Introduction
Hamstring (HT) and bone-patellar-tendon-bone (BPTB) autografts are commonly used in anterior cruciate ligament reconstruction (ACLR). Peroneus longus (PL) tendon offers comparable graft properties with lower self-reported donor-site morbidity, but strength and functional outcomes remain understudied.
Objectives
To compare strength and performance between PL, BPTB and HT autografts at 6- and 9 months post-ACLR.
Study design
Retrospective cohort study
Methods
Seventy-three sub-elite athletes who had undergone primary ACLR (BPTB n=30; HT n=28; PL n=15), underwent assessments of isokinetic knee flexion/extension, isometric hip abduction/extension and ankle plantarflexion strength, as well as double and single leg countermovement (CMJ) and drop jump kinetics at 6- and 9 months post-surgery. Linear mixed models were performed, analysing graft × time effects on each outcome, adjusted for age, sex, and concomitant procedures; between-graft effect sizes were also computed.
Results
All measures improved between 6 and 9 months across all graft types. At 6 months, BPTB showed reduced involved-limb quadriceps strength vs PL (−0.41 Nm/kg, 95% CI −0.75 to −0.08; d=−1.33; p=0.017) but not vs HT (−0.21 Nm/kg; d=−0.41; p=0.145). HT had involved-limb hamstring weakness vs BPTB (−0.20 Nm/kg; d=−0.48; p=0.010) and PL (-0.17 Nm/kg; d=-0.90; p=0.049) at 6 months, persisting only compared to BPTB at 9 months (-0.18 Nm/kg; d=-0.35; p=0.019). PL autografts showed better single-leg CMJ height compared to HT at both timepoints (3.5 and 3.2 cm; d=0.76-0.87; p≤0.05) and compared to BPTB at 6 months only (2.7 cm; d=0.98; p=0.039). Plantarflexion strength improved bilaterally across all grafts, with no graft × time interaction (p=0.82).
Conclusions
Patients with a PL graft showed significantly better quadriceps strength compared to BPTB, less knee flexor strength deficits than those with HT grafts, and no deficit in ankle plantarflexion strength. These initial results suggest PL tendon autografts might be a good choice to protect strength and function following ACLR.
