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 (2) to predict 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 4916 consecutive primary TKA. This study’s findings demonstrated that intraoperative MCL bony avulsion injury can be managed successfully with screw and washer construct without the need for increased prosthetic constraint in primary TKA. It was shown that the presence of severe varus deformity, knee subluxation, and “cup and saucer” morphology tend to have an elevated chance of MCL avulsion injury.