLT grafts demonstrated significantly larger mean graft diameter (8.9 ± 0.6 mm) compared to HT grafts (8.1 ± 0.7 mm; P = 0.001). Operative time was significantly shorter in the PLT group (78.6 ± 11.3 min vs. 86.2 ± 12.7 min; P = 0.02). Early post-operative pain scores were lower in the PLT group (P < 0.05). At 6 months, the PLT group showed significantly higher IKDC (82.6 ± 6.3 vs. 78.9 ± 7.4; P = 0.04) and Lysholm scores (89.4 ± 5.8 vs. 85.1 ± 6.4; P = 0.03). Knee stability outcomes, including Lachman grade, pivot shift, and KT-1000 measurements, were comparable across groups. Donor-site morbidity was significantly lower in the PLT group, with minimal ankle strength deficit compared to notable hamstring weakness in the HT group. Complication rates were low and similar across both groups. Conclusion: PLT autograft demonstrated larger graft diameter, reduced post-operative pain, better early functional outcomes, and lower donor-site morbidity compared with the traditional hamstring autograft while maintaining equivalent knee stability. PLT appears to be a reliable and effective graft option for primary ACL reconstruction, especially in individuals where preservation of hamstring strength is desirable.