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.

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.