69 patients with an acute grade III medial collateral ligament (MCL) tear with concomitant anterior cruciate ligament tear were randomized to undergo either anatomic MCL repair or triangular-vector MCL reconstruction following single-bundle ACL reconstruction. The purpose of this study was to compare the clinical results between these two treatments via imaging and functional results at a minimum of 2 year follow-up. Results indicated similar outcomes for medial opening measurements and IKDC scores, however short-term anteromedial rotatory stability was better in the group who underwent MCL reconstruction.