Management of Iatrogenic Medial Collateral Ligament Injury in Primary Total Knee Arthroplasty: A Systematic Review



1 Shohadaye Haftom-e-Tir Hospital, school of medicine, Iran University of Medical Sciences, Tehran, Iran

2 Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran



Objectives: The medial collateral ligament (MCL) injury is one of the possible complications of primary 
total knee arthroplasty (TKA), which can lead to coronal-plane instability that requires surgical revision. 
Injured MCL can result in joint instability and polyethylene wear. Different strategies have been 
proposed for MCL reconstruction based on the location of the injury. However, there is a lack of clarity 
regarding the optimal method for handling an iatrogenic MCL injury throughout a TKA.
Methods: A PRISMA flow diagram was used to guide the systematic literature review. An extensive search was 
conducted in PubMed, Embase, Scopus, Web of Science, and Google Scholar. Newcastle Ottawa scale checklist 
was used to assess the methodological quality of the articles.
Results: A total of 19 qualitative studies, including non-cadaveric patients with MCL injury during TKA, were 
identified after analyzing the full text of the articles. All included studies were either retrospective, observational 
cohort or case series. A total of 486 patients were studied to gather information on the methods used to repair the 
MCL and their results. Most injuries arose in the tibial attachment, which surgeons mostly realized during the final 
stages of surgery. Used techniques can be categorized into three main groups: Primary repair, Repair with 
augmentation, and changing prosthesis characteristics.
Conclusion: This systematic review demonstrated that the most popular management of iatrogenic MCL injury was 
using suture anchors, staples, screws and washers, and more constrained prostheses. The proper method should 
be decided considering the site of the MCL injury.
 Level of evidence: I


Main Subjects

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