Management of combined ACL and MCL injuries remains a complex clinical decision, particularly when determining whether graft reconstruction or suture augmentation should be used to address the MCL component. Emerging evidence suggests that both approaches can restore stability when performed alongside ACL reconstruction, but each carries distinct considerations. Graft reconstruction may provide stronger structural support in cases of severe ligament damage, while suture augmentation offers a less invasive option that reinforces the native ligament and may allow faster recovery. Clinical outcomes indicate that careful patient selection—based on injury severity, tissue quality, and functional demands—is critical when choosing the optimal strategy. These findings underscore the need for individualized treatment planning to achieve reliable knee stability and functional recovery.