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

Cheng-Yi Lin; Po-Jen Lai; Ming-Ta Yang; Er-Yuan Chuang; Wen-Pei Chang; Tan Cheng Aun; Pei-Wei Weng

doi:10.1111/os.70234

Orthopaedic Surgery ›› 2026, Vol. 18 ›› Issue (1) :126 -137. DOI: 10.1111/os.70234

CLINICAL ARTICLE

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

Author information +

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

². Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

³. Center for General Education, Taipei Medical University, Taipei, Taiwan

⁴. Clinical Research Center, Taipei Medical University Hospital, Taipei, Taiwan

⁵. Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan

⁶. International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan

⁷. Cell Physiology and Molecular Image Research Center, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan

⁸. Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

⁹. School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan

¹⁰. Department of Orthopaedics, Lam Wah Ee Hospital, Penang, Malaysia

¹¹. Research Center of Biomedical Device, Taipei Medical University, Taipei, Taiwan

¹². Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

wengpw@tmu.edu.tw

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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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Cheng-Yi Lin, Po-Jen Lai, Ming-Ta Yang, Er-Yuan Chuang, Wen-Pei Chang, Tan Cheng Aun, Pei-Wei Weng. Delayed Simultaneous Reconstruction of the ACL and MCL Using Ipsilateral Single Hamstring Tendon Autograft With A Modified Technique. Orthopaedic Surgery, 2026, 18(1): 126-137 DOI:10.1111/os.70234

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