Seventy-one patients with complete anterior cruciate ligament (ACL) injuries were randomized to receive either a peroneus longus (PL) tendon autograft (n=36) or a hamstring tendon (HST) autograft (n=35) for arthroscopic ACL reconstruction. The primary outcome was knee functional recovery assessed by the IKDC and Lysholm scores. Secondary outcomes included autograft diameter, ankle function using AOFAS score (PL group only), knee stability, and complications. Outcomes were assessed up to 18 months postoperatively. Overall, the results of the study revealed no significant differences in knee functional outcomes between the PL and HST groups. The PL group had a significantly larger graft diameter and minimal donor site morbidity. These findings suggest that PL tendon autografts are a safe and effective alternative to HST grafts in ACL reconstruction, with equivalent functional outcomes and low donor site morbidity.