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

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.