Associated Morbidity After the Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy

The Outside-In, Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy

“…15 Thus far, it is unclear whether the location of the release makes a difference in the amount of additional joint space opening, although all have been performed safely without causing significant short-or long-term morbidity to patients. 2,7,11,13,15 Future research is needed to quantify the additional joint space opening provided by percutaneous MCL release and document its return to normal postoperatively. Finally, a lack of consensus exists for postoperative bracing after the release.…”

“…The percutaneous, outside-in approach of "pie crusting" the medial collateral ligament (MCL) is 1 method described in the literature by which surgeons may increase the effective medial joint space of the knee intraoperatively to reduce these risks. 2 Despite concerns regarding the associated morbidity of performing MCL release during knee arthroscopy, a recent systematic review of the current literature showed this technique to be an efficacious way of increasing the medial joint space of the knee without causing any significant short-or long-term complications. 2 With additional evidence emerging that supports the use of this technique, further description and standardization of its performance should be established to facilitate its future use and examination in the literature.…”

“…2 Despite concerns regarding the associated morbidity of performing MCL release during knee arthroscopy, a recent systematic review of the current literature showed this technique to be an efficacious way of increasing the medial joint space of the knee without causing any significant short-or long-term complications. 2 With additional evidence emerging that supports the use of this technique, further description and standardization of its performance should be established to facilitate its future use and examination in the literature. 3 The technique described in this article is used routinely at our institution in situations in which valgus stress proves to be insufficient in adequately increasing the medial joint space of the knee.…”

Regarding “Associated Morbidity After the Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy”

“…After reading the systematic review by Dr. Moran et al entitled "Associated Morbidity After the Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy," 1 we noticed that they have missed some information, leading to an incorrect statement mentioned at the discussion section: "Claret et al made no mention in their study about where the release was performed." 1 During the discussion of our article, we describe where the release was performed. "Punctures were made to the deep MCL," 2 "the highest strains on the MCL have been recorded in the posterior region of the ligament proximal to the joint line with the knee in extension during valgus loading.…”

Percutaneous Medial Collateral Ligament Release Improves Medial Compartment Access During Knee Arthroscopy

“…Several studies have described this technique for this purpose, and a recently published systematic review concluded that this technique was an effective means of increasing the medial tibiofemoral joint space without causing residual valgus laxity, pain, loss of function, or damage to the saphenous nerve or greater saphenous vein. 6 , 7 , 8 , 9 , 10 , 11 , 12 Despite the conclusions drawn from previous studies and the senior author’s experience that this is an effective method of increasing the medial tibiofemoral joint space, there has been only 1 study of 18 patients quantifying medial compartment opening intraoperatively immediately after the release is performed. 13 It also remains unclear how long any iatrogenic laxity takes to resolve or whether bracing is required postoperatively.…”