[Translated article] Comparison of peroneus longus and hamstring autografts in ACL reconstruction: Graft diameter and donor-site morbidity analysis.

Abstract

Background: Surgeons increasingly consider the peroneus longus tendon an effective alternative to hamstring autografts for anterior cruciate ligament reconstruction (ACLR). Choosing the right graft critically impacts long-term knee stability, prompting surgeons to strictly avoid undersized tissues. This study retrospectively compared clinical outcomes, knee stability, and comprehensive donor-site morbidity in ACLR utilizing peroneus longus versus hamstring tendon autografts.

Methods: We evaluated 30 patients undergoing arthroscopic ACLR in this retrospective review. The cohort was divided equally into hamstring tendon group (n=15), initially prepared as 4-strand constructs and augmented to 6 strands when intraoperative sizing fell below 7.5 mm and a peroneus longus graft group (n=15), prepared as 2-strand constructs. One senior surgeon applied the identical surgical technique, fixation method, and postoperative protocol across both groups. We assessed functional outcomes (Lysholm and IKDC scores) at a minimum 2-year follow-up and measured graft diameters intraoperatively. To evaluate donor-site morbidities, we recorded thigh circumference, AOFAS scores, FADI scores, and ankle range of motion (ROM).

Results: All 30 patients completed at least two years of follow-up (range 24-31 months). Statistically, the two cohorts showed comparable clinical outcomes and overall knee stability (P > 0.05). Initial peroneus longus diameter (mean 8.71 mm) exceeded initial hamstring diameter (mean 7.65 mm) (P<0.001); 6 cases augmented to 6 strands reached a final mean of 8.2 mm. Furthermore, ankle assessments (AOFAS, FADI, and ROM) revealed no joint dysfunction or sports restrictions in the peroneus longus patients.

Conclusion: Peroneus longus patients experienced less anteromedial knee pain and notably less thigh hypotrophy than the hamstring group. Given its larger structural diameter and comparable short-term clinical outcomes, the peroneus longus tendon serves as a robust and viable alternative autograft for ACLR.

Level of evidence: Level III.