Functional Outcomes of Anatomic Single Bundle Primary ACL Reconstruction with Peroneus Longus Tendon (Without a Peroneal Tenodesis) Versus Hamstring Autografts

Document Type : RESEARCH PAPER


Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India



Objectives: There is a paucity of comparative studies on the Peroneus longus tendon versus 
conventional hamstring autograft use in primary single-bundle ACL reconstruction. To date, there are 
no studies that reported donor ankle functional outcomes when a peroneus lon gus graft is harvested 
without performing a tenodesis to peroneus brevis.
Methods: A single-center retrospective comparative study was undertaken to evaluate the functional outcomes 
(IKDC & Tegner-Lysholm scores) of primary isolated single bundle anatomic ACL Reconstruction with Peroneus 
Longus tendon (PL group) versus Hamstring (HT group) autografts. Further, an evaluation of donor ankle morbidity 
using the AOFAS score for the PL group and persistent anteromedial thigh pain and paraesthesia around the knee
for the HT group was also performed.
Results: 30 patients were evaluated in each group. The mean graft diameter was 8.61 +/- 0.66mm (HT) & 9.6 +/-
0.84mm (PL) and the mean graft length was 7.39cm (HT) & 7.86cm (PL) respectively. The mean IKDC scores were 
58.2 (Pre-op) & 89.52 (1 year) for the HT group and 61.8 (Pre-op) & 90.9 (1 year) for the PL group respectively. The 
mean Tegner-Lysholm scores were 69.83 (Pre-op) & 91.96 (1 year) for the HT group and 70.66 (Pre-op) & 92.36 (1 
year) for the PL group respectively.10% of the HT group had residual anteromedial thigh pain & 6.7% had 
paraesthesia at one-year follow-up. In the PL group, the mean AOFAS score was 96.37 +/- 2.49 at the end of one 
year. Two cases (6.66%) reported paraesthesia around the harvested site.
Conclusion: Peroneus longus tendon appears to be a better autograft choice than hamstrings for primary ACL 
reconstruction. Further, without a peroneal tenodesis, the functional outcomes of the donor ankle remained 
 Level of evidence: III


Main Subjects