This systematic review aimed to evaluate the available literature on clinical and functional outcomes, complications, and return to sport in patients treated surgically for distal medial collateral ligament (MCL) lesions, either isolated or associated with other knee ligament injuries.

The study followed PRISMA guidelines and included research reporting postoperative outcomes in patients undergoing surgery for medial knee instability related to distal MCL lesions. The analysis considered surgical techniques, rehabilitation protocols, clinical scores (Lysholm, IKDC, and Tegner), valgus stress radiographs, return-to-sport rates, and complications.

A total of 70 patients (55 male, 15 female) with a mean age of 26.9 years were included. The average time from injury to surgery was 3.9 weeks, with a mean follow-up of approximately 45.8 months. Overall, 10% of patients experienced complications, and 8.6% required revision surgery.

Clinical outcomes were generally favorable, with a mean Lysholm score of 87.2, while return to sport was commonly achieved within 6–9 months after surgery. Tegner scores indicated a relatively high level of postoperative sports activity (mean 7.8).

Despite some variability across studies, the findings suggest that surgical treatment of distal MCL lesions generally leads to satisfactory clinical and functional outcomes, low complication rates, and a high rate of return to recreational sports.