Outcome of arthroscopic anterior cruciate ligament reconstruction by hamstring and medial collateral ligament reconstruction by peroneus longus autograft in anteromedial knee instability

Abstract

Background: Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are a common cause of anteromedial knee instability and often require surgical reconstruction to restore function and stability. This study evaluated the functional outcomes, knee stability and complications following arthroscopic ACL reconstruction using a hamstring autograft and MCL reconstruction using a peroneus longus autograft. Methods: This prospective observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, from September 2021 to March 2024. A total of 23 patients with combined ACL-MCL injuries underwent reconstruction and were evaluated preoperatively and at 9 months postoperatively using Lachman’s test, valgus stress test, Lysholm Knee Score and knee flexion range of motion (ROM). Postoperative complications, including surgical site infection, donor site morbidity and residual instability, were also assessed. Results: Significant improvements in knee stability and function were observed at 9 months postoperatively (p<0.001). Lachman’s test was negative in 86.96% of patients, while valgus stress testing demonstrated medial stability in 82.61%. The mean Lysholm Knee Score increased from 52.83±9.11 preoperatively to 87.30±6.30 postoperatively (p<0.001). Normal knee flexion was achieved in 82.61% of patients. Complications were minimal, including surgical site infection in 4.35%, donor site morbidity in 13.04% and residual instability in 13.04% of patients. Conclusions: Hamstring autograft ACL reconstruction combined with peroneus longus autograft MCL reconstruction provides excellent functional recovery and knee stability with minimal complications. Larger studies with longer follow-up are needed to confirm these findings.