Anterior Cruciate Ligament Reconstruction and Medial Collateral Ligament Augmentation With Pedicled Gracilis Tendon to Address Anteromedial Rotatory and Valgus Instability.

Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries with persistent grade II valgus (Fetto/Marshall classification) or anteromedial rotatory instability pose a significant risk to ACL graft integrity if treated in isolation. This single-stage procedure involves ACL reconstruction using a quadriceps tendon autograft combined with minimally invasive MCL augmentation using a pedicled gracilis tendon with preserved distal attachment. This gracilis-based approach addresses both superficial MCL and deep MCL stabilization in cases with valgus laxity at 20° to 30° of knee flexion. The present article outlines graft harvest, tunnel placement, graft routing, and fixation, emphasizing isometric reconstruction and graft protection. This combined procedure is believed to restore native knee biomechanics and to reduce ACL graft failure risk.