Introduction - Injuries to the medial aspect of the knee are the predominant type of knee ligament injuries. Most of these injuries result from motor vehicle collisions and sports-related incidents, with the typical mechanisms involving either a valgus force, tibial external rotation, or a combination of valgus and external rotation forces applied to the knee. For these reasons, it is essential that medial collateral ligament (MCL) injuries receive appropriate attention and optimal medical care. Aim & objectives – (1) To evaluate and compare the clinical outcomes between Medial Collateral Ligament Anatomical Ligament repair and Triangular Ligament Reconstruction in treating Grade-III MCL injury. (2) To study the complications in MCL Reconstruction or Repair by above mentioned two different surgical techniques. Methodology - Patients presenting with Acute Isolated Grade-III Medial Collateral Ligament (MCL) tears in conjunction with Anterior Cruciate Ligament (ACL) deficiency, who attended the Arogyashree Orthopedics Outpatient Department, Emergency Department, and the Department of Orthopedics and Sports Medicine at Kamineni Hospitals, L B Nagar, Hyderabad, between April 2016 and January 2018, were included in the study. A cohort of 50 patients diagnosed with Acute Isolated Grade-III Medial Collateral Ligament (MCL) Tear and concomitantly with Anterior Cruciate Ligament (ACL) injury was selected based on medical history, clinical evaluation, and radiological findings (radiography and magnetic resonance imaging). Purposive sampling was done to recruit patients in to ALR and TLR groups based on intraoperative findings that repair or reconstruction should be performed on primary surgeon’s experience and protocol. Results - Out of the 50 patients who underwent MCL Repair or Reconstruction (both TLR and ALR), 27 patients were in the age group of less than 30 years(15 patients in Anatomical Ligament Repair group and 12 patients in Triangular Ligament Reconstruction group),15 patients were in the age group 31 – 40 years (6 patients in Triangular Ligament reconstruction group and 9 patients in Anatomical Ligament Repair group) and 8 were in age group of more than 40 years(5 patients in Triangular Ligament Reconstruction group and 3 patients in Anatomical Ligament Repair group). In Triangular Ligament Reconstruction group, Median score of Lachman test at Pre-op period was 3, at Immediate Post-Op was 1, at 6 weeks was 1, at 12 weeks was 0 and at 24 weeks was 0. In Anatomical Ligament Repair group, Median score of Lachman test at Pre-op period was 3, at Immediate Post-Op was 1, at 6 weeks was 1, at 12 weeks was 0 and at 24 weeks was 0. In Triangular Ligament Reconstruction group, Slocum Test at Pre-op was positive in 100%, at Immediate Post Op period, 6 weeks, 12 weeks and 24 weeks 100% were negative. In Anatomical Ligament Repair group, Slocum Test at Pre-op was positive in 96.3%, at Immediate Post Op period and 6 weeks 100% were negative and at 12 weeks and 24 weeks 96.3% were negative. Triangular Ligament reconstruction group, IKDC Objective Score at pre-op period 21.7% had Grade C, 78.3% had Grade D. At Immediate Post-Op period, 60.9% had Grade A, 39.1% had Grade B. At 6 weeks, 78.3% had Grade A, 21.7% had Grade B, at 12 weeks 82.6% had Grade A and 17.4 % had Grade B and at 24 weeks 95.7% had Grade A and 4.3%had Grade B. Anatomical Ligament Repair group, IKDC Objective Score at pre op period 25.9% had Grade C, 74.1% had Grade D. At Immediate Post-Op period, 55.6% had Grade A, 44.4% had Grade B. At 6 weeks, 88.9% had Grade A, 11.1% had Grade B, at 12 weeks 88.9% had Grade A and 11.1% had Grade B and at 24 weeks 92.6% had Grade A and 7.4% had Grade B. Conclusion - Satisfactory outcomes in both groups regarding IKDC Objective scores, ROM deficits, and anteromedial rotational stability, as evidenced by comparisons between preoperative and postoperative data. Adherence of the patient to postoperative instructions is crucial for preserving the range of motion. Consistent supervised physiotherapy and evaluation of the patient are essential components of postoperative care. There is no distinct advantage for the Triangular Ligament Reconstruction technique compared to Anatomical Ligament Repair regarding functional and radiological outcomes.