New work performed at the University of Virginia (UVA) in Charlottesville has examined six studies (234 knees) where patients were treated with an arthroscopic medial collateral ligament (MCL) release using the “pie crusting” technique.
Their work, “Associated Morbidity After the Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy,” appears in the March 2020 edition of Arthroscopy.
Co-author Mark Miller, the S. Ward Casscells Professor of Orthopaedic Surgery at UVA, explained the purpose of the study to OTW, “We were struggling with patients that had tight medial compartments and access was difficult. This sometimes may have resulted in articular cartilage scuffing and failure to adequately diagnose and treat meniscal tears in the very back of the knee.”
Asked to describe a “pie crusting” technique, he explained that he performs it by using an 18-gauge spinal needle to “poke” small holes in the capsule of the knee below the skin. He then moves it in a front to back manner through the same skin poke to gradually release the tight capsule and medical collateral ligament.
In his study, Dr. Miller along with the other authors wrote, “This MCL release typically generated grade I MCL laxity, which usually diminished or resolved over time and did not require brace application. The functional outcome scores of patients undergoing MCL release did not differ from those of patients undergoing the same procedure without MCL release. Postoperative pain was not significantly different between patients who underwent MCL release and those who did not. There was a 0% incidence of injury to the saphenous nerve or greater saphenous vein with MCL release in the included studies.”
It was surprising, said Dr. Miller, to find that patients had some discomfort at two weeks. “But this went away by six weeks,” he added.
“The knee laxity (opening) allowed us to get excellent access (opened twice as much as before release) and completely recovered at six weeks.”
