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

Abstract

Purpose To quantify intraoperative joint space widening afforded by the outside-in, percutaneous release of the medial collateral ligament (MCL) and to evaluate its impact on medial compartment width and functional outcomes at 6-week follow-up for patients undergoing a partial medial meniscectomy without postoperative bracing. Methods Patients with posteromedial meniscus tears and no evidence of ipsilateral knee pathology, undergoing partial medial meniscectomy, were enrolled. Intraoperatively, medial compartment width was quantified with fluoroscopy before and after the percutaneous MCL release with an 18-gauge spinal needle proximal to the joint line. At 6-week follow-up, valgus stress radiographs re-evaluated medial compartment width. International Knee Documentation Committee (IKDC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were completed preoperatively and at 6-week follow-up to evaluate functional outcomes. A paired sample t test performed at a 95% confidence interval (CI) was used to compare these variables. Results Forty-two patients, mean (± standard deviation) age 55.3 ± 10.7 years, were available for analysis of intraoperative medial compartment widening. Medial compartment width increased from 5.95 ± 1.32 to 11.09 ± 1.74 mm intraoperatively after MCL release. At 6-week follow-up, radiographic assessment demonstrated a mean medial compartment width of 5.85 ± .99 mm, which represented an insignificant change compared with the preoperative value (CI –0.68 to .33, P = .474). PROMIS and IKDC scores significantly improved from baseline, with increases of 6.9 ± 12.4 (CI 2.0 to 11.8, P = .008) and 11.7 ± 17.8 (CI 4.7 to 18.8, P = .002), respectively. Conclusions Percutaneous MCL release during knee arthroscopy improves visualization and facilitates instrumentation by providing an almost 2× wider working space within the medial tibiofemoral joint. In this study, the performance of percutaneous MCL release did not result in any complications. Radiographic and clinical resolution of iatrogenic laxity was demonstrated by 6-weeks postoperatively, without the use of postoperative bracing. Level of Evidence IV, therapeutic case series.

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

“…The most remarkable result of the current study is that while both groups demonstrated an improvement in clinical scores (Lysholm, Tegner, IKDC and VAS) compared to the preoperative period, the improvement was statistically superior in the arthroscopic partial meniscectomy with pie-crusting group compared to the arthroscopic partial meniscectomy group at 24 months postoperatively. In studies focusing on patients exclusively utilising the pie-crusting technique, clinical scores exhibited a notable improvement when compared to preoperative measurements [13,30,31]. Unlike our study, studies comparing patients who underwent the pie-crusting technique with the control group found no statistically significant difference in favour of the control group in any of the clinical outcomes at last follow-ups [6,11,20].…”

“…While various techniques aim to improve visualisation and access during arthroscopic surgery, their widespread use is hindered by technical complexity, potential morbidity and limited applicability to specific lesions [3,21,23,25,27]. The percutaneous pie-crusting release of the MCL, has been subsequently adopted by various authors in arthroscopic surgeries [6,11,13,14,20,28,30,31]. Given the lack of consensus and concerns raised by some surgeons about its routine use, the true perioperative effectiveness of this technique needs further examination, as noted by Moran et al [29].…”

Knotless Re-tensionable Direct Fixation of Medial Meniscus Posterior Root Tears

“…Percutaneous release of the posterior fibers of the medial collateral ligament and/or posterior oblique ligament is performed under valgus tension using a spinal needle to open the medial compartment enough to perform posterior root repair without iatrogenic cartilage damage. 9 A standard diagnostic arthroscopy is performed including the confirmation of an MMPRT without significant osteoarthritis (OA) in the medial compartment ( Fig 1 ). The anterolateral portal is used as the viewing portal during the entire procedure.…”

Survey Results Concerning Current Trends in Meniscus Repair Indications and Preferences from Members of the Pediatric Research in Sports Medicine (PRiSM) Society

“…Regarding MCL fenestration, recent studies have shown it to be a viable technique that does not lead to residual valgus laxity. 25,26 However, further literature is needed to determine if MCL relaxation improves healing and patient reported outcomes after meniscus repair. With regards to post operative restrictions and rehab, prior literature reviews have shown a lack of high-quality evidence in this area.…”