# Combined medial collateral ligament and posterior oblique ligament reconstruction demonstrates favourable patient‐reported outcomes and medial knee stability in Grade III injuries: A systematic review

## TL;DR

Combined MCL and POL reconstruction for severe knee injuries shows good patient outcomes and improved knee stability, but more research is needed to standardize the surgical technique.

## Contribution

This study is the first systematic review to evaluate combined MCL–POL reconstruction for Grade III medial knee injuries.

## Key findings

- Patient-reported outcomes exceeded minimal clinically important difference thresholds.
- Valgus opening on stress radiographs significantly decreased post-surgery.
- Return to sport rates ranged from 64% to 91% with a 20.2% overall complication rate.

## Abstract

To assess clinical and functional outcomes of combined medial collateral ligament and posterior oblique ligament (MCL–POL) reconstruction in isolated and multiligamentous Grade III medial knee injuries.

A systematic review was conducted according to PRISMA and Cochrane guidelines. MEDLINE, EMBASE and CENTRAL were searched to 13 August 2025. Studies were eligible if they included patients undergoing combined MCL–POL reconstruction for acute or chronic medial knee instability and reported clinical, functional or radiographic outcomes. Studies involving MCL or POL repair, advancement or non‐reconstructive procedures were excluded. Data on patient characteristics, surgical technique, patient‐reported outcome measures (PROMs), valgus stability, return to sport and complications were extracted.

Twelve studies met the inclusion criteria, involving 350 patients (61.7% female). Mean age was 33.1 ± 4.4 years (range: 27.4–45.6), with mean follow‐up of 41.5 ± 13.5 months (range: 12–86). Mean postoperative Lysholm, subjective International Knee Documentation Committee and Tegner scores were 86.0 (range: 74.8–93.4), 76.3 (range: 66.4–87.8) and 4.9 (range: 3.5–7), respectively, with post‐operative values exceeding established minimal clinically important difference (MCID) thresholds where applicable. Return to recreational or high‐level sport ranged from 64% to 91%. Valgus opening on stress radiographs decreased from 7.5 to 1.2 mm, and 88% of knees were graded as ‘normal’ or ‘nearly normal’ on the IKDC objective scale. The overall complication rate in 327 patients was 20.2%, most commonly arthrofibrosis (5.8%) and superficial infection (4.6%). MCL–POL graft failure was uncommon (1.2%).

This systematic review suggests that MCL–POL reconstruction for Grade III MCL injuries in isolated and multiligamentous injury patterns may provide reliable short to mid‐term clinical and functional outcomes, with greater medial stability than previously reported and acceptable safety profile. However, a lack of standardization and consensus in surgical technique remains, and future prospective studies are needed to determine the comparative efficacy of different techniques.

Level IV.