Guillem Claret1, Jordi Montañana1, José Rios2, Miguel-Ángel Ruiz-Ibán3, Dragos Popescu1, Montse Núñez4, Lluis Lozano1, Andres Combalia5, Sergi Sastre6. 1. Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Catalonia, Spain. 2. Stadistic Department, IDIBAPS, Hospital Clínic de Barcelona, Catalonia, Spain. 3. Unidad de Cirugía Artroscópica, Departamento de COT, Hospital Ramón y Cajal, Madrid, Spain. 4. Rheumatology Department, IDIBAPS, Hospital Clínic de Barcelona, Catalonia, Spain. 5. Hospital Clinic de Barcelona, Orthopaedics and Traumatology Surgery Department, Spain. 6. Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Catalonia, Spain. Electronic address: ssastre@clinic.ub.es.
Abstract
BACKGROUND: Pie crusting (PC) of the medial collateral ligament (MCL) in the knee has been used empirically to achieve more space in the medial compartment during knee arthroscopy. However, there are no reported studies analyzing the functional results of the application of the PC technique to the MCL in patients undergoing arthroscopic meniscectomy of the medial meniscus, and to determine the rate of iatrogenic injury and associated morbidity. DESCRIPTION OF TECHNIQUE: The patient was in a supine position with a tourniquet and a side post. Percutaneous controlled release of the posterior part of the MCL was performed using an intramuscular needle, and a mild valgus force was applied while viewing with the arthroscope of the controlled progressive gain in medial compartment space. PATIENTS AND METHODS: A retrospective clinical study of 140 patients undergoing arthroscopic meniscectomy with or without MCL PC was conducted. Tegner and Lysholm tests and visual analogue scales were used to assess pain and functional results. RESULTS: The patients in the group with meniscectomy and PC had higher scores on the Lysholm scale, less pain at rest after two months, and achieved significantly better pain control during physical activity at six months. No complication, residual instability, or iatrogenic injury to the cartilage were observed in the meniscectomy plus PC group. CONCLUSION: The MCL PC technique for medial meniscectomy is a safe and effective way to reduce iatrogenic injury to the cartilage and does not affect knee stability. Decompression of the medial compartment results in better functional outcomes at two months and lesser pain during physical activity at six months.
BACKGROUND: Pie crusting (PC) of the medial collateral ligament (MCL) in the knee has been used empirically to achieve more space in the medial compartment during knee arthroscopy. However, there are no reported studies analyzing the functional results of the application of the PC technique to the MCL in patients undergoing arthroscopic meniscectomy of the medial meniscus, and to determine the rate of iatrogenic injury and associated morbidity. DESCRIPTION OF TECHNIQUE: The patient was in a supine position with a tourniquet and a side post. Percutaneous controlled release of the posterior part of the MCL was performed using an intramuscular needle, and a mild valgus force was applied while viewing with the arthroscope of the controlled progressive gain in medial compartment space. PATIENTS AND METHODS: A retrospective clinical study of 140 patients undergoing arthroscopic meniscectomy with or without MCLPC was conducted. Tegner and Lysholm tests and visual analogue scales were used to assess pain and functional results. RESULTS: The patients in the group with meniscectomy and PC had higher scores on the Lysholm scale, less pain at rest after two months, and achieved significantly better pain control during physical activity at six months. No complication, residual instability, or iatrogenic injury to the cartilage were observed in the meniscectomy plus PC group. CONCLUSION: The MCLPC technique for medial meniscectomy is a safe and effective way to reduce iatrogenic injury to the cartilage and does not affect knee stability. Decompression of the medial compartment results in better functional outcomes at two months and lesser pain during physical activity at six months.
Authors: Michael A Gaudiani; Derrick M Knapik; Matthew W Kaufman; Michael J Salata; James E Voos; Michael R Karns Journal: Arthrosc Sports Med Rehabil Date: 2020-01-19