A prospective randomized controlled trial investigating peroneus longus versus hamstring tendon autograft in anterior cruciate ligament reconstruction

This is a prospective, single-blinded randomized controlled trial (RCT) comparing outcomes in patients undergoing anterior cruciate ligament reconstruction (ACLR) with one of two autograft constructs: 1) a hamstring tendon (HT) autograft, or 2) a peroneus longus tendon (PLT) autograft. The intervention (the surgical procedure with one of the two graft types) will be administered by the treating orthopaedic surgeon. While both constructs are used in clinical practice, for the purpose of trial registration the ‘intervention’ is the PLT autograft surgical construct. The surgical time for both techniques is approximately 45 minutes. This may be extended by 15–20 minutes if concomitant meniscal repair is performed. The appropriate intervention will be ensured in all patients via internal monitoring by the research team, liaising with a specific member of the nursing team independent of the study but present at all surgeries. Adherence to the intervention (or surgery type) is monitored through surgical operation records, which document graft type, concomitant procedures, and intraoperative details. Following surgery, postoperative rehabilitation will follow standard clinical practice under the direction of the patient’s own physiotherapist or exercise physiologist. This will typically involve therapist visits 1–2 times per week as required over the initial 12 weeks, followed by periodic supervised therapy from 3–12 months post-surgery. Initially, all patients without meniscal repair will be permitted to weight bear as tolerated using crutches. Where meniscal pathology requires repair, restrictions on weight bearing or loaded range of motion will follow the meniscal protocol until full weight bearing is allowed. Briefly, and standardized across all patients, early rehabilitation will focus on reducing pain and swelling, restoring knee range of motion, and regaining quadriceps control. From 2–3 weeks, outpatient rehabilitation will include progressive exercises dictated by individual conditioning and progression. From 6 weeks, emphasis will shift to single-leg strengthening. From 3 months, a criterion-based return to jogging, hopping, and jumping will be initiated, progressing to higher-level sport-specific activities as tolerated.