Percutaneous Partial Outside-In Release of Medial Collateral Ligament for Arthroscopic Medial Meniscus Surgery With Tight Medial Compartment by Finding a “Magic Point”

Abstract

The medial meniscus is one of the more commonly injured structures as compared with the lateral meniscus. In patients with tight medial joint space, it is difficult to visualize the posterior horn and posterior root of medial meniscus and even more difficult to use instrumentation for surgical procedures. Normally, the mean medial joint space (4.74 ± 0.75 mm) is less than the mean lateral joint space width (5.63 ± 0.86). Forceful instrumentation in a tight and a narrow medial joint compartment may cause damage to the articular cartilage, which may increase chances of arthritis in future. To increase the opening of the medial compartment after valgus extension stress position of the knee, different techniques of medial collateral ligament release have been described in the literature. However, the majority of articles describe a multiple-puncture method to the medial collateral ligament called the “pie-crusting” method, not explaining the exact point or precise location of release. Here, we describe a simple and reliable method of medial collateral ligament release by finding the exact release point, a “magic point” to increase the medial joint compartment width to facilitate better visualization and instrumentation for surgical procedures.

Knee Meniscus Posterior Root Repair with FiberTak

“… 10 , 11 Fortunately, many of these patients showed clinical improvement, despite findings of incomplete or failed healing on second-look arthroscopy. 7 …”

“…After confirmation of the root tear, to improve not only visualization but also to avoid cartilage damage when managing sutures, the medial collateral ligament is lengthened, by percutaneous partial outside-in using the “magic point,” according to Bancha Chernchujit. 7 …”

Meniscal Root Repair With Mini-Open Medial Collateral Ligament Release

“…10 Damage to the saphenous vein and greater saphenous nerve are the involved risks with this technique. 10 Chernchujit et al 6 described a technique in which multiple punctures to the MCL were avoided by finding a precise point of release anterior to the saphenous vein. However, complete release of the MCL was a noted disadvantage with this technique.…”

“…However, complete release of the MCL was a noted disadvantage with this technique. 6 We advocate for the use of a mini-open release of the distal MCL that both creates a working space within the joint in a controlled fashion and allows for anatomic fixation at the end of the case, not afforded by percutaneous release techniques which relies on the MCL to scar in despite trephination.…”

“…Popular techniques describe releasing the MCL through an arthroscopic piecrusting method via a large-bore needle. 5 Chernchujit et al 6 described an outside-in release in which they found an exact release point of the MCL, anterior to the saphenous vein, avoiding multiple punctures to the native structure. In this Technical Note, we report our experience performing a MCL release using a mini-open technique at the distal MCL insertion via a small incision that is also used for transtibial meniscal root fixation.…”