Prospective Study of Clinical and Functional Outcomes after Medial Collateral Ligament Reconstruction by Rerouting Hamstring Tendon

BACKGROUND: Medial collateral ligament (MCL) injuries are among the most frequently encountered ligamentous injuries of the knee, accounting for approximately 35%-40% of all knee ligament injuries in active and athletic populations. High-grade MCL injuries, particularly when associated with multiligament knee trauma, may result in persistent valgus instability and functional impairment, often necessitating surgical reconstruction in chronic or symptomatic cases. MATERIALS AND METHODS: This prospective cohort study was conducted at a tertiary care teaching hospital between November 2022 and November 2024. Thirty patients undergoing MCL reconstruction were included and followed for a minimum of 12 months. Twelve patients had isolated Grade III MCL tears, and eighteen had multiligament knee injuries with associated Grade III MCL tears. All patients underwent MCL reconstruction using a semitendinosus tendon rerouting technique. Clinical assessment included valgus stress testing for knee stability and functional evaluation using the International Knee Documentation Committee (IKDC) score. Preoperative and postoperative outcomes were compared within and between groups using appropriate statistical tests. RESULTS: Preoperatively, valgus stress opening was significantly greater in the multiligament injury group compared to the isolated MCL group (P < 0.001), while preoperative IKDC scores were comparable (P = 0.848). At 12-month follow-up, both groups demonstrated significant improvement in medial knee stability and functional outcomes. Postoperative valgus stress opening remained slightly higher in the multiligament group (P < 0.001), but postoperative IKDC scores were comparable between groups (P = 0.602). Both groups showed similar percentage improvement in valgus stability (81.82%) and IKDC scores. Complications were more frequent in the multiligament group, though no graft failures were observed. CONCLUSION: MCL reconstruction using a rerouted hamstring tendon effectively restores medial knee stability with comparable functional outcomes in isolated and multiligament injuries. The technique is reliable and cost-effective, requiring minimal implants, thereby reducing the overall financial burden on patients.