Outcomes of Anterior Cruciate Ligament Reconstruction with a Peroneus Longus Tendon Graft
DOI:
https://doi.org/10.63403/re.v33i1.474Keywords:
Peroneus longus tendon, Anterior cruciate ligament reconstruction, Return to sport, Functional evaluationAbstract
Introduction: the peroneus longus tendon (PLT) has emerged as an alternative graft for anterior cruciate ligament (ACL) reconstruction, supported by evidence demonstrating its strength, adequate diameter, and low donor-site morbidity. Reported outcomes are comparable to traditional grafts, with preserved joint stability and favorable functional scores. However, there remains a need to integrate ankle and knee functional assessment during the first postoperative year, considering the biomechanical relationship between both joints and their relevance in return-to-sport decisions.
Objective: was to present our experience using the PLT as a graft for ACL reconstruction, evaluating donor-site morbidity and the functional evolution of the ankle and knee at 3, 6, and 12 months postoperatively.
Materials and methods: a prospective case series was conducted including 86 patients who underwent ACL reconstruction between June 2023 and November 2025 using autologous PLT grafts. Ankle function was assessed with AOFAS and FADI scores at 3, 6, and 12 months. In patients completing 12-month follow-up, IKDC, Tegner, and ACL-RSI scores were additionally recorded to evaluate knee function and return-to-sport readiness. Patients with chronic ankle instability or clinical flatfoot on the graft-harvest side were excluded.
Results: a total of 47 patients (37 males, 10 females) were analyzed, with a mean age of 31.19 ± 11.64 years. The mean graft diameter was 8.68 ± 0.61 mm. Mean graft length was 262.5 ± 4.24 mm in women and 269.72 ± 7.30 mm in men. At 3 months, mean AOFAS and FADI scores were 89.10 ± 10.13 and 87.95 ± 11.27, respectively. At 6 months, scores improved to 96.53 ± 6.64 and 98.84 ± 3.83, respectively. At 12 months, AOFAS reached 98.36 ± 3.79 and FADI 98.29 ± 4.24. Among patients with one-year follow-up, IKDC averaged 93.4 ± 10.4, Tegner 95.76 ± 7.67, and ACL-RSI 91.87 ± 10.39.
Conclusion: the PLT demonstrated safety and efficacy as an autograft for ACL reconstruction, showing low donor-site morbidity and excellent ankle functional recovery. Twelve-month outcomes confirmed a sustained favorable evolution, supporting its use in both primary and revision ACL reconstructions.
Level of evidence: IV. Retrospective cohort study
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