{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:44:31Z","timestamp":1792082671019,"version":"4.4.0"},"reference-count":58,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate 2\u2010year clinical, radiological, and patient\u2010reported outcomes after combined anterior cruciate ligament (ACL) reconstruction and single\u2010strand superficial medial collateral ligament (sMCL) reconstruction using a peroneus longus split graft (PLSG) in patients with anteromedial rotatory instability (AMRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with ACL insufficiency and clinically and intraoperatively confirmed AMRI who underwent combined ACL and sMCL reconstruction using a PLSG were retrospectively identified and prospectively followed. AMRI was diagnosed in this study based on a combination of ACL insufficiency, increased anteromedial drawer in external tibial rotation, medial laxity on valgus stress testing at 20\u00b0 of knee flexion, pivot\u2010shift grading as an indicator of overall rotatory instability of the knee, and supportive arthroscopic findings such as the medial meniscus squeeze sign. At a minimum follow\u2010up of 2 years, 59 of 63 patients (mean age 30 years, 48% female) were available for evaluation. Postoperative stability was assessed using KT\u20101000 instrumented side\u2010to\u2010side measurements for the Lachman test and anterior drawer test at 90\u00b0 flexion with neutral and 15\u00b0 external tibial rotation (AMRI\u2010related). Pivot\u2010shift grading and valgus stress radiographs obtained at 20\u00b0 of knee flexion were additionally performed. Patient\u2010reported outcome measures (PROMs) included International Knee Documentation Committee (IKDC) Subjective, Lysholm, Tegner activity scale, and return\u2010to\u2010any\u2010sport rate. A non\u2010inferiority margin of 3\u2009mm for side\u2010to\u2010side differences was predefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean side\u2010to\u2010side difference for the AMRI\u2010related anterior drawer was 0.0\u2009\u00b1\u20091.3\u2009mm (95% CI: \u22120.4 to 0.3\u2009mm), meeting the predefined non\u2010inferiority criterion (upper one\u2010sided 95% confidence limit 0.3\u2009mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The mean Lachman side\u2010to\u2010side difference was 1.8\u2009mm\u2009\u00b1\u20091.3\u2009mm and remained within clinically acceptable limits. A negative pivot\u2010shift was observed in 93% of patients. IKDC (59\u2009\u00b1\u200920 to 85\u2009\u00b1\u200912;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and Lysholm (61\u2009\u00b1\u200925 to 89\u2009\u00b1\u200911;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) scores improved significantly, whereas the Tegner Activity Scale (5.8\u2009\u00b1\u20091.7 to 5.2\u2009\u00b1\u20091.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007) showed a small but significant decrease. The mean side\u2010to\u2010side difference in medial joint opening on valgus stress radiographs was 0.6\u2009mm\u2009\u00b1\u20091.0\u2009mm, remaining below the predefined clinical reference threshold. At 2 years, 66% of patients had returned to any sports.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Combined ACL and single\u2010strand sMCL reconstruction using a PLSG was associated with low postoperative side\u2010to\u2010side differences, satisfactory postoperative stability, favourable postoperative PROMs and low ankle donor\u2010site morbidity at 2\u2010year follow\u2010up. This tunnel\u2010sparing technique may be considered a reasonable surgical option for patients with ACL insufficiency and clinically relevant concomitant AMRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70941","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:34:05Z","timestamp":1791210845000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Single\u2010strand superficial medial collateral ligament reconstruction with a peroneus longus split graft provides reliable control of anteromedial rotatory instability combined with anterior cruciate ligament reconstruction: A 2\u2010year clinical cohort 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