Which Fibers of the Medial Collateral Ligament (MCL) Should Be Released in the Pie Crust Technique Applied During Knee Arthroscopy: Superficial MCL or Deep MCL?

Abstract

Background Knee arthroscopy is the most common surgery performed to treat meniscal injuries. The pie crust (PC) technique is applied during knee arthroscopy to increase joint vision of the medial femorotibial compartment and reduce the risk of iatrogenic damage. Medial collateral ligament (MCL) release is applied in the PC technique. Currently, there are no studies directly comparing the release of the superficial MCL (sMCL) or deep MCL (dMCL) when applied during the PC technique. In this study, we compared the clinical and functional results of the release of the deep and proximal tibial attachment of the superficial fibers of the MCL. Methodology We evaluated the results of 67 (27 women and 40 men) patients who underwent the PC technique during knee arthroscopy due to a medial meniscal tear. The patients who underwent the PC technique were divided into two groups according to the release of the deep and superficial fibers of the MCL. All patients were evaluated for pain, functional capacity, and laxity using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Oxford Knee scores. All patients were evaluated with radiographic examinations such as valgus laxity angle and medial tibiofemoral compartment opening height. Results The KOOS and Oxford Knee Scores in both groups showed a statistically significant increase at 12 months postoperatively compared with the preoperative values (p = 0.005, 0.002, 0.002, and 0.01, respectively). No statistically significant difference was found between the groups (p > 0.05). When the valgus laxity angle before the PC technique was compared with the 12-month result after the procedure, no statistically significant difference was noted (p > 0.05). There was no evidence of complications such as chondral injury and saphenous nerve or vein injury among patients in either group. Conclusions In this study, we did not observe laxity in the long-term follow-up of the groups in which the superficial or deep fibers of the MCL were released. In our view, the PC technique has similar effects on surgical outcomes regardless of sMCL and dMCL release techniques.

Australian orthopaedic surgeons' knowledge and practice of medial collateral ligament release in knee arthroscopy

“…This potentially indicates a lack of education and scientific understanding of the anatomy or method of release. The evidence is limited, however, a recent study found no radiological or functional difference when releasing the deep versus superficial MCL 9 . Current techniques could be improved with better anatomical understanding.…”

“…The evidence is limited, however, a recent study found no radiological or functional difference when releasing the deep versus superficial MCL. 9 Current techniques could be improved with better anatomical understanding.…”

The pie-crust surgical technique for medial collateral ligament release: enhancing visualization of the medial compartment in knee arthroscopy

“…Studies ( 1 , 2 ) have examined changes in the medial joint space and reported varying degrees of medial space increase in the immediate postoperative period, which tend to stabilize over time. The use of postoperative knee braces has been recommended in some cases to mitigate the risk of instability, although it is not universally required ( 1 , 8 , 9 ). Clinical results suggest that the decision to use a brace postoperatively should be individualized and based on the patient’s condition and surgeon’s preference ( 8 , 9 ).…”

“…The use of postoperative knee braces has been recommended in some cases to mitigate the risk of instability, although it is not universally required ( 1 , 8 , 9 ). Clinical results suggest that the decision to use a brace postoperatively should be individualized and based on the patient’s condition and surgeon’s preference ( 8 , 9 ). Fortunately, many patients experience favorable postoperative outcomes, including improved functional scores ( 8 , 9 ).…”

“…In recent years, partial release of MCL to increase the medial tibiofemoral joint space and reduce the chondral injury risk has gained popularity ( 7 , 8 ). Among these techniques, “pie-crust” represents the most widely used procedure with a minimally invasive approach ( 9 ).…”