Peroneus Longus Tendon Autograft in ACL Reconstruction – Clinical and Biomechanical Outcomes

Open Access

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction aims to restore knee stability and function. While hamstring and patellar tendon autografts are standard, the peroneus longus tendon (PLT) has emerged as a strong alternative due to its biomechanical strength and easy harvest. Aim: To evaluate clinical, functional, and biomechanical outcomes of ACL reconstruction using ipsilateral PLT autograft at 24-month follow-up. Methods & Materials: This prospective study included 18 patients with isolated ACL rupture who underwent arthroscopic single-bundle ACL reconstruction using PLT autograft. Stability was assessed using Lachman and pivot shift tests, and anterior tibial translation was measured with a KT-1000 arthrometer. Functional outcomes were evaluated with IKDC, Lysholm, Tegner, and Cincinnati scores and the single-leg hop test. Biomechanical parameters were compared with the contralateral ACL. Donor site morbidity and complications were noted. Results: At 24 months, stability and function improved markedly. Lachman and pivot shift positivity decreased from 100% to 5.6%. Anterior tibial translation reduced from 9.4 ± 2.0 mm to 2.2 ± 0.9 mm (p < 0.001). Functional scores improved significantly (p < 0.001), and hop performance increased from 72 ± 10% to 94 ± 5%. PLT grafts showed good stiffness, high load to failure, minimal elongation, and acceptable rotational stability, comparable to native ACL. Donor site morbidity was low (11%), with no graft ruptures. Conclusion: PLT autograft offers strong clinical, functional, and biomechanical results with minimal morbidity, supporting its use as an effective alternative for ACL reconstruction.