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Medial collateral ligament (MCL) injuries are commonly seen in orthopedic practice. Most MCL injuries are isolated and can be treated nonsurgically with focus on brace protection of the ligament, range of motion, gait training, and relatively quick return to full activity. A subset of MCL injuries, however, requires operative treatment. It is critical to identify patients with medial instability and develop an operative plan that will restore stability and function to the injured knee. Many MCL reconstruction and repair techniques have been described, and improvement in outcomes with improvement of technique remains an area of great interest. This review discusses several MCL reconstruction options and outlines the authors’ preferred MCL reconstruction technique.