Design: Prospective multicentre registry with propensity weighting
Population: 489 primary ACL reconstructions, French Arthroscopy Society, 2020–2022
Primary outcome: IKDC subjective score
Effect: Non-hamstring vs hamstring β 7.89 (95% CI 3.45–12.33); graft × operative MCL interaction β −7.02 (−15.26 to 1.22)

Some surgeons avoid hamstring grafts when the MCL is also injured, worried that harvesting semitendinosus and gracilis weakens medial dynamic support. A French Arthroscopy Society registry looked at 489 primary ACL reconstructions between 2020 and 2022, grouped by MCL status and graft type, with propensity weighting.

Non-hamstring grafts were associated with higher IKDC subjective scores overall (β 7.9 points, 95% CI 3.5–12.3), and with higher return-to-sport confidence and subjective knee value. Combined injuries treated non-operatively did worse than isolated ACL tears. MCL status did not significantly modify the graft effect, though the interaction estimate for operatively treated MCL injuries had a wide interval.

A third of eligible patients were missing data, and graft choice was the surgeon's, so the finding is an association. It does not settle whether hamstring grafts are harmful in combined injuries.

Expect poorer subjective scores after combined ACL-MCL injuries than isolated ACL tears.
Consider non-hamstring grafts, which were associated with better patient-reported scores in this registry.
Do not base graft choice on MCL status alone; the data showed no clear interaction.
Record graft type and MCL management in local registries to build better evidence.

Why it matters

It tests a common reason for avoiding hamstring grafts and does not find support for it.

The statistics, in plain English

A non-significant interaction (P=0.095) with a wide interval means the study cannot exclude a moderate effect of MCL status; 'no evidence of a difference' is not 'evidence of no difference'.