Return to Sport Level Following Primary Anterior Cruciate Ligament Reconstruction Using Peroneus Longus Tendon Autograft Compared to Hamstring Tendon Graft: A Systematic Review

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed procedures in sports orthopaedics. While hamstring tendon (HT) autografts are widely used, the peroneus longus tendon (PLT) has emerged as a favorable autograft alternative due to adequate length, tensile strength, and low donor-site morbidity. However, synthesized evidence comparing return to sport rates, time to return, and functional outcomes for patients who underwent ACLR with PLT compared to HT grafts remains limited, highlighting the need for comparative evaluation.

A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Scopus were searched from database inception through October 2025. Studies reporting RTS outcomes following primary ACLR with PLT autograft were included. RTS rates, time to RTS, postoperative patient-reported outcome measures (PROMs), and graft diameter were extracted when available.

Overall, seven studies comprising 640 patients (412 PLT, 228 HT) were included in this review. Overall, 588 patients (91.9%) were male, with a mean age of 27.8 years in the PLT cohort and 27.6 years in the HT cohort. Mean follow-up was 22 months (range, 6-60 months). RTS rates ranged from 85.8% to 100% following PLT ACLR and from 80.8% to 100% following HT ACLR, with one study reporting a significantly higher RTS rate in the PLT cohort (p = 0.034). Time to RTS was earlier with PLT autograft in 4 of the included studies. Postoperative International Knee Documentation Committee (IKDC) scores in the PLT cohort ranged from 89.9 to 94.7, with no consistent differences compared with HT grafts. Lysholm scores ranged from 92.0 to 96.6 and were comparable between graft types. Graft diameter was consistently larger with PLT autograft (8.7-9.1 mm) compared with HT autograft (7.6-8.3 mm).

Primary ACLR using peroneus longus tendon autograft demonstrates high return-to-sport rates, earlier return-to-sport timelines, and comparable functional outcomes relative to hamstring tendon autografts, with the added advantage of larger graft diameter. These findings support PLT as a viable autograft option in appropriately selected patients. Further high-quality randomized controlled trials are needed to evaluate long-term outcomes.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1954

This document is currently not available here.

Share

COinS