Dai-Soon Kwak1, Yong In2,3, Tae Kyun Kim4, Han Suk Cho2,3, In Jun Koh5,6. 1. Catholic Institute for Applied Anatomy, The Catholic University of Korea College of Medicine, Seoul, 137-701, Korea. 2. Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea. 3. Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, 137-701, Korea. 4. Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 463-707, Korea. 5. Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea. hinman74@naver.com. 6. Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, 137-701, Korea. hinman74@naver.com.
Abstract
PURPOSE: Despite the documented clinical efficacy of the pie-crusting technique for medial collateral ligament (MCL) release in varus total knee arthroplasty, its quantitative effects on medial gaps and safety remain unclear. This study was undertaken to determine the efficacy (quantitative effect and consistency of the number of punctures) and the safety (frequency of early over-release) of the pie-crusting technique for MCL release. METHODS: From ten pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo pie crusting in extension (group E) or in flexion (group F). Pie crusting was performed in the superficial MCL using a blade until over-release occurred. After every puncture, the incremental medial gap increase was recorded, and the number of punctures required for 2- or 4-mm gap increases was assessed. RESULTS: In group E, the extension gap increased from 0.8 to 5.0 mm and the flexion gap increased from 0.8 to 3.0 mm. In group F, the extension gap increased from 1.0 to 3.0 mm and the flexion gap increased from 2.6 to 6.0 mm. However, the gap increments were inconsistent with those that followed the preceding blade punctures, and the number of punctures required to increase the gaps by 2 or 4 mm was variable. The number of punctures leading to over-release in group E and group F was 6 ± 1 and 3 ± 1 punctures, respectively. Overall, 70% of over-release occurred earlier than the average number of punctures leading to over-release. CONCLUSIONS:Pie crusting led to unpredictable gap increments and to frequent early over-release. Surgeons should decide carefully before using the pie-crusting technique for MCL release and should be cautious of performing throughout the procedure, especially when performing in a flexed knee. LEVEL OF EVIDENCE: Therapeutic study, Level I.
RCT Entities:
PURPOSE: Despite the documented clinical efficacy of the pie-crusting technique for medial collateral ligament (MCL) release in varus total knee arthroplasty, its quantitative effects on medial gaps and safety remain unclear. This study was undertaken to determine the efficacy (quantitative effect and consistency of the number of punctures) and the safety (frequency of early over-release) of the pie-crusting technique for MCL release. METHODS: From ten pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo pie crusting in extension (group E) or in flexion (group F). Pie crusting was performed in the superficial MCL using a blade until over-release occurred. After every puncture, the incremental medial gap increase was recorded, and the number of punctures required for 2- or 4-mm gap increases was assessed. RESULTS: In group E, the extension gap increased from 0.8 to 5.0 mm and the flexion gap increased from 0.8 to 3.0 mm. In group F, the extension gap increased from 1.0 to 3.0 mm and the flexion gap increased from 2.6 to 6.0 mm. However, the gap increments were inconsistent with those that followed the preceding blade punctures, and the number of punctures required to increase the gaps by 2 or 4 mm was variable. The number of punctures leading to over-release in group E and group F was 6 ± 1 and 3 ± 1 punctures, respectively. Overall, 70% of over-release occurred earlier than the average number of punctures leading to over-release. CONCLUSIONS: Pie crusting led to unpredictable gap increments and to frequent early over-release. Surgeons should decide carefully before using the pie-crusting technique for MCL release and should be cautious of performing throughout the procedure, especially when performing in a flexed knee. LEVEL OF EVIDENCE: Therapeutic study, Level I.
Entities:
Keywords:
Medial collateral ligament release; Pie crusting; Total knee arthroplasty; Varus knee
Authors: Peter C M Verdonk; Jerome Pernin; Alban Pinaroli; Tarik Ait Si Selmi; Philippe Neyret Journal: Knee Surg Sports Traumatol Arthrosc Date: 2009-03-17 Impact factor: 4.342
Authors: Adolph V Lombardi; Michael P Nett; W Norman Scott; Henry D Clarke; Keith R Berend; Mary I O'Connor Journal: J Bone Joint Surg Am Date: 2009-08 Impact factor: 5.284
Authors: Thomas Herschmiller; Matthew J Grosso; Gregory J Cunn; Taylor S Murtaugh; Thomas R Gardner; Jeffrey A Geller Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-11-22 Impact factor: 4.342
Authors: Shady S Elmasry; Peter K Sculco; Mohammad Kia; Cynthia A Kahlenberg; Michael B Cross; Andrew D Pearle; David J Mayman; Timothy M Wright; Geoffrey H Westrich; Carl W Imhauser Journal: J Orthop Res Date: 2020-05-25 Impact factor: 3.494