This study reports 18 patients with 19 combined ligament injuries with complete anterior cruciate ligament (ACL) tear and a minimum grade II medial collateral ligament (MCL) tear who underwent early reconstruction of the ACL and nonoperative treatment of the MCL. Inclusion criteria included ACL reconstruction performed within 3 weeks of initial injury, no history of antecedent injury to the ipsilateral knee, and 2-year follow-up data. Associated injuries were noted in 11 patients including 6 isolated lateral meniscal tears, 1 isolated medial meniscal tear, 5 combined meniscal tears, 1 chondral injury, and 1 patellar fracture. Subjective minimum 2-year follow-up yielded a mean Lysholm score of 94.5 and a mean Tegner activity score of 8.4. Serial clinical examinations demonstrated good functional outcomes, range of motion, and strength. No patient experienced ACL graft failure or valgus instability or required subsequent surgery for chondral or meniscal damage. One patient required a second surgery for arthrofibrosis. Clinical and functional outcomes in this study were good with low motion complication rates. Based on our data, early surgical reconstruction of the ACL and nonoperative treatment of the MCL in combined injuries is acceptable and results in excellent clinical and functional outcomes.