Comparison of Functional Outcomes After Using Hamstring Graft Versus Peroneus Longus Graft Reconstruction in Patients Having Anterior Cruciate Ligament Injury

Background: Anterior cruciate ligament (ACL) rupture is a common injury in young and active individuals. Hamstring autografts remain the conventional choice for ACL reconstruction; however variable graft quality has prompted evaluation of alternative grafts. The peroneus longus tendon has recently emerged as a potential option due to its favorable biomechanical properties and minimal functional deficit at the donor site. The objective is to compare functional outcomes, graft stability, and donor site morbidity between peroneus longus tendon and hamstring tendon autografts in arthroscopic ACL reconstruction. Material and Methods: This prospective comparative study included 20 patients (12 males, 8 females; mean age 27.6 years) who underwent arthroscopic ACL reconstruction between December 2022 and December 2023. Patients were divided into two groups: peroneus longus (n=10) and hamstring tendon (n=10) autografts. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm scores. Donor site morbidity was evaluated using ankle range of motion (ROM), Foot and Ankle Disability Index (FADI), and American Orthopedic Foot and Ankle Society (AOFA) scores. Statistical analysis was performed using Student’s t-test. Results: Both groups showed significant postoperative improvement in IKDC and Lysholm scores, with no statistical difference between peroneus longus and hamstring groups at final follow-up. Donor site ankle ROM was preserved in the peroneus longus group with a mean AOFA score of 93.42 ± 1.7 and FADI score of 97%. Knee stability outcomes were comparable, with no graft re-tears reported. Conclusion: Peroneus longus tendon autograft offers excellent functional outcomes and knee stability comparable to hamstring autografts, with minimal donor site morbidity. It represents a reliable and safe alternative graft option for ACL reconstruction. Keywords: Anterior cruciate ligament, Peroneus longus tendon, Hamstring tendon, Arthroscopic reconstruction, Functional outcomes, Donor site morbidity.

Background: Anterior cruciate ligament (ACL) reconstruction is a standard orthopedic procedure, with hamstring tendon autografts (HT) traditionally serving as the preferred graft choice. Recently, the peroneus longus tendon (PLT) has emerged as a promising alternative due to comparable biomechanical strength and minimal donor-site morbidity. Objective: To compare the functional outcomes of arthroscopic ACL reconstruction using hamstring tendon autograft versus peroneus longus tendon autograft. Study Design: Comparative prospective study. Setting: Department of Orthopedic Surgery, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: From August 2024 to July 2025. Methods: A total of 60 patients with ACL tears were enrolled and equally divided into two groups. Group A underwent ACL reconstruction using an ipsilateral hamstring tendon autograft, while Group B received an ipsilateral peroneus longus tendon autograft. All patients followed a standardized postoperative rehabilitation protocol. Functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) score and the Modified Cincinnati Score (MCS), assessed preoperatively and at six months postoperatively. Statistical analysis was performed using SPSS version 25, with p < 0.05 considered significant. Results: The mean age was 28.87 ± 6.75 years in Group A and 28.07 ± 6.11 years in Group B. Males constituted 90.0% in Group A and 83.3% in Group B. At the six-month follow-up, both groups demonstrated significant improvement in functional outcomes. The mean postoperative IKDC scores were 83.27 ± 3.79 (Group A) and 84.83 ± 3.07 (Group B), while mean MCS values were 85.33 ± 2.46 and 86.17 ± 1.96, respectively. No statistically significant difference was observed between the two groups (p > 0.05). Conclusion: Arthroscopic ACL reconstruction using either hamstring or peroneus longus tendon autografts provides excellent and comparable functional outcomes. Although the peroneus longus tendon group showed slightly higher IKDC and MCS scores, the difference was not statistically significant, supporting its use as a viable alternative graft source.

Selection of an optimal autograft for anterior cruciate ligament (ACL) reconstruction remains debatable due to concerns regarding graft adequacy and donor-site morbidity. This study compared the clinical and functional outcomes of peroneus longus tendon and hamstring tendon autografts in ACL reconstruction. In this prospective comparative study, 60 patients underwent arthroscopic single-bundle ACL reconstruction for unilateral ACL tears using autografts of either hamstring (n = 30) or peroneus longus tendons (n = 30), followed by a standardized rehabilitation protocol. Knee function was assessed using the International Knee Documentation Committee (IKDC) score, and ankle function using the Foot and Ankle Ability Measure (FAAM) preoperatively and at one, three, and six months following the intervention. Baseline characteristics were comparable between groups. Graft length and tunnel dimensions were similar, while graft thickness was significantly more in the peroneus longus group (p < 0.001). Improvement in IKDC scores was significant in both groups; the hamstring group showed better scores at three months (p = 0.001), with no significant difference at six months. FAAM scores were comparable at all follow-ups, demonstrating preserved ankle function in the peroneus longus group. Peroneus longus tendon autograft provides comparable short-term functional outcomes to hamstring tendon autograft, with the advantage of greater graft thickness and no clinically significant ankle morbidity.

Background: Combined anterior cruciate ligament (ACL) reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) have demonstrated reduced risk of graft rerupture as compared with isolated ACLR. However, concerns remain that the risk of osteoarthritis (OA) may be increased by the addition of ALLR. Purpose/Hypothesis: The aim of this study was to evaluate the incidence of OA with isolated ACLR in comparison with ACLR + ALLR at medium-term follow-up. We hypothesized that there would be no differences between the groups. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR + ALLR with hamstring tendon autograft between January 2011 and March 2012 were propensity matched to patients who underwent isolated ACLR with bone–patellar tendon–bone (BPTB) or hamstring tendon autograft in the same period. Medium-term radiographic evaluation was performed using the International Knee Documentation Committee (IKDC) radiographic OA grading scale, modified Kellgren-Lawrence grade, and the surface fit method to assess percentage of joint space narrowing. Clinical outcomes were assessed with the following measures: IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and ACL Return to Sport after Injury. Results: A total of 80 patients (42 ACLR + ALLR and 38 isolated ACLR) were analyzed with a mean follow-up of 104 months. There was no significant difference between groups for joint space narrowing in the medial or lateral tibiofemoral or lateral patellofemoral (PF) compartment. However, 36.8% in the isolated ACLR group versus 11.9% in the ACLR + ALLR group had narrowing of the medial PF compartment (P = .0118). A lateral meniscal tear increased the risk of lateral tibiofemoral narrowing by nearly 5 times (odds ratio, 4.9; 95% CI, 1.547-19.367; P = .0123). The risk of medial PF narrowing was >4-fold with an isolated ACLR (odds ratio, 4.8; 95% CI, 1.44-19.05; P = .0179). Between the isolated ACLR group and the ACLR + ALLR group, the secondary meniscectomy rate was 13.2% versus 11.9% (not significantly different). There was no difference between groups in KOOS, Tegner, or IKDC scores. There was also no difference between groups for grades of osteoarthritic change for any classification system. Patients who received a BPTB graft had medial PF joint narrowing in 66.7% of cases as compared with 11.9% in those who received ACLR + ALLR (P = 0.118). Conclusion: ACLR + ALLR did not increase the risk of OA in the lateral tibiofemoral compartment when compared with an isolated ACLR at medium-term follow-up. Isolated ACLR using BPTB was associated with a significantly increased risk of medial PF joint space narrowing. Registration: NCT05123456 (ClinicalTrials.gov identifier).

BACKGROUND Anterior cruciate ligament (ACL) reconstruction commonly uses a hamstring tendon autograft, but the peroneus longus tendon can also be used. This study aimed to compare outcomes of anterior cruciate ligament reconstruction in 106 patients using peroneus longus tendon and hamstring tendon autografts. MATERIAL AND METHODS ACL repair was performed on 54 patients using a hamstring tendon autograft and 52 patients with a peroneus longus tendon autograft. Knee function was assessed using the International Knee Documentation Committee (IKDC) and Lysholm scores, while the ankle was evaluated using the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot &amp; Ankle Disability Index (FADI) scores. Donor-site morbidity and graft characteristics were compared. RESULTS There was no difference between the 2 groups in terms of knee IKDC and Lysholm scores (p=0.49, p=0.68, respectively). The diameter of the peroneus longus tendon graft (8.56±0.93) was significantly larger than the hamstring tendon (7.44±0.6) (p<0.001). The peroneus graft harvesting time was significantly shorter (p<0.001). Thigh hypotrophy and donor-site morbidity were significantly higher in the hamstring group (p<0.001 and p=0.006). The donor ankle AOFAS score was 93.46±3.8, and the FADI score was 93.48±4.6. No morbidity associated with the peroneus longus graft was observed. CONCLUSIONS Patients who underwent ACL reconstruction using the peroneus longus tendon experienced faster knee rehabilitation and less donor-site morbidity, such as thigh hypotrophy and knee pain. The peroneus longus tendon, with its larger diameter, fewer graft-related complications, and similar knee scores compared to the hamstring group, is considered a suitable alternative graft source.

BackgroundEver since the arthroscopic reconstruction of the anterior cruciate ligament (ACL) has begun, the use of the peroneus longus (PL) graft for primary ACL reconstruction (ACLR) has never been thought of. There is very little literature on it. Hence, our study aims to compare the functional outcomes, knee stability, donor site morbidity, and assessment of thigh muscle wasting in patients with ACL injury managed by arthroscopic single bundle reconstruction with peroneus longus tendon (PLT) and hamstring tendons (HT), respectively.MethodsAll adults aged 16-50 years of either gender presenting with symptoms of symptomatic ACL deficiency were admitted for arthroscopic single-bundle ACLR and allocated into two groups (peroneus longus and hamstring tendon). Functional scores (International Knee Documentation Committee (IKDC), Lysholm score), clinical knee evaluation (anterior drawer, Lachman, and pivot shift test), donor site morbidity (American Orthopedic Foot and Ankle Society ankle hindfoot score (AOFAS)), and thigh circumference were recorded preoperatively and at six months and one year postoperatively. The same post-op rehabilitation protocol was followed in both groups.ResultsOne hundred and ninety-four patients (hamstring n = 96, peroneus n = 98) met the inclusion criteria. There were no significant differences between the preoperative, six-month postoperative, and one-year postoperative scores between the hamstring and peroneus longus groups in the IKDC (p=0.356) and Lysholm knee score (p=0.289). The mean for the AOFAS was 99.05 ± 3.56 and 99.80 ± 0.70 in the PLT and HT groups, respectively, showing no statistical difference, with a significant improvement in thigh muscle wasting among the PLT group at final follow-up (p < 0.001).ConclusionWe observed similar knee stability and functional outcomes and no obvious donor site morbidity among both groups. These patients also had better responses to physiotherapy in recovering from their thigh muscle wasting. So, we can recommend that a PL graft can be a safe, viable, and effective option for usual arthroscopic single-bundle ACL reconstruction.

The hamstring tendon (HT) autograft is currently the most widely utilised autograft option for anterior cruciate ligament (ACL) reconstruction. However, recent studies endorse the peroneus longus tendon (PLT) autograft as a viable alternative. To evaluate this, we systematically reviewed randomised controlled trials (RCTs) to compare the efficacy of PLT against HT autografts. Our search encompassed Cochrane, Embase, OVID, PubMed, and Scopus databases for RCTs comparing outcomes of PLT and HT autografts in ACL reconstruction. Primary outcomes included Lysholm and International Knee Documentation Committee (IKDC) scores, while secondary outcomes involved American Orthopaedic Foot and Ankle Society (AOFAS) scores, graft diameters and donor-site complications. Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration) and heterogeneity was assessed with I2 statistics. 683 patients from 6 RCTs were included, with 338 (49.5%) patients treated with PLT autografts. Follow-up ranged from 12 to 30 months. Despite lower preoperative Lysholm scores in the PLT group, no significant differences were observed at 6 and 12 months. Although preoperative and 6-month IKDC scores were lower in the PLT group, no significant differences were found at 12 and 24 months. AOFAS scores showed no significant preoperative difference, but slightly lower scores were noted in the PLT group at 12 or 24 months. There was no significant difference in graft diameter, while donor-site complications were fewer in the PLT group. In summary, the PLT autograft is a promising and non-inferior alternative to the HT autograft, demonstrating equivalent outcomes in patient-reported knee and ankle metrics, comparable graft diameters and fewer donor-site complications.

Background: Anterior cruciate ligament (ACL) tear occurs between 29 to 38 cases per 100.000 people annually with more than half of cases requiring an ACL reconstruction. Peroneus longus tendon (PLT) has growing popularity as an autograft for ACL reconstruction providing comparable outcomes with proper graft diameter size, lack of donor site morbidity and uncomplicated harvesting technique. Unfortunately, certain studies did not agree with the superiority of PLT to the standard hamstring tendon (HT). Objective: The aim of study is to compare the knee functional outcome of an ACL reconstruction using peroneus longus and hamstring tendon according to recent publications. Methods: This study conducted a thorough systematic search for relevant scientific reports on multiple medical databases, including PubMed, Embase, and Google Scholar, using a combination of keywords such as "peroneus longus," “hamstring tendon,” "ACL reconstruction," “IKDC,” and “Lysholm”. The search was performed in April 2013-2023, resulting in 1567 studies. Two reviewers (RR, WA) independently screened the abstracts and reference lists, with any discrepancies resolved through consensus, concluding 5 included studies. Results: Five studies are included with a total of 538 patients consisting of 267 patients who underwent ACL reconstruction with PLT and 271 patients who underwent ACL reconstruction with HT. Up to 24 months follow-up, there are equally balanced satisfactory functional outcomes between ACL reconstruction using peroneus longus and hamstring tendon, in terms of IKDC (I2 = 74%; SMD = 0.08 95%CI, -0.21 to 0.38; p = 0.57) and Lysholm score (I2 = 75%; SMD = 0.06 95%CI, -0.27 to 0.39; p = 0.73). Conclusion: ACL reconstruction using the peroneus longus tendon is a safe and effective procedure with excellent short to long term functional outcome of the knee. Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon.

These abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, SPL designates a Sports Physical Therapy Section platform presentation. J Orthop Sports Phys Ther 2014;44(1):A47–A74. doi:10.2519/jospt.2014.44.1.A47

Background: Favorable outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) are often gauged by successful return to play (RTP), a low incidence of subsequent ACL injury, and positive patient-reported outcomes. Level 1 sports place the highest demands on the knee by requiring frequent pivoting, changes in direction, and jumping. Purpose: To analyze the outcomes of primary ACLR in level 1 athletes and identify pre- and intraoperative factors associated with RTP, ipsilateral ACL reinjury, contralateral ACL injury, and International Knee Documentation Committee (IKDC) score at 5 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: A consecutive cohort of 1432 patients who underwent primary ACLR by 2 orthopaedic surgeons were prospectively evaluated. The RTP rate, incidence of ipsilateral/contralateral ACL injury, and IKDC score were analyzed at 5 years. Comparative analysis of clinical variables was performed between those who achieved favorable outcomes and those who did not. Outcomes at 5 and 2 years were also compared. Results: The mean age was 24.3 ± 7.3 years (males: 75%, females: 25%). Gaelic football was the predominant sport (40%), followed by soccer (19%). The RTP rate was 87.4%, with 59.8% of athletes still playing at an equivalent or higher level at 5 years. The incidence of ipsilateral reinjury for athletes who resumed level 1 sport was 4.3% for bone–patellar tendon–bone (BPTB) autografts with screw fixation and 19.7% for hamstring tendon (HT) autografts with EndoButton and screw fixation. The incidence of contralateral ACL injury was 13.7%. The mean IKDC score at 5 years (86.6 ± 10.9) was comparable to that at 2 years (86.8 ± 10.1). Patients were more likely to RTP with each year of decreasing age (OR, 1.06; P < .001), with a higher preoperative Marx score (OR, 1.08; P < .001) or a higher 5-year IKDC score (OR, 1.06; P < .001). The risk of ipsilateral ACL reinjury increased each year of decreasing age (OR, 1.11; P < .001) or when an HT autograft was used (OR, 5.56; P < .001). Younger age was also associated with contralateral ACL injury (OR, 1.1; P < .001). Female sex, older age, concomitant meniscal/chondral injuries, and lower preoperative Anterior Cruciate Ligament Return to Sport after Injury scores were associated with lower IKDC scores at 5 years. Conclusion: Most patients could return to level 1 sports, although their performance level was impacted. Those who returned to sport maintained their performance level over the 5 years. The ipsilateral reinjury rate for BPTB autografts with screws was significantly lower than that for HT autografts with EndoButton and screw fixation. Most ACL reinjuries occurred between 2 and 5 years of follow-up. Younger patients had an increased risk of a subsequent ACL injury to either knee, regardless of graft type. IKDC scores were lower in female patients, older patients, and those with concomitant meniscal/cartilage injuries. Registration: NCT02771548 (ClinicalTrials.gov identifier).

This review aimed to assess whether peroneus longus tendon (PLT) autograft would have comparable functional outcomes and graft survival rates when compared to hamstring tendon (HT) autograft for anterior cruciate ligament (ACL) reconstruction. PubMed, Web of Science, Cochrane Library, Ovid (MEDICINE), and EMBASE databases were queried for original articles from clinical studies including the keywords: ACL reconstruction and PLT autograft. Studies comparing PLT autograft versus HT autograft were included in this analysis and the following data were extracted from studies meeting the inclusion criteria: graft diameter, functional outcomes (Tegner activity scale, Lysholm score, and International Knee Documentation Committee (IKDC) subjective score), kneelaxity (Lachman test), and complications (donor site pain or paresthesia, graft failure). Besides, the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Foot and Ankle Disability Index (FADI) pre-operation and at last follow-up were also compared among patients using PLT autograft. Meta-analysis was applied using Review Manager 5.3 and p < 0.05 was considered statistically significant. Twenty-three studies including 925 patients with ACL reconstruction met inclusion criteria. Of these, 5 studies included a direct comparison of PLT autograft (164 patients) versus HT autograft (174 patients). No significant difference was observed between PLT and HT autografts for Tegner activity scale, Lachman test, donor site pain, or graft failure. However, PLT groups demonstrated better Lysholm score (mean difference between PLT and HT groups, 1.55; 95% CI 0.20-2.89; p = 0.02) and IKDC subjective score (mean difference between PLT and HT groups, 3.24; 95% CI 0.29-6.19; p = 0.03). No difference of FADI was found (n.s.) but AOFAS was slightly decreased at last post-operative follow-up for patients with PLT autograft compared with pre-operative scores (mean difference of 0.31, 95% CI 0.07-0.54, p = 0.01). PLT autograft demonstrated comparable functional outcomes and graft survival rates compared with HT autograft for ACL reconstruction. However, a slight decrease in AOFAS score should be considered during surgical planning. Hence, the PLT is a suitable autograft harvested outside the knee for ACL reconstruction to avoid the complication of quadriceps-hamstring imbalance which can occur when harvesting autografts from the knee. Level II.

Objectives: The objective of this study was to determine whether there is any significant difference between the functional outcome of the knee using a hamstring (HS) graft and peroneus longus (PL) tendon graft after arthroscopic anterior cruciate ligament (ACL) reconstruction. Materials and Methods: A study was done on 140 patients from January 2021 to January 2022 as per inclusion criteria. All patients underwent arthroscopic ACL reconstruction using PL tendon and HS tendon grafts. Patients were followed up with the International Knee Documentation Committee (IKDC) and Modified Cincinnati Score (MCS) for a period of 12 months. Average time of surgery and complications if any were noted. Results: At one year follow-up, the IKDC score was 91.98 ± 3.92 and 91.74 ± 6.93, respectively, for PL and HS groups with P = 0.803. Similarly, the MCS had P = 0.161 and mean values for PL and HS groups being 92.86 ± 3.88 and 91.80 ± 4.67, respectively. Conclusion: The present study shows that the PL tendon autograft has slightly better outcomes on knee functional scores (IKDC and MCSs) to that derived from HS graft in arthroscopic reconstruction of ACL tear over one year of follow-up. PL can be considered as an alternative graft option, but further studies are needed in other sex and age groups and using different functional knee scores to establish the superiority of PL graft over HS graft.

Introduction: Arthroscopic Anterior Cruciate Ligament (ACL) reconstruction using hamstring tendon autografts is commonly used in day-to-day practice. Recently, the quadriceps tendon has been considered as a graft choice for primary ACL reconstruction due to its reliable graft size and resistance to rupture. The available literature comparing Quadriceps and Hamstring autografts in ACL reconstruction is limited. Therefore, the present study was conducted to compare the functional outcomes of these autografts using suspensory fixation at the femoral and tibial sites. Aim: To compare the functional outcomes of quadriceps tendon versus hamstring tendon autografts for primary ACL reconstruction. Materials and Methods: A randomised controlled study was conducted at Department of Orthopaedics, BLDE’s Shri BM Patil Medical College and Research Centre, Vijayapur, Karnataka, India, from January 2021 to April 2023. Thirty-four patients were included in the study and randomised into two groups: one group was operated with a quadriceps tendon graft, and the other group used a hamstring tendon autograft. Both groups underwent surgery using suspensory fixation, and postoperative rehabilitation was similar. Functional outcomes (assessed using Lysholm and International Knee Documentation Committee (IKDC) scores), return to preinjury activity, and complications were evaluated. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. The Mann-Whitney U test was applied to compare pre- and postoperative functional outcomes (Lysholm and IKDC scores) at 6, 12, and 24 months, with a significance level of p&lt;0.05. Results: Out of 34 patients, 27 (79%) were male and 7 (21%) were female. The follow-up period ranged from a minimum of 24 months to a maximum of 26 months. The mean Lysholm score in the hamstring group increased from 47 preoperatively to 92 at six months postoperatively, while in the quadriceps group, it increased from 46 preoperatively to 90 at six months postoperatively. The reliability and validity of the IKDC score for the hamstring group also increased from 46 preoperatively to 79 at six months, and for the quadriceps group, it increased from 44 preoperatively to 78 at six months. A total 31 of the cases (91%) returned to their preinjury activity, while 3 patients (9%) (2 from the hamstring group and 1 from the quadriceps group) experienced knee stiffness, which restricted their ability to squat and sit cross-legged. There were no significant differences in Lysholm and IKDC scores between the hamstring and quadriceps tendon autografts at 6, 12, and 24 months postoperatively. Conclusion: Patients undergoing single bundle ACL reconstruction have comparable functional outcomes with either hamstring or quadriceps grafts at the end of the 2-year follow-up period, with no specific graft site complications. The soft tissue quadriceps tendon autograft can be considered as an equally viable option for graft selection.

Background: Recent literature has recognized a correlation with depression and poor self-reported functional outcome after orthopaedic procedures. However, the effect of depression on anterior cruciate ligament reconstruction (ACLR) outcome has never been studied. Purpose: To quantify the incidence of major depressive disorder (MDD) and correlate depression symptoms with patient-rated knee function in patients undergoing ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: In this multicenter prospective cohort study, 64 consecutive adult patients undergoing primary ACLR were given the 16-item self-report Quick Inventory of Depressive Symptomatology (QIDS) to assess MDD symptoms preoperatively and at 6 weeks, 12 weeks, 24 weeks, and 1 year postoperatively. Lysholm and International Knee Documentation Committee (IKDC) subjective scores were obtained at the same time points to assess self-reported knee function. A QIDS score ≥6 served as a validated threshold for diagnosis of MDD. MDD and non-MDD group assignment was based on preoperative QIDS score. Student t test analysis was performed to compare ACLR outcomes between MDD and non-MDD patients. Correlation among QIDS, Lysholm, and IKDC scores was determined with Spearman r value. Results: A total of 27 patients (42%) were categorized in the MDD group. At baseline, the MDD group reported mean Lysholm (50.8) and IKDC (43.7) scores that were significantly lower than those (64.9 and 57.0, respectively) reported by the non-MDD group (P < .05). Both cohorts showed similar and significant absolute improvement from baseline to 1 year postoperatively (MDD vs non-MDD, increase in mean Lysholm: +24.4 vs +23.5 [P = .63]; MDD vs non-MDD, increase in mean IKDC: +28.1 vs +32.3 [P = .21]). While Lysholm and IKDC scores improved in both groups, at 1-year follow-up, MDD patients reported significantly lower mean Lysholm (75.2 vs 88.4; P = .04) and mean IKDC (71.8 vs 89.3; P = .001) scores as compared with their non-MDD counterparts. In addition, a moderate inverse correlation was found between QIDS and Lysholm scores (r = −0.50) and between QIDS and IKDC scores (r = −0.54). Interestingly, 4 patients experienced complications in the MDD cohort (15%), while there were no complications in the non-MDD group. Conclusion: This study suggests that ACLR may be an equally effective intervention for MDD and non-MDD patients, given their similar significant absolute improvements in functional scores from baseline to 1 year after ACLR. However, MDD patients still reported significantly lower self-reported functional scores at baseline and 1 year postoperatively.

Anterior cruciate ligament (ACL) reconstruction using hamstring tendon autograft is a common procedure in orthopedic surgery to treat ACL rupture. Graft diameter is very important in successfulness of ACL reconstruction. The purpose of this study was to evaluate the influence of hamstring autograft diameter on patient-reported functional scores following ACL reconstruction. The diameter of grafts were collected retrospectively from medical records of the patients who underwent primary ACL reconstruction with hamstring autograft in the Soeradji Tirtonegoro General Hospital, Klaten, Central Java. The patient-reported functional scores data according to the International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected by phone call interview from the patients after more than six months post-reconstruction. The comparison between graft diameter and patient-reported functional scores was analyzed by independent t test. A p<0.05 was considered significant.Thirty-two patients who fulfilled the inclusion and exclusion criteria were involved in the study who were divided into two groupswith 16 patients in each group i.e.Group 1 with graft diameter 8mm and Group 2 with graft diameter >8mm.The result showed significant difference in KOOS and IKDC score between the both groups (p<0.05). Patients who underwent ACL reconstructionwith graft diameter >8mm (Group 2) had higher KOOS and IKDC score compared to graft diameter 8mm (Group 1) (p<0.05). In conclusion, ACL reconstructionwith increased hamstring autograft diameter >8 mm associated with better patient-reported functional scores in 6 monthsfollow-up after ACL reconstruction.