Does medial collateral ligament pie-crusting induce residual laxity in arthroscopic management of medial meniscus tears? A prospective study of 40 cases

Lons, Adrien; Boureau, F.; Drumez, Élodie; Pasquier, Gilles; Putman, Sophie

doi:10.1016/j.otsr.2018.05.007

Cited by 20 publications

(31 citation statements)

References 16 publications

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“…The 4 studies meeting the inclusion criteria consisted of a total of 192 patients undergoing percutaneous sMCL lengthening 7,[17][18][19] (Table 1). Men comprised 92% of patients (118 of 128); patient sex was not recorded in a single study.…”

Section: Resultsmentioning

confidence: 99%

Percutaneous Superficial Medial Collateral Ligament Release Outcomes During Medial Meniscal Arthroscopy: A Systematic Review

Gaudiani

Knapik²,

Kaufman

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To systematically review the literature to better understand the technique, outcomes, and complications after percutaneous superficial medial collateral ligament (sMCL) lengthening during knee arthroscopy to address isolated medial meniscal pathology. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using a PRISMA checklist. The inclusion criteria consisted of English-language articles or articles with English-language translations documenting the use of percutaneous sMCL lengthening during arthroscopic knee surgery to treat isolated meniscal pathology (repair vs meniscectomy) with reported postoperative outcomes and complications. Results: Four studies met the inclusion criteria, consisting of a total of 192 patients undergoing percutaneous sMCL lengthening. No perioperative complications related to iatrogenic chondral damage, fracture, or additional meniscal injury were reported. Mild postoperative pain at the medial needle tract site lasting up to 15 days after surgery was reported in 52% of patients (46 of 88). At final follow-up, laxity on valgus stress testing showed a range from 0 to 1.1 mm with a range from e0.3 to 0.9 of radiographic medial joint space widening compared with preoperative radiographs. The length of follow-up ranged from 1.5 to 24 months. Conclusions: The percutaneous "pie-crusting" technique remains the most commonly reported technique to lengthen the sMCL during arthroscopic meniscal surgery. Percutaneous lengthening represents a safe and effective method of increasing medial joint space visualization, with no reported perioperative or postoperative complications and with minimal, likely clinically insignificant residual joint laxity after surgery on valgus stress testing at final follow-up compared with preoperative values. Level of Evidence: Level IV, systematic review of Level IV studies.

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Section: Resultsmentioning

confidence: 99%

Percutaneous Superficial Medial Collateral Ligament Release Outcomes During Medial Meniscal Arthroscopy: A Systematic Review

Gaudiani

Knapik²,

Kaufman

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Commonly, MCL release has been described in an outside-in percutaneous manner, in which a needle is used to disrupt the fibers of the superficial MCL. 3,[6][7][8][9][10][11] Alternatively, Javidan et al 12 described a method in which a banana blade was used to perform an arthroscopic release of the deep MCL. Chung et al 9 also described a method in which they performed an open release of the distal insertion of the superficial MCL with a periosteal elevator.…”

Section: Discussionmentioning

confidence: 99%

“…Chung et al 9 also described a method in which they performed an open release of the distal insertion of the superficial MCL with a periosteal elevator. In descriptions in which a needle was used percutaneously to generate joint space widening, methods of fiber disruption included inflicting multiple punctures in the MCL 7,8,10,11,13 and division of fibers. 3,6,14 We advocate for the use of a single superficial puncture site with additional subcutaneous disruption of fibers, as it minimizes the invasiveness of the procedure while allowing for control of joint space widening under direct visualization.…”

Section: Discussionmentioning

confidence: 99%

“…Studies examining the percutaneous release of the MCL also notably differ in the location of the MCL release, which has varied from the femoral side of the MCL, 7 the tibial side of the MCL, 14 or at the joint line. 11,13 One study examining outcome after percutaneous MCL release even made no mention of where Figure 6. Intra-articular visualization through the anterolateral portal is used to confirm the adequacy of the release performed on the medial collateral ligament (MCL) and can be used to ensure appropriate access to the injury of interest.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Moran

Demers

Awowale

et al. 2020

Arthroscopy Techniques

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The outside-in, percutaneous release of the medial collateral ligament (MCL) is a technique used to increase the medial tibiofemoral joint space during arthroscopy to facilitate the use of instrumentation and improve visualization without causing iatrogenic cartilage damage. A recent systematic review of the literature has shown this technique to be efficacious and safe, with no evidence of associated short-or long-term complications. This technique has been used for this indication by the senior author without requiring any deviation from our institution's standard protocol for knee arthroscopy. In an attempt to standardize this technique's utilization and allow for further evaluation in the literature, the senior author's method for this percutaneous, outside-in approach of "pie crusting" the MCL is described.

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The pie‐crusting release of the medial collateral ligament in arthroscopic partial meniscectomy is associated with improved clinical outcomes without altering radiological measurements

Ercan,

Arıcan,

Karaçoban

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to evaluate how the pie‐crusting technique affects clinical and radiological outcomes in patients undergoing arthroscopic partial meniscectomy.MethodsA total of 68 patients with Kellgren–Lawrence (K‐L) grade 2 who underwent arthroscopic partial meniscectomy between 2015 and 2021 were evaluated and divided into two groups as arthroscopic partial meniscectomy (36 patients) and arthroscopic partial meniscectomy with pie‐crusting (32 patients) according to whether the pie‐crusting technique was applied or not. All patients were evaluated at a minimum 2‐year follow‐up in terms of Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) score and Visual Analogue Scale (VAS) score. To assess the impact of the pie‐crusting technique, radiological measurements were conducted using radiographs taken before and after pie‐crusting, as well as postoperative radiographs.ResultsLysholm, Tegner, IKDC and VAS scores exhibited statistically significant differences after surgery compared to preoperative evaluations in both groups (p < 0.05). Furthermore, these scores were significantly superior in the arthroscopic partial meniscectomy with pie‐crusting group compared to the arthroscopic partial meniscectomy group at 24 months postoperatively (p < 0.05). While the radiological measurements in the arthroscopic partial meniscectomy with pie‐crusting group showed statistically significant differences before and after pie‐crusting (p < 0.05), no significant difference was observed between before pie‐crusting and 12 and 24 months postoperatively (n.s.).ConclusionThe current study is the first to demonstrate the true effectiveness of the pie‐crusting technique. The application of the pie‐crusting technique when necessary results in a statistically significant improvement in clinical scores without affecting radiological measurements for patients undergoing arthroscopic partial meniscectomy compared to not utilising it.Level of EvidenceLevel III.

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Does medial collateral ligament pie-crusting induce residual laxity in arthroscopic management of medial meniscus tears? A prospective study of 40 cases

Abstract: IV, prospective study without control group.

Cited by 20 publications

References 16 publications

Percutaneous Superficial Medial Collateral Ligament Release Outcomes During Medial Meniscal Arthroscopy: A Systematic Review

Percutaneous Superficial Medial Collateral Ligament Release Outcomes During Medial Meniscal Arthroscopy: A Systematic Review

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

The pie‐crusting release of the medial collateral ligament in arthroscopic partial meniscectomy is associated with improved clinical outcomes without altering radiological measurements

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