“…Pie-crusting can allow for improved visualization, as well as more space to maneuver instruments, and can limit the risk of iatrogenic damage to the medial femoral condyle and tibial plateau. 24 Fig 2 Arthroscopic view of a right knee from an anteromedial portal showing decortication of the medial meniscal root (MMR) attachment site using a curved curette. The footprint should be decorticated until healthy bony bleeding is observed.…”
Meniscal root tears are an increasingly recognized condition. These tears can cause the meniscus to become extruded outside the joint, which can diminish the biomechanical functionality of the meniscus. Anatomic repair of the meniscal root has previously been described, but this surgical procedure may not adequately address severe extrusion of the meniscal tissue. Additionally, when a primary anatomic repair fails, meniscal extrusion can increase, which can possibly accelerate joint degeneration if untreated. Therefore, the purpose of this Technical Note is to describe our surgical technique for revision medial meniscal root repair with a peripheral stabilization suture to address medial meniscal root tears with severe meniscal extrusion.
“…Pie-crusting can allow for improved visualization, as well as more space to maneuver instruments, and can limit the risk of iatrogenic damage to the medial femoral condyle and tibial plateau. 24 Fig 2 Arthroscopic view of a right knee from an anteromedial portal showing decortication of the medial meniscal root (MMR) attachment site using a curved curette. The footprint should be decorticated until healthy bony bleeding is observed.…”
Meniscal root tears are an increasingly recognized condition. These tears can cause the meniscus to become extruded outside the joint, which can diminish the biomechanical functionality of the meniscus. Anatomic repair of the meniscal root has previously been described, but this surgical procedure may not adequately address severe extrusion of the meniscal tissue. Additionally, when a primary anatomic repair fails, meniscal extrusion can increase, which can possibly accelerate joint degeneration if untreated. Therefore, the purpose of this Technical Note is to describe our surgical technique for revision medial meniscal root repair with a peripheral stabilization suture to address medial meniscal root tears with severe meniscal extrusion.
“…Pie crusting, or the "inside-out" technique, involves iteratively puncturing the overly tight ligament with a needle or scalpel to reduce the tension in that ligament. 8,9 Previous ex vivo [10][11][12][13][14] and in vivo 8,15 studies have shown that pie crusting does reduce the tension in ligaments, but tracking these reductions in tension remain challenging. Indeed, improper ligament tensioning is one of the primary factors associated with knee stiffness and pain, 16,17 which are two common reasons patients report not being satisfied following TKA.…”
Surgeons routinely perform incremental releases on overly tight ligaments during total knee arthroplasty (TKA) to reduce ligament tension and achieve their desired implant alignment.However, current methods to assess whether the surgeon achieved their desired reduction in the tension of a released ligament are subjective and/or do not provide a quantitative metric of tension in an individual ligament. Accordingly, the purpose of this study was to determine whether shear wave tensiometry, a novel method to assess tension in individual ligaments based on the speed of shear wave propagation, can detect changes in ligament tension following incremental releases. In seven medial and eight lateral collateral porcine ligaments (MCL and LCL, respectively), we measured shear wave speeds and ligament tension before and after incremental releases consisting of punctures with an 18-gauge needle. We found that shear wave speed squared decreased linearly with decreasing tension in both the MCL (r 2 avg = 0.76) and LCL (r 2 avg = 0.94). We determined that errors in predicting tension following incremental releases were 24.5 N and 12.2 N in the MCL and LCL, respectively, using specimen-specific calibrations.These results suggest shear wave tensiometry is a promising method to objectively measure the tension reduction in released structures. Clinical Significance: Direct, objective measurements of the tension changes in individual ligaments following release could enhance surgical precision during soft tissue balancing in TKA. Thus, shear wave tensiometry could help surgeons reduce the risk of poor outcomes associated with overly tight ligaments, including residual knee pain and stiffness.
“…Kwak et al [14] reported pie-crusting using a sharp blade, while Koh et al [13] reported a safer method for pie-crusting using an injection needle. Excessive Pie-crusting may disrupt the MCL; however, this approach is considered a relatively safe procedure [15]. Pie-crusting elongates the MCL and achieves good alignment, and postoperative results are also considered to be acceptable [12].…”
Section: Introductionmentioning
confidence: 99%
“…Although several studies have been conducted on cadaver knees or in vitro knees during TKA pie-crusting [10,12,[15][16][17], a virtual MCL model has not been created thus far, and pie-crusting has not been examined using the nite element method (FEM).…”
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