The article reviews current evidence and expert opinion on surgical strategies for managing combined ACL–MCL injuries, noting that treatment remains controversial and should be individualized. While traditional approaches often involve nonoperative treatment of the MCL with delayed ACL reconstruction, emerging techniques such as primary MCL repair with suture augmentation and internal bracing have gained support, as they can improve knee stability and protect the ACL graft during healing. Biomechanical data suggest that suture augmentation can enhance valgus and rotational stability when repairing the MCL, and restoring proper MCL function may reduce stress on the ACL graft. At the same time, graft choice for ACL reconstruction (e.g., bone-patellar tendon-bone vs hamstring autograft) can influence medial stability, particularly in high-grade MCL injuries, with some evidence favoring patellar tendon grafts for better medial stability outcomes. Overall, the article underscores the importance of an evidence-based, anatomy-driven approach that balances ligament healing, knee mechanics, and patient-specific factors to optimize functional outcomes.