Current issue
Journal content
Articles in press
Archive
About the Journal
About the Polish Annals of Medicine
Editorial Board
Abstracting & indexing
Open Access policy
Charges
Affiliated institutions
Contact
Instructions
Peer review process
Guide for authors
Publication ethics
Ethics and Patient Consent
User License
Usage of third party materials
Disclaimer
Statement on Artificial Intelligence
Reviewers
Guide for reviewers
Review Form
RESEARCH PAPER
Anterior Cruciate Ligament reconstruction with Bone-Tendon-Bone and Medial Collateral Ligament augmentation with semitendinosus to correct chronic anteromedial rotator instability of the knee: A prospective single-center study
1
University Hospital of Trauma, Tirana, Albania
2
General University Hospital of Patras, Patras, Greece
3
Faculty of Medicine, University of Medicine, Tirana, Albania
Submission date: 2025-12-22
Final revision date: 2026-03-04
Acceptance date: 2026-03-04
Online publication date: 2026-05-28
Publication date: 2026-05-28
Pol. Ann. Med. 2026;33:157-163
KEYWORDS
Anterior Cruciate Ligament reconstructionpostoperative careanteromedial rotator instabilityMedial Collateral Ligament augmentation
TOPICS
ABSTRACT
Introduction:
Anterior Cruciate Ligament (ACL) reconstruction in patients with a more than one-year rupture is associated with anteromedial rotator instability (AMRI). Additional procedures to correct developmental AMRI have demonstrated improved outcomes compared to isolated ACL reconstruction. Purpose: ACL reconstruction and Medial Collateral Ligament (MCL) augmentation will restore the AMRI.
Aim:
In this study, we present a unique approach to treating chronic AMRI. We observed the development of chronic AMRI in patients who had neglected their ACL rupture.
Material and methods:
In this prospective single-arm case series, 32 patients with chronic AMRI (more than 1 year since injury) were included. A Bone-Tendon-Bone BTB graft for ACL reconstruction and semitendinosus tendon augmentation of the MCL were performed, and a 2-year follow-up was conducted to assess knee stability and Range of Motion (ROM).
Results and discussion:
At the end of the follow-up, most patients showed a significant improvement in their International Knee Documentation Committee (IKDC) scores, with knee stability restored to normal in 90.7% of cases. These findings demonstrate substantial post-operative improvement following the combined ACL reconstruction and MCL augmentation.
Conclusions:
The BTB reconstruction of the ACL with an augmented MCL was associated with significant improvement in knee stability and functional scores in patients with chronic AMRI. This technique requires minimal additional action compared to a simple BTB technique, making it a feasible option for orthopedic surgeons.
Anterior Cruciate Ligament (ACL) reconstruction in patients with a more than one-year rupture is associated with anteromedial rotator instability (AMRI). Additional procedures to correct developmental AMRI have demonstrated improved outcomes compared to isolated ACL reconstruction. Purpose: ACL reconstruction and Medial Collateral Ligament (MCL) augmentation will restore the AMRI.
Aim:
In this study, we present a unique approach to treating chronic AMRI. We observed the development of chronic AMRI in patients who had neglected their ACL rupture.
Material and methods:
In this prospective single-arm case series, 32 patients with chronic AMRI (more than 1 year since injury) were included. A Bone-Tendon-Bone BTB graft for ACL reconstruction and semitendinosus tendon augmentation of the MCL were performed, and a 2-year follow-up was conducted to assess knee stability and Range of Motion (ROM).
Results and discussion:
At the end of the follow-up, most patients showed a significant improvement in their International Knee Documentation Committee (IKDC) scores, with knee stability restored to normal in 90.7% of cases. These findings demonstrate substantial post-operative improvement following the combined ACL reconstruction and MCL augmentation.
Conclusions:
The BTB reconstruction of the ACL with an augmented MCL was associated with significant improvement in knee stability and functional scores in patients with chronic AMRI. This technique requires minimal additional action compared to a simple BTB technique, making it a feasible option for orthopedic surgeons.
REFERENCES (18)
1.
Gonzalez-Pola R, Gómez Mont-Landerreche JG, Herera-Lozano A, et al. Rotational instability of the knee: Injury of the anterior cruciate and anterolateral knee ligaments, MRI findings. J Muscuoscelet Surg Res. 2021;5:24–9. https://doi.org/10.4103/jmsr.j....
2.
Fu FH, van Eck CF, Tashman S, et al. Anatomic anterior cruciate ligament reconstruction: A changing paradigm. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):640–648. https://doi.org/10.1007/s00167....
3.
Slocum DB, Larson RL. Rotatory instability of the knee: Its pathogenesis and a clinical test to demonstrate its presence. J Bone Joint Surg. 1968;50–A:211–225.
4.
Zantop T, Schumacher T, Diermann N, et al. Anterolateral rotational knee instability: Role of posterolateral structures. Winner of the AGA-DonJoy Award 2006. Arch Orthop Trauma Surg. 2007;127(9):743–752. https://doi.org/10.1007/s00402....
5.
Stephen JM, Halewood C, Kittl C, et al. Posteromedial Meniscocapsular Lesions Increase Tibiofemoral Joint Laxity With Anterior Cruciate Ligament Deficiency, and Their Repair Reduces Laxity. Am J Sports Med. 2016;44(2):400–408. https://doi.org/10.1177/036354....
6.
Engebretsen L, Lind M. Anteromedial rotatory laxity. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):27972804. https://doi.org/10.1007/s00167....
7.
Sims WF, Jacobson KE. The posteromedial corner of the knee: Medial-sided injury patterns revisited. Am J Sports Med. 2004;32(2):337–345. https://doi.org/10.1177/036354....
8.
Koga H, Muneta T, Yagishita K, Ju YJ, et al. Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):88–94. https://doi.org/10.1007/s00167....
9.
Badran A, Elganiny M, Elrhman A. Chronic anteromedial rotatory instability of the knee: Technique and results of a near-anatomical reconstruction. Egypt Orthop J. 2019;54(2):126–132. https://doi.org/10.4103/eoj.eo....
10.
Robinson JR, Bull AM, Amis AA. Structural properties of the medial collateral ligament complex of the human knee. J Biomech. 2005;38(5):1067–1074. https://doi.org/10.1016/j.jbio....
11.
Hughes JD, Rauer T, Gibbs CM. Diagnosis and treatment of rotatory knee instability. J EXP ORTOP 6. 2019;48. https://doi.org/10.1186/s40634....
12.
Todhe D, Cipi R, Hysenaj A. Internal brace ligament augmentation vs. anatomical repair with hamstrings of the ACL– a clinical data comparison study. Open Access Macedonian Journal of Medical Sciences, VOL.10 A: Basic Sciences Sports Medicine 2022. https://doi.org/10.3889/oamjms....
13.
Rodrigues CAS, Albano TR, Pereira Melo AK, et al. Y-Balance Test after ACL Reconstruction: The relationship with knee and hip muscle strength, ankle dorsiflexion range of motion and postural stability. J Bodyw Mov Ther. 2024;40:2099–2104. https://doi.org/10.1016/j.jbmt....
14.
Liau ZQG, Thirukumaran K, Yeo KZG, Mok YR, Lee YHD. Outcomes of ACL Reconstruction with Concomitant Meniscal Surgery: A Retrospective Cohort Study. Orthop J Sports Med. 2025. Available from: https://pubmed.ncbi.nlm.nih.go.... Accessed: December 20, 2025.
15.
Zaffagnini S, Bignozzi S, Martelli S, et al. Does ACL reconstruction restore knee stability in combined lesions? An in vivo study. Clin Orthop Relat Res. 2007;454:95–99. https://doi.org/10.1097/BLO.0b....
16.
Canata GL, Chiey A, Leoni T. Surgical technique: Does mini-invasive medial collateral ligament and posterior oblique ligament repair restore knee stability in combined chronic medial and ACL injuries? Clin Orthop Relat Res. 2012;470(3):791–797.
17.
Grapatsas K, Tsilogianni Z, Papatriantafyllou A, et al. Undiagnosed Marfan Syndrome During Military Enlistment: Challenges for Medical Qualification and a Brief Clinical Review. Pol Ann Med. 2025;32(2):220–224. https://doi.org/10.29089/paom/....
18.
van Grinsven S, van Cingel RE, Holla CJ, et al. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1128–1144.
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
