Comparative Study between the Functional Outcome of Arthroscopic Reconstruction of Anterior Cruciate Ligament Tear by Quadriceps and Peroneus Longus Tendon Autograft

Author(s): Dr. Md. Nazrul Islam, Prof. Dr. Abu Zaffar Chowdhury, Dr. Chowdhury Iqbal Mahmud2 Dr. Debashish Dey, Dr. Md. Golam Shaikh Ferdous, Dr. Aynun Nahar Rabeya Diba, Dr. Aminur Rasul

Background: Anterior Cruciate Ligament Reconstruction (ACLR) is among the most frequently performed orthopedic procedures globally. Despite its prevalence, controversy persists regarding the optimal graft choice. Recently, alternative grafts such as Quadriceps Tendon (QT) and Peroneus Longus Tendon (PLT) have gained attention over the traditional Hamstring graft.

Aim of the study: To compare the functional outcomes, graft characteristics, and donor-site morbidity of arthroscopic ACLR using QT versus PLT autografts.

Methods: A prospective comparative study was conducted on 36 patients with isolated ACL injuries at the Department of Orthopaedic Surgery, BSMMU, Dhaka, between September 2022 and September 2024. Patients were equally allocated into two groups: QT (n = 18) and PLT (n = 18). Functional outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively using the Lysholm and IKDC subjective scores. Donor site morbidity in the PLT group was evaluated using the AOFAS score. Statistical significance was set at p < 0.05.

Result: The comparative study had a mean age of 28.44 ± 5.70 years (range, 20–42), with a male predominance of 83.3%. The right knee was involved in 63.9% of cases, and injuries primarily resulted from road traffic accidents (47.2%) and sports-related trauma (44.4%). The mean interval from injury to surgery was 5.08 ± 3.37 months, and preoperative demographic and clinical parameters were comparable between the QT and PLT groups. The QT group demonstrated a significantly larger graft diameter than the PLT group (8.53 ± 0.56 mm vs. 8.08 ± 0.43 mm; p = 0.027). Both groups showed significant improvements in Lysholm (QT: 90.11 ± 3.72; PLT: 91.61 ± 3.17) and IKDC scores (QT: 89.22 ± 4.33; PLT: 90.56 ± 4.39) at final follow-up, without significant intergroup differences. Knee range of motion was slightly higher in the PLT group (136.11 ± 3.23° vs. 132.50 ± 5.75°), and donor site morbidity remained low (AOFAS: 95.11 ± 3.69). Complications occurred in 27.8% of QT and 11.1% of PLT patients, with excellent outcomes achieved in 77.8% and 88.9%, respectively.

Conclusion: Arthroscopic ACLR using QT or PLT autografts provides excellent functional improvement. The PLT group demonstrated slightly better functional outcomes and lower donor-site morbidity, whereas the QT group offered a larger graft diameter. Both graft options are viable alternatives to traditional Hamstring grafts.