Evaluating the Peroneus Longus Tendon as an Alternative Graft in Anterior Cruciate Ligament Reconstruction

Abstract

Anterior Cruciate Ligament (ACL) reconstruction remains one of the most common orthopedic procedures, with graft selection playing a critical role in determining surgical success and patient outcomes. Traditionally, hamstring tendons, bone-patellar tendon-bone (BPTB), and quadriceps tendons have been the primary graft choices. However, recent studies have explored the use of the Peroneus Longus Tendon (PLT) as a viable alternative autograft for ACL reconstruction. This review aims to provide a comprehensive analysis of the anatomical, biomechanical, and clinical aspects of the PLT, comparing its structural integrity, donor site morbidity, and long-term functional outcomes with conventional graft options. Additionally, we discuss the surgical technique, advantages, and potential complications associated with PLT harvest and implantation. Emerging evidence suggests that the PLT demonstrates favorable tensile strength, minimal functional loss at the donor site, and satisfactory clinical results, making it a promising option for primary and revision ACL reconstruction. This review highlights current evidence, identifies existing gaps in the literature, and proposes directions for future research to establish PLT as a standard graft choice in ACL reconstruction surgery