Evaluation of Therapeutic Outcomes for Intraoperative MCL Injury in Subjects Undergoing Total Knee Arthroplasty: a Cohort Study

Background Total knee arthroplasty (TKA) is an effective procedure for replacing damaged knee joints, recommended when conservative treatments fail. Intraoperative medial collateral ligament (MCL) injuries are a known complication of TKA, potentially impacting patient recovery and overall surgical outcomes. Effective management of these injuries is crucial to ensuring optimal function and stability of the knee postoperatively. This study aims to evaluate the therapeutic outcomes for patients who sustained intraoperative MCL injuries during TKA, focusing on recovery, stability, and the need for additional interventions. Material and Methods In this prospective cohort study, over 2 years, 553 patients with advanced severe knee arthritis underwent TKA, and only 13 patients had intraoperative MCL injury. After surgery, patients followed a partial weight-bearing protocol with a locked knee brace for two weeks, followed by physiotherapy to restore motion over six weeks gradually. The patients were followed up for 12 months. The International Knee Documentation Committee (IKDC) score was used to evaluate patients before and after surgery, and collected data was analyzed. Results None of the patients who experienced intraoperative MCL injury showed any knee instability during the 12-month follow-up period. The statistical analysis revealed no significant relationship between MCL injury and gender (P = 0.786). The mean pain score decreased from 90 preoperatively to 3.8 postoperatively, indicating a statistically significant improvement in knee pain (P < 0.001). No significant association was found between the IKDC score in intraoperative MCL injury and patient gender (P = 0.806). A comparison of the mean IKDC scores post-surgery between individuals who had intraoperative MCL injury (77.78) and received treatment and the control group without intraoperative MCL injury (80.00) revealed that MCL injury, when treated, had no significant effect on the IKDC score (P = 0.141). The mean IKDC score increased from 28.2 preoperatively to 77.8 postoperatively, indicating a statistically significant improvement in knee function (p-value < 0.001). Conclusion When MCL injury is treated intraoperatively, it has no significant effect on the IKDC score and significantly improves knee function. MCL injury during TKA, managed with primary repair and reinforcement with hamstring autograft or reattachment to the bone using pull-out techniques followed by six weeks of knee brace use postoperatively, is associated with favorable and treatable outcomes.