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Background:Intraoperative injury to the medial collateral ligament (MCL) is a rare but important complication of total knee arthroplasty (TKA).While described treatment methods are mainly primary repair and revision with a more constrained implant,a few studies have investigated the outcomes of primary reconstruction without constrained implants.Purposes:A retrospective study was performed to evaluate the prevalence of iatrogenic injury to the MCL during primary TKA and determine the clinical outcomes of MCL reconstruction without the use of a constrained device.Methods:We retrospectively reviewed the records of all 1749 patients (2054 knees) who underwent primary TKA between 2007 and 2013.Seventeen patients (0.83%) had recognized intraoperative injury to the MCL;the remaining 1732 patients (2037 knees) served as controls.We attempted to reconstruct the ligament with the unconstrained prosthesisin in all patients.We determined Knee Society scores (KSS) in all patients.No patients were lost to follow up.The minimum follow up was 36 months (average,51 months;range,36-72 months).Results:The mean KSS for all MCL injury knees for pain and function averaged 88 and 84 points,respectively,compared with 92 and 86 for the control group.No patients treated without increased prosthetic constraint were revised for instability;no revisions for instability were performed in the 37 patients treated with additional constraint.Conclusions: We were able to get excellent results by reconstructing the ligaments without a constrained implants.Level of Evidence:Level Ⅳ,therapeutic study.