The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome

Claret, G; Montañana, J.; Ríos, José; Ibán, Miguel Ángel Ruiz; Popescu, Dragos; Núñez, Montserrat; Lozano, Luisa Seco; Combalía, Andrés; Sastre, Sergi

doi:10.1016/j.knee.2015.07.013

Cited by 52 publications

(62 citation statements)

References 17 publications

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“…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%

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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Section: Discussionmentioning

confidence: 99%

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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“…Bellemans et al used this technique to release the MCL with a 19-G needle in the vicinity of the knee joint line, which produced a mean 2.4 mm increase of the medial joint space [15]. It has been reported that application of this technique to the opening of the medial space of the knee joint under arthroscopy, whether through an open skin incision or percutaneous acupuncture for MCL release, improves the medial visual field [2,6,[18][19][20]. In this study, the pie-crusting technique was used to release the PMC of the knee joint, and a satisfactory visual field of the posterior joint space was obtained under valgus stress of the knee in a half-extension position, in which not only the posterior shape of the meniscus was fully revealed, but also it was possible to insert the surgical instruments into the posterior space accurately and smoothly, and no further iatrogenic cartilage injury occurred.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there are two kinds of pie-crusting release technique for the PMC during arthroscopic medial meniscus surgery according to the literature reports, that is inside-out technique and outsidein technique [2][3][4][5][6][18][19][20]. Compared with the former, the latter used in our study has the following advantages: no invasion of the intra-articular space, easy and effective puncturing operation without risk of iatrogenic cartilage injury, controlled release of the PMC, lower hypothetical risk of infection, and needle access independent of intra-articular structures [3,19].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the outside-in technique has the disadvantage of potentially injuring to the saphenous vein and nerve during the process of percutaneous PMC penetrating. However, this can be effectively avoided by familiarity with the posteromedial anatomy of the knee joint and accurate intraoperative puncture [5,18,19]. Another disadvantage is the over-release of the PMC, but no residual laxity described for long-time follow-up to our knowledge [6,9,20].…”

Section: Discussionmentioning

confidence: 99%

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Arthroscopic pie-crusting release of the posteromedial c omplex of the knee for surgical treatment of medial meniscus injury

Han

Wang

et al. 2020

Preprint

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Background: The posteromedial complex (PMC), including the posterior part of the MCL and the posterior oblique ligament (POL), has a restrictive effect on the opening of the posteromedial gap of the knee in the half-extension position. We evaluated the radiological and clinical results of pie-crusting release of the PMC for arthroscopic meniscal surgery in tight knees.Methods: Sixty patients with posterior injury of the medial meniscus were reviewed. All patients accepted arthroscopic pie-crusting release of the PMC. Fourty patients accepted meniscoplasty, and 20 patients accepted meniscal suturing. To evaluate the arthroscopic opening of the medial gap in 20° half-extension under 11-kg valgus stress, the width of the medial space before and after release were measured. During follow-up, the medial stability was evaluated by radiographic measurements of the joint space width (JSW). MRI was conducted to evaluate healing of the MCL and meniscus. Knee functions were evaluated using VAS, Lysholm, IKDC and Tegner scoring systems.Results: In all patients, meniscus operations were performed without iatrogenic cartilage injury. After PMC release, the arthroscopic width of the medial space was 5.7 ± 0.5 mm, larger than that before release (2.5 ± 0.5 mm, p < 0.01). The follow-up time was 21.93 ± 7.04 months, there was no residual valgus laxity of the knee. The radiographic JSW was 5.97 ± 0.8 mm preoperatively, 9.2 ± 1.1 mm in the 1st week postoperatively, and 6.1 ± 0.9 mm by the 3rd postoperative month, showing no differences between preoperative and 3 months postoperative measurement (p > 0.05). For sutured meniscus, MRI showed healing in 15 patients while five had two-grade abnormal signals. VAS, Lysholm, IKDC and Tegner scores were 1.80 ± 0.51, 80.08 ± 3.74, 82.17 ± 4.64 and 5.48 ± 0.59, respectively, showing significant differences compared with the preoperative scores (5.57 ± 0.69, 48.17 ± 4.22, 51.42 ± 4.02 and 3.20 ± 0.68, respectively, P < 0.01).Conclusions: Pie-crusting release of the PMC can increase the posteromedial space and improve the visual field of the knee under arthroscopy, while neither causing no residual valgus instability of the knee nor affecting the clinical outcome at the final follow-up.

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“…It is mandatory to achieve a sufficiently large opening of the femorotibial joint line to permit work in the compartment. If the medial compartment is still tight, selective partial medial collateral ligament (MCL) release using the pie-crusting technique avoids iatrogenic injuries of the articulating surfaces without affecting knee stability 75. Conversely, the lateral compartment is approached putting the knee in a figure-of-four position, with the heel of the involved side over the contralateral limb.…”

Section: Allograft Extrusionmentioning

confidence: 99%

Meniscal transplantation: state of the art

et al. 2017

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Meniscal resection is the most common surgical procedure in orthopaedics. When a large meniscal loss becomes clinically relevant, meniscal allograft transplantation (MAT) is a feasible option. However, although this technique has evolved since the ‘80s, there are still several controversial issues related to MAT. Most importantly, its chondroprotective effect is still not completely proven. Its relatively high complication and reoperation rate is another reason for this procedure not yet being universally accepted. Despite its controversial chondroprotective effect, nevertheless, MAT has become a successful treatment for pain localised in a previously meniscectomised knee, in terms of pain relief and knee function. We conducted a careful review of the literature, highlighting the most relevant studies in various aspects of this procedure. Precise indications, how it behaves biomechanically, surgical techniques, return to sport and future perspectives are among the most relevant topics that have been included in this state-of-the-art review.

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The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome

Cited by 52 publications

References 17 publications

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

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

Arthroscopic pie-crusting release of the posteromedial c omplex of the knee for surgical treatment of medial meniscus injury

Meniscal transplantation: state of the art

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