Table 5.

-Significant observations from the individual studies.

S.No	Study	Sample population	Type and characteristics of PLT graft	Significant findings
1	Chan	Biomechanical study (4 cadaveric specimens of PLT)	PLT graft tested on MTS machine in a single-looped manner	Ultimate tensile strength:3050 N
				Stiffness: 346 N/mm
2	Zhao	Ninety two patients undergoing knee ligamentous reconstruction	Anterior ½ of PLT (AHPLT)	Mean failure load: 322.35 ± 663.18 N(97.69 ± 19.48 % of semitendinosus, 147.94 ± 41.3 % of gracilis)
				Distance between tendon stripperand bifurcation of deep peroneal nerve:4.6–10.4 cm
				PreoperativeAOFAS: 97.4 ± 2.0
				Postoperative AOFAS:97.2 ± 1.6 (p = 0.85)
				Preoperative FADI: 96.8 ± 2.2
				Postoperative FADI:96.9 ± 2.5 (p = 0.91)
				No peroneal nerve injury, PLT tendinopathy
3	Nazem	15 patients with insufficient (size < 8 mm) hamstring tendons for ACL reconstruction	Hamstring tendon reinforced with PLT	1Significant post-operative (minus) pre-operative difference in ankle ROM* (flexion/extension) (p < 0.05) 2Comparison of operated and non-operated ankles: a. No significant difference inmoments in sagittal and coronal planes (p > 0.05); b. Significant difference in moments in transverse planes (p = 0.006); c. Significant difference in the force in all 3 planes (p < 0.05) 3Comparison of operated and non-operated extremities: No significant difference in mean spatiotemporal gait parameters (p.0.05) * - Range of motion
4	Liu	8patients with non-satisfactory HT graft (diameter < 7 mm) in ACLR	Half-PLT graft augmentation of HT (HT+1/2PLT)	Mean diameter (HT+1/2PLT):9.6 mm (Range: 9.5–10 mm) Outcome: •Mean IKDC score: 86 (Ranging between 83 and 89) •Mean Lysholm score: 84.4 Mean Lysholm score: 84.4 (Ranging between 80 and 90) •Mean donor side FADI: 135.8 (Ranging between 134 and 136) HT+1/2PLT: Safe and successful option
5	Angthong	24 patients undergoing ACL reconstruction	PL autograft and endobutton fixation	Mean follow-up: 12.8 months
				Ankle anterior drawer: Normal – 83.3 %; average pre-operative AOFAS: 100.0 ± 0.0; Mean post-operative (6 months) AOFAS: 96.0 ± 9.6 (p = 0.06); Mean pre-operative VAS-FA score:99.7 ± 1.1; Mean post-operative (13 months) VAS-FA scores:95.4 ± 12
				At 7th month isokinetic testing: Significantly lower peak eversion and inversion torquesafter PLT harvest (p < 0.05)
				Authors DIDNOT recommend PLT as first option in ACLR due to ankle morbidity(in 1 year)
6	Rudy	Biomechanical study (6 cadaveric specimens of PLT)	Compared cadaveric PLT and hamstring grafts	Tensile strength of PLT: Similar to hamstring
				Both PLT and hamstring: Similar biomechanical properties
				P longus: Recommended as alternative donor in multiligamentous reconstruction (Not as 1st option in ACLR)
7	Rhatomy	Patients undergoing single bundle ACLR (52 patients with 24 PLT grafts)	Compared PLT and hamstring grafts	PLT vs Hamstring:8.8 ± 0.7 mm vs 8.2 ± 0.8 mm (p = 0.012); Statistically similar pre- and post-operative (at 1 year) knee scores (IKDC, modified Cincinnati Lysholm) between hamstring and PLT groups PLT group: Mean AOFAS: 97.3 ± 4.2; Mean FADI: 98 ± 3.4 Hamstring group: Significant decrease in thigh circumference (p = 0.002) Benefits of PLT graft:Large graft diameter; Minimal thigh wasting; Excellent ankle functional scores (AOFAS, FADI)
8	Wong	Biomechanical	38 PLT prepared using 2-strand graft technique; cyclic loading	No significant difference in intrinsic material property or tendon fatigue
				Tendon stiffness: Decreased with age
9	Bi	Patients undergoing all inside anatomical single bundle ACLR	Compared reconstruction with AHPLT (62 cases) and semitendinosus grafts	Comparison between semitendinosus and AHPLT: No significant difference w.r.t IKDC score, KT 1000, Pivot shift test, VAS
				No ankle-related complications
				Mean AOFAS score: No significant differences between semitendinosus (99.5 ± 1.21) and AHPLT (99.1 ± 1.40)
				Clinical and radiological outcome similar between the two groups
10	Khajotia	25 patients undergoing ACL repair	Triple layered PLT autograft	IKDC score:Normal −84 %, Abnormal/severely abnormal −16 %
				Mean IKDC Score: 83.53
				Lachman test: Normal - 72 %, 1+ laxity - 20 %, 2+ and 3+ - 4 %
				Pivot shift: Negative - 60 %, Pivot glide - 36 %, Gross pivot shift – 4 %
				Donor site morbidity: No patient had ankle dysfunction; Pressure pain – 2 patients
11	Shi	Biomechanical testing 38 ACL + MCL(GradeIII) injuries	ACL reconstruction using doubled autologous PLT or quadrupled autologous HT	Doubled PLT: Ultimate tensile strength – Comparable with quadrupled HT and significantly better than native ACL
				PLT vs HT groups: Similar clinical/functional outcome
				PLT: No deterioration in ankle biomechanical testing after graft harvest; Suitable autograft in ACL + MCL(GradeIII) injuries
12	Song	156 single-bundle ACLR		Mean PLT graft diameter: 8.3 mm
				Graft diameter: Associated with duration since injury and height/weight
				<8 mm: 21 (13.5 %) patients
				8 and 9 mm: 85 (54.5 %) patients
				≥9 mm:50 (32.0 %) patients
13	Rhatomy	39 patients(28 males) with isolated rupture of ACL (16–45 years of age)		PLT girth:8.56 ± 0.82
				PL diameter correlates significantly (p < 0.05) with height/weight/BMI (p < 0.05)
14	Trung	30 patients with combined ACL + MCL injuries	Arthroscopic ACLR with AHPLT	Mean diameter of AHPLT autograft: 7 mm
				Pre-operative vs 6-months post-operative: Significantly improved Lysholm score (59 vs 94.27); no difference in AOFAS
				PLT: Safe autograft choice in ACLR
15	Kumar	25 patients(28 males) with isolated rupture of ACL		Preserved power of foot eversion after graft harvest
				IKDC score: Normal in 92 % (23 cases)
				PLT Harvest: Minimally affect gait or stability of ankle
				PLT: Satisfactory graft choice for ACLR – easier graft harvesting, satisfactory size, good cosmesis
16	Rhatomy	52 patients undergoing isolated ACLR	ACL reconstruction using HT (n = 28), versus PLT (n = 24) grafts	PL diameter: 8.8 ± 0.7 mm; Hamstring diameter: 8.2 ± 0.8 mm (significant difference: p = 0.012)
				Similar functional outcome between PL and HT grafts (IKDC, modified Cincinnati, Lysholm)
				Mean AOFAS Score: 97.3 ± 4.2 (PLT)
				Mean FADI:98 ± 3.4 (PLT)
				Hamstring group: Significant decrease in thigh circumference (p = 0.002)
				PLT autograft:
				Comparable functional knee scores to hamstring graft at 1 year
				Benefits of PL: Less thigh wasting, excellent ankle function, excellent graft size
17	Rhatomy	31 patients undergoing ACL reconstruction(22 male); age: 27.58 ± 8.69 years	PLT autograft	Similar ankle eversion [Harvest side: 65.87 ± 7.63 N vs contralateral side: 66.96 ± 8.38 N] and 1st ray plantar flexion [Harvest side: 150.64 ± 11.67 N vs contralateral side: 152.10 ± 12.16 N] strengths
				Ankle function: Excellent results
				Mean FADI: 99.71 ± 0.57, AOFAS: 98.71 ± 3.03
18	Sharma	10 cases of ACL reconstruction	PLT autograft	PLT: Excellent graft for ACLR
				Advantages: Simple harvest technique, large size, less complications (decreased thigh wasting), satisfactory ankle function (AOFAS/FADI), Comparable knee function to hamstring autografts at 1 year (Modified Cincinnati, Lysholm)
19	Sakti	20 patients undergoing primary ACL reconstruction	PLT autograft	Height, weight, true leg and shank lengths: Significantly correlated with graft diameter
				Height, true leg length: Significantly correlated with PLT graft length
20	Rhatomy	75 patients undergoing single-bundle ACLR	PLT	PLT graft diameter: 8.38 ± 0.68 mm
				Excellent knee (IKDC, Tegner-Lysholm and modified Cincinnati) and ankle function (mean AOFAS - 98.93 ± 3.1; mean FADI – 99.79 ± 0.59) at 2 years post-operatively
				Low complication rate: Maintained thigh girth (knee); excellent serial ankle hop
21	Shao	21 patients (mean age: 34 ± 11.2 years [mean follow-up 31.8 ± 7.7 months	Whole length, full-thickness PLT	Clinical ankle parameters:
				AOFAS: 98.7 ± 2.5 (pre-operative) vs 98.5 ± 2.4 (post-operative); p = 0.48
				Karlsson-Peterson (hindfoot score): 98.3 ± 2.4 (pre-operative) vs 97.9 ± 2.5 (post-operative); p = 0.162
				Statistically similar a. Bilateral square hop (p = 0.109); b. Bilateral plantar flexion peak force (p = 0.371)
				Substantially reduced eversion peak force (p < 0.001)
				MRI: Universal PL regeneration
				Total bilateral PLT index: 82.9 ± 17.4 % [in healthy controls, 99.4 ± 4.3 %]
				Excellent foot/ankle functional outcome and PLT regenerative potential
22	Kumar	100 (80 males; age: 27.25 ± 9.11 years) patients undergoing single bundle primary ACL reconstruction		Mean diameter of PLT graft: 8.55 ± 0.73 mm
				Mean IKDC score: 55.77 ± 15.11 (Pre-operative); 96.12 ± 3.52 (post-operative)
				Mean Modified Cincinnati score: 66.12 ± 17.32 (pre-operative); 94.36 ± 7.21 (post-operative)
				Mean Tegner-Lysholm score: 68.45 ± 15.65 (pre-operative); 90.44 ± 8.56 (post-operative)
23	Joshi	48 non-athletic adults undergoing primary ACL reconstruction	Graft harvest time: 7.4 (ranging between 5 and 9) minutes Doubled graft thickness: 7.9 mm (ranging between 7 and 9 mm) Mean length: 29.4 ± 2.34 cm	At 2-year followup:
				Patient satisfaction with outcome of knee surgery: 96 %
				Patient satisfaction with status of ankle joint: 95 %
				Mean postoperative IKDC and AOFAS scores: 78.16 ± 6.23 and 98.4 ± 4.1, respectively
				Neurovascular deficit: None
				Benefits of PLT: Easier to harvest, better ultimate tensile strength, better graft size (girth and length), shorter time to harvest, minimal harvest-related morbidity; good functional outcome/stability of knee
24	Vijay	23 patients of ACL injury	Mean length of PLT graft - 8.5–9.0 cm Mean diameter - 8.5 mm PLT (vs HT) autograft – better graft size (diameter, length)	Functional outcome of the knee (Lysholm and Modified Cincinnati scores) - Significant improvement in PLT group (p = 0.002) compared to hamstring PLT group: Ankle function (AOFAS): Reduced at 6 months; Improved at 1-year Knee flexion strength: Significantly improved
25	Goyal	Revision ACLR (10 patients) and multi-ligamentous knee injury (27 patients)	Mean length and diameter of doubled PLT: 26.2 ± 2.6 (22–31) cm; and 7.9 ± 0.68 (7.5–8.5) mm	Substantially improved 2-year knee functional scores [VAS, Lysholm and IKDC scores]
				No significant harvest-treated morbidity or complications