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

Cheng-Yi Lin1, Po-Jen Lai2, Ming-Ta Yang3,4

  • 1Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.

Orthopaedic Surgery
|December 26, 2025
PubMed
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Simultaneous anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstruction using hamstring autografts effectively restores knee stability in chronic combined injuries. This technique offers comparable outcomes to isolated ACL reconstruction for severe MCL injuries.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Knee Ligament Reconstruction

Background:

  • Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries present complex management challenges.
  • Optimal surgical strategies for chronic ACL and MCL injuries, particularly with varying MCL severity, remain debated.
  • This study addresses the need for effective surgical techniques for combined chronic ACL and grade III MCL injuries.

Purpose of the Study:

  • To introduce and evaluate a novel surgical technique for simultaneous reconstruction of chronic ACL and grade III MCL injuries.
  • To assess the efficacy of simultaneous ACL and MCL reconstruction in improving chronic MCL instability.
  • To compare outcomes of simultaneous reconstruction versus simple ACL reconstruction in combined injuries.

Main Methods:

Keywords:
anterior cruciate ligamenthamstring autograftmedial collateral ligamentreconstructionvalgus instability

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  • A cohort of 41 patients with combined ACL and MCL injuries were analyzed.
  • Patients were divided into simple ACL reconstruction (SAR) and simultaneous ACL and MCL reconstruction (SAMR) groups.
  • A single ipsilateral hamstring autograft was used for both ACL and MCL reconstruction in the SAMR group, with clinical and MRI assessments performed.

Main Results:

  • Both SAR and SAMR groups demonstrated significant improvements in range of motion, functional scores, and knee stability (Lachman test, valgus instability).
  • No significant differences in postoperative outcomes were observed between the SAR and SAMR groups.
  • High-quality grafts were confirmed by postoperative MRI in both treatment groups.

Conclusions:

  • A novel surgical technique utilizing hamstring autografts for simultaneous ACL and MCL reconstruction is presented.
  • This technique achieves knee stability comparable to isolated ACL reconstruction in patients with combined ACL and severe MCL injuries.
  • Further research with larger cohorts and long-term follow-up is recommended to validate these findings.