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BACKGROUND: Medial collateral ligament injury in total knee arthroplasty is a rare but serious complication. There are different opinions on the treatment of medial collateral ligament injury. OBJECTIVE: To analyze the injury site of medial collateral ligament in primary total knee arthroplasty and evaluate the curative effect of local suture repair combined with brace protection and support after injury. METHODS: A retrospective analysis of 14 cases of iatrogenic medial collateral ligament injury during total knee arthroplasty in Department of Joint Surgery, Affiliated Hospital of Qingdao University from January 2016 to January 2018 (trial group) was conducted. All cases were treated with local suture repair combined with brace protection for 6 weeks. 110 cases without injury of medial collateral ligament in the same period were selected as controls (control group). The location of medial collateral ligament injury was recorded and the causes of injury were analyzed. Range of motion and American knee society knee score were compared between the two groups before and after operation. RESULTS AND CONCLUSION: (1) Totally 12 cases of medial collateral ligament injury, including 11 cases of anterior bundle and 1 case of posterior bundle, who experienced transverse injury; and 2 cases of tibial avulsion. (2) Range of motion of the knee joint in the trial group and the control group was significantly improved after operation compared with preoperation (P < 0.05), and there was no significant difference between the two groups in range of motion at 2 months and 1 year after operation (P > 0.05). (3) At the last follow-up, American knee society knee score was significantly higher in the trial and control groups compared with preoperation (P < 0.05); however, there was no significant difference between the two groups (P > 0.05). (4) In the first total knee arthroplasty, the injury of the anterior bundle and body of the medial collateral ligament was the main injury, and the direct repair of the ligament combined with the protection of the post-operative brace for 6 weeks can achieve a good therapeutic effect, without the use of restrictive prosthesis, ligament reconstruction and other complex surgical treatment. [ABSTRACT FROM AUTHOR]