Comparable Outcome Scores for Medial Collateral Ligament Reconstruction and Repair in Isolated and Combined Grade III Injuries, with Lower Rates of Complication Following Repair at 2-year Follow-up: A Systematic Review

To compare patient-reported outcomes and complications of medial collateral ligament (MCL) repair versus reconstruction in patients with grade III MCL injuries, and to report whether these were isolated or associated lesions, with minimum 2-year follow-up. A comprehensive search of PubMed, Scopus, and Embase was conducted from database inception to August 2024 according to PRISMA 2020 guidelines. Studies reporting outcomes and complications following repair or reconstruction of grade III MCL injuries with ≥2-year follow-up were included. Data on concomitant procedures were extracted to determine the frequency of isolated versus combined lesions. A total of 12 studies met the criteria, comprising 388 patients: 277 underwent MCL reconstruction and 111 underwent MCL repair. Mean follow-up was 37.6 months for reconstruction and 56.2 months for repair. The majority of injuries were COMBINED LESIONS: , with concomitant anterior cruciate ligament (ACL) reconstruction performed in 70.8% of reconstruction and 58.6% of repair cohorts. Postoperative IKDC scores ranged 54.3 to 89 for reconstruction and 79.1 to 88.8 for repair; Lysholm scores ranged 59.4 to 94.8 and 83.8 to 98.5, respectively. Complications occurred in 14.4% of reconstruction and 4.5% of repair patients, most commonly range of motion deficits. Reoperation rates were comparable (6.1% vs. 7.2%). Both reconstruction and repair for grade III MCL injuries yielded favorable outcomes at ≥2-year follow-up. MCL repair demonstrated slightly higher IKDC and Lysholm scores with fewer complications overall. Most cases involved COMBINED MCL AND ACL INJURIES: , highlighting the rarity of isolated grade III MCL lesions. LEVEL OF EVIDENCE: is level IV, systematic review of level II to IV studies.