This is a prospective, single-blinded, randomized controlled trial. Sixty patients (≥18 years) with an isolated ACL injury will be randomly assigned to receive an ACL reconstruction using either a Peroneus Longus Tendon (PLT) autograft or a Hamstring Tendon (HST) autograft. The primary objective is to compare early functional outcomes between the two groups at 6 weeks and 3 months post-surgery, using the Lysholm Knee Score. The study aims to demonstrate the non-inferiority of the PLT graft. All surgeries will be performed arthroscopically at Khyber Teaching Hospital, Peshawar, followed by a standardized rehabilitation protocol.

This study compares two autograft sources for anterior cruciate ligament (ACL) reconstruction. While the hamstring tendon (HST) is a widely used standard, it is associated with donor-site complications such as anterior knee pain and weakness. The peroneus longus tendon (PLT) has emerged as a potential alternative, offering similar biomechanical strength with the possibility of reduced donor-site morbidity. However, robust comparative data, particularly focusing on early functional recovery, remain limited, creating a need for high-quality evidence to guide surgical decision-making.

To this end, the trial is designed as a single-center, prospective, randomized controlled study. Sixty patients will be randomly assigned to receive ACL reconstruction using either a PLT or HST autograft, with functional outcomes assessed via the Lysholm Knee Score at six weeks and three months postoperatively. The methodology includes rigorous allocation concealment, blinding of the outcome assessor, and an intention-to-treat statistical analysis to robustly test the non-inferiority of the PLT graft.

The trial has received ethical approval, and all participants will provide informed consent. The findings aim to contribute meaningful evidence to clinical practice and will be disseminated through peer-reviewed publications and scientific conferences, with the goal of informing safer and more effective surgical choices for patients with ACL injuries.

Inclusion Criteria:

• Patients aged 18 years or older.
• Isolated, primary Anterior Cruciate Ligament (ACL) injury confirmed by clinical assessment and Magnetic Resonance Imaging (MRI).
• Provides written informed consent for the surgical procedure and study participation, including follow-up assessments.

Exclusion Criteria:

• Multiligament knee injuries (e.g., concomitant PCL, MCL, or LCL injuries).
• Previous surgery or history of fracture in the involved lower limb.
• Radiographic evidence of osteoarthritis in the affected knee.
• Presence of any neuromuscular disease.

De-identified individual participant data (IPD) that underlie the results reported in the primary publication will be made available to researchers upon reasonable request, following the completion of the trial and primary analysis. This includes demographic data, baseline clinical characteristics, surgical details, and outcome measures (Lysholm Knee Scores at all time points).

Data will become available beginning 6 months after the publication of the primary results manuscript. Data will be available for a minimum of 5 years.

Data access requests will be reviewed by the trial's principal investigator and steering committee. Requestors will be required to submit a methodologically sound research proposal. Access will be granted following the execution of a data use/sharing agreement that commits the requestor to: 1) using the data only for the approved research, 2) securing the data appropriately, 3) destroying the data after analyses are complete, 4) not attempting to re-identify participants, and 5) acknowledging the data source in any publications. Proposals must also obtain approval from an authorized Institutional Review Board (IRB) or Ethics Committee.

Due to the nature of the surgical intervention, the participating surgeons and patients cannot be blinded to the group assignment. However, the independent assessor responsible for collecting the primary outcome (Lysholm Knee Score) will be blinded to which graft type the participant received.