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. 2026 Jan;18(1):126-137.
doi: 10.1111/os.70234. Epub 2025 Dec 26.

Delayed Simultaneous Reconstruction of the ACL and MCL Using Ipsilateral Single Hamstring Tendon Autograft With A Modified Technique

Cheng-Yi Lin  1 , Po-Jen Lai  2 , Ming-Ta Yang  3   4 , Er-Yuan Chuang  5   6   7 , Wen-Pei Chang  8   9 , Tan Cheng Aun  10 , Pei-Wei Weng  2   5   11   12
Affiliations

Delayed Simultaneous Reconstruction of the ACL and MCL Using Ipsilateral Single Hamstring Tendon Autograft With A Modified Technique

Cheng-Yi Lin et al. Orthop Surg. 2026 Jan.

Abstract

Purpose: Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are common and present challenges in management. While ACL reconstruction has been established, the optimal approach for combined ACL and MCL injuries remains debatable owing to the varying severity and chronicity of MCL injuries. This study aimed to describe a novel surgical technique for chronic ACL and grade III MCL injuries and assess whether simultaneous ACL and MCL reconstruction improves chronic MCL instability.

Methods: A total of 41 patients diagnosed with combined ACL and MCL injuries were included in the study. Twenty-five patients were allocated into the simple ACL reconstruction (SAR) group while 16 patients were allocated into the simultaneous ACL and MCL reconstruction (SAMR) group according to MCL injury severity. The surgical technique utilized a single ipsilateral hamstring autograft for both ACL and MCL reconstruction. Clinical assessments, including range of motion (ROM), functional score, Lachman test, and valgus instability, were conducted before and after surgery. Postoperative magnetic resonance imaging (MRI) was used to evaluate graft quality.

Results: Postoperative outcomes revealed significant improvements in ROM, functional scores, Lachman test, and valgus instability in both groups. There were no significant differences between the SAR and SAMR groups, suggesting that patients with combined ACL rupture and severe MCL injuries can achieve similar stability outcomes as those with ACL rupture and mild MCL injuries. The MRI results revealed high-quality grafts in both groups.

Conclusion: This study introduces a novel technique using simple hamstring autografts for simultaneous ACL and MCL reconstruction, and this surgical technique can achieve knee stability comparable to that of low-grade MCL injuries and can be used for single ACL reconstruction. Further research with larger sample sizes and long-term follow-up is needed to confirm these findings.

Keywords: anterior cruciate ligament; hamstring autograft; medial collateral ligament; reconstruction; valgus instability.

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Conflict of interest statement

The authors declare no conflicts of interest in the conduct and reporting of this research.

Figures

FIGURE 1
FIGURE 1
Knee MRI of “patient A” in the SAMR group. (A, B) First MRI after injury; (C, D) MRI after 3 months of follow‐up. (A) Sagittal fat‐suppressed proton density‐weighted MRI showing ACL rupture, and (B) coronal T2 MRI revealing MCL (white arrows) injury with femoral condyle and proximal tibia bone edema. Three months later, (C) sagittal fat‐suppressed proton density‐weighted MRI revealed increased intensity and fiber discontinuity in the ACL. (D) Coronal T1‐wighted MRI revealed MCL (white arrows) was detached from the femoral site and still mildly swollen.
FIGURE 2
FIGURE 2
Postoperative anteroposterior and lateral X‐ray of “patient A” in the SAMR group.
FIGURE 3
FIGURE 3
A left knee was drawn. A diagrammatic representation of the surgical steps of our MCL reconstruction technique is shown in the figure. The pink tendon represents a hamstring autograft secured to the remaining fibers of the ruptured MCL via advanced repair with nonabsorbable sutures. The ACL reconstruction is not presented in the figure.
FIGURE 4
FIGURE 4
Postoperative 12‐month MRI and SI evaluation in the T2‐weighted coronal view in “Patient A”. The red lines represent the contour of the ACL graft, and the green lines represent the contour of the MCL graft. Compared with the PCL (not shown in this image), these grafts were both Grade I.
FIGURE 5
FIGURE 5
The flow of participants throughout the research.
See this image and copyright information in PMC

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