Effective Restoration of Valgus Stability and Functional Improvement after Medial Collateral Ligament Reconstruction Using a Double-Bundle Triangular Tibial-Sling Technique with a Single Graft
S.M.D.G. Canuto, E.S. Mameri, F.S. Pimenta, V.B.C. De Padua, C.P. Helito, C.E.D.S. FrancioziObjectives:
To evaluate the clinical outcomes following medial collateral ligament (MCL) reconstruction using a double-bundle triangular tibial-sling technique, with a minimum 2-year follow-up.
Methods:
This multicenter prospective cohort study included patients undergoing primary MCL reconstruction between 2020 and 2022. Patient-reported outcomes (Lysholm, IKDC subjective, and Tegner) were assessed preoperatively and at final follow-up (≥24 months). Statistical significance was evaluated using paired tests, and clinical relevance was quantified with distribution-based thresholds (0.5 SD, SEM, and MDC₉₅). Objective valgus stability at 0° and 30° of knee flexion was graded and compared using objective IKDC criteria pre- and postoperatively. Multivariable logistic regression was performed to identify independent predictors of failure to restore normal valgus stability.
Results:
Sixty-five patients (mean age 32.0 ± 9.9 years; mean follow-up 32.9 ± 7.6 months) were included. Lysholm and IKDC subjective scores demonstrated statistically and clinically significant improvements, with most patients exceeding MDC₉₅ thresholds, while Tegner activity levels were maintained. At final follow-up, normal or near-normal valgus stability (IKDC A/B) was achieved in 98.5% of knees at 0° and 93.8% at 30° of flexion (p < 0.0001). Complete normalization (IKDC A) was achieved in 78.5% and 67.7% of cases at 0° and 30°, respectively. Multivariable analysis identified concomitant posterior cruciate ligament (PCL) injury as the only independent predictor of reduced likelihood of restoring normal valgus stability.
Conclusion:
Double-bundle tibial-sling MCL reconstruction results in statistically and clinically meaningful functional improvement and reliably restores objective valgus stability at ≥2 year follow-up. PCL involvement negatively influences complete stability restoration.