Rajkumar N, Soundarrajan D, Dhanasekararaja P, et al. - This study was undertaken to investigate the clinical and radiological outcome of intraoperative bony avulsion of the medial collateral ligament (MCL) treated with screw and washer construct and to prognosticate the preoperative factors which may contribute to the avulsion-type MCL injury during primary total knee arthroplasty (TKA). Between January 2011 and December 2015, intraoperative MCL avulsion injury occurred in 46 (0.8%) of the 4,916 consecutive primary TKA. Researchers matched 41 knees in a 1:2 ratio after exclusion with controls without MCL injury and compared for the various clinical, radiological, and functional parameters. The findings revealed that in primary TKA, intraoperative MCL bony avulsion injury can be managed successfully with screw and washer construct without the need for elevated prosthetic constraint. The outcomes of this study exhibited that presence of severe varus deformity, knee subluxation, and ‘cup and saucer’ morphology tend to have an elevated chance of MCL avulsion injury.