Evaluation of Knee Outcomes and Anterior Cruciate Ligament Graft Failure When Comparing Medial Collateral Ligament Reconstruction Versus MCL Repair in Patients With Multiple Ligament Knee Injuries: A Systematic Review
Authors: Floyd Edward R. , Tollefson Luke V. , Falaas Kari L. , Ebert Nicholas J. , Struyk Griffin D. , Carlson Gregory B. , LaPrade Robert F. 
Published: February 2025

Background: A paucity of data exists to guide surgical management of the medial collateral ligament (MCL). High-grade MCL injuries are often treated with surgical repair or reconstruction; however, guidelines for choosing one or the other technique remain unclear. Purpose: To systematically review the literature to determine whether repair versus reconstruction of the MCL in multiligament knee injuries results in improved outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed between January 1980 and January 2024. The initial search yielded 85 studies. Exclusion criteria included <2 years of follow-up, technical/case reports, articular fractures, and undifferentiated multiligament results. Extracted data included patient characteristics, ligaments injured, chronicity of injury, incidence of failure, arthrofibrosis, patient-reported outcome scores, and stress radiographs. Failure was included as reported by studies and included clinical failure (graft laxity), failure of the repair or reconstruction, or the need for a lysis of adhesions or manipulation under anesthesia. Statistical analysis included unpaired t tests and chi-square goodness-of-fit tests. Results: In total, 30 studies were included in the final analysis (458 repairs, 590 reconstructions). The mean patient age for the repair group was 33.1 years (SD, 5.11 years) with a mean follow-up time of 4.2 years (SD, 2.59 years) and the mean patient age for the reconstruction group was 33.4 years (SD, 4.40 years) with a mean follow-up time of 3.1 years (SD, 1.41 years). There was no significant difference found between the reconstruction and repair groups of the MCL for the Lysholm, subjective International Knee Documentation Committee, Tegner scores, and stress radiographs ( P > .05). Arthrofibrosis rates for MCL reconstruction (5.4%) were determined to be significantly less than those within the repair group (11.6%) ( P < .001). Failure rates for MCL reconstruction (2.9%) were determined to be significantly less when compared with the MCL repair group (5.7%) ( P = .024). Anterior cruciate ligament (ACL) failure rates for MCL reconstruction (0.2%) were determined to be significantly less than those within the repair group (2.3%) ( P = .002). Conclusion: This systematic review showed that MCL reconstructions demonstrated decreased postoperative arthrofibrosis compared with MCL repairs across all studies. Studies reporting on failures reported decreased clinical failures and ACL graft failures in the setting of concomitant ACL and MCL reconstructions compared with MCL repairs. Future randomized controlled studies are needed to further determine the best surgical technique for patients with multiligament knee injuries.