Refractory Prepatellar Degloving Injury following Low-Energy Trauma With Predisposing Total Knee Arthroplasty: Incidence and Treatment Experience

Background: Morel-Lavallée lesions (MLLs) are closed soft-tissue degloving injuries typically caused by high-energy trauma, most commonly occurring around the hip. They are associated with high recurrence following conservative management. The approach of total knee arthroplasty (TKA) involves partial dissection of the prepatellar subcutaneous layer. This raised our interest in understanding the epidemiology of prepatellar soft tissue degloving injury with predisposing total knee arthroplasty. Currently, the literature is limited. This study aims to examine the incidence, clinical course, and report our experience in treating patients with refractory MLLs with predisposing ipsilateral primary TKA. Methods: A retrospective review was conducted among the primary TKAs performed between January 2018 and December 2023. Medical records were reviewed. Patients who required reoperation due to refractory prepatellar subcutaneous hematoma or seroma were identified. Results: Among the 6499 primary TKA procedures, 74 (1.1%) required reoperation. Six patients were diagnosed with prepatellar degloving injury. Four patients resolved following aspiration and applying compression bandage. Two patients had refractory lesions necessitating surgical intervention. They had developed MLLs following low-energy contusions, failed multiple aspirations, and one patient had multiple failed surgical debridements. Both patients were eventually treated successfully with “Whittling debridement” and pseudocapsule intralayer suturing. No recurrence was observed within 6 months. Conclusion: Refractory prepatellar subcutaneous degloving injury, MLL, following TKA is rare but may be challenging to manage. The “Whittling debridement” and pseudocapsule intralayer suturing technique may be a viable option for managing these refractory lesions.