{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T02:29:30Z","timestamp":1793845770148,"version":"4.6.1"},"reference-count":48,"publisher":"SAGE Publications","issue":"13","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"State of Florida Department of Health","id":[{"id":"https:\/\/ror.org\/03e1xkn26","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100007307","name":"arthrex","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007307","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Traditional superficial medial collateral ligament (sMCL) reconstruction techniques have not consistently restored native laxity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose\/Hypothesis:<\/jats:title>\n                    <jats:p>The purpose of this study was to develop a retensionable inlay\/onlay hybrid medial collateral ligament (MCL) reconstruction through comparison to a biomechanically and clinically validated reconstruction. It was hypothesized that increasing the distal footprint on the tibia through a double-bundle construct and a retensionable construct would better restore native laxity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 27 cadaveric knees were tested on a 6 degrees of freedom robot system. Knees were tested with valgus and external rotation (ER). Each knee was tested in a native state and an injured state after sectioning of the sMCL. One of 3 reconstructions using an anterior tibialis allograft was then performed: (1) single-bundle inlay reconstruction, (2) double-bundle inlay\/onlay hybrid reconstruction with tibial fixation at both the proximal and distal (PD) tibial insertions of the sMCL footprint, or (3) double-bundle inlay\/onlay hybrid reconstruction with tibial fixation at the anterior and posterior (AP) aspects of the distal sMCL tibial insertion. The constructs used retensionable variable-loop devices, allowing for retensioning after knee cycling. The constructs were tested after cycling and retensioning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Sectioning of the sMCL resulted in significantly increased laxity compared to the native state for both valgus and ER laxity testing (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). After flexion cycling and subsequent retensioning, both AP and PD double-bundle reconstructions demonstrated significantly higher restoration of stability compared to cycled single-bundle reconstructions (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Both double-bundle reconstructions were significantly closer to the native state than the single-bundle reconstruction for valgus rotation (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and ER (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05). For valgus testing, there was no difference between retensioned double-bundle constructs and the native state, with a pooled valgus difference of 0.56\u00b0 (95% CI, 0.05\u00b0-1.06\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .032). For ER testing, no differences were found between the retensioned AP double-bundle and the native state (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .836), suggesting more complete restoration was achieved by AP double-bundle restoration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A retensionable inlay\/onlay hybrid double-bundle MCL reconstruction with a larger femoral footprint and 2 distal anterior-posterior tibial footprints produced superior restoration of the uninjured state when compared to a traditional single-bundle inlay reconstruction. For double-bundle reconstructions, an anterior-posterior tibial fixation achieved mean values closer to the native state than proximal-distal fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>A double-bundle retensionable inlay\/onlay hybrid reconstruction is an effective alternative to a single-bundle inlay reconstruction technique. The double-bundle reconstruction may better withstand early unrestricted range of motion during postoperative phases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465261480465","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:46:22Z","timestamp":1790243182000},"page":"3199-3210","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Retensionable Inlay\/Onlay Hybrid Double-Bundle Medial Collateral Ligament Reconstruction Produces Superior Restoration of the Uninjured State When Compared to a Single-Bundle Inlay Reconstruction"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8607-1939","authenticated-orcid":false,"given":"Adam W.","family":"Anz","sequence":"first","affiliation":[{"name":"Andrews Research &amp; Education Foundation, Gulf Breeze, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Waller","sequence":"additional","affiliation":[{"name":"Andrews Research &amp; Education Foundation, Gulf Breeze, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4281-9490","authenticated-orcid":false,"given":"Jeremy","family":"Carroll","sequence":"additional","affiliation":[{"name":"Andrews Research &amp; Education Foundation, Gulf Breeze, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabe","family":"Colbrunn","sequence":"additional","affiliation":[{"name":"Andrews Research &amp; Education Foundation, Gulf Breeze, Florida, USA"},{"name":"Kent State University, School of Engineering, Kent, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiden Cole","family":"Magoolaghan","sequence":"additional","affiliation":[{"name":"Andrews Research &amp; Education Foundation, Gulf Breeze, Florida, USA"},{"name":"Ohio Northern University, T.J. Smull College of Engineering, Ada, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7866-6878","authenticated-orcid":false,"given":"Jessi","family":"Truett","sequence":"additional","affiliation":[{"name":"Center for Behavior Analysis, University of West Florida, Pensacola, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achraf","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Statistics, University of West Florida, Pensacola, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3872-9772","authenticated-orcid":false,"given":"Mangesh","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Andrews Research &amp; Education Foundation, Gulf Breeze, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Callanan","sequence":"additional","affiliation":[{"name":"Willis-Knighton Health System, Shreveport, Louisiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2021.10.019"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967121989312"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2017.07.017"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/26350254251408067"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06139-6"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671231201461"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06084-4"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546508324969"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241251462"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221096464"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.34.3.227-a"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231224477"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509347996"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2023.05.029"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671241240375"},{"issue":"11","key":"e_1_3_2_17_2","article-title":"Surgical techniques for the reconstruction of medial collateral ligament and posteromedial corner injuries of the knee: a systematic review","volume":"31","author":"DeLong JM","year":"2015","unstructured":"DeLong JM, Waterman BR. 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