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Associated Morbidity After the Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy
Thomas E Moran1, John T Awowale1, Brian C Werner1
1Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, U.S.A.
Purpose:
To summarize available data on the morbidity associated with percutaneous release of the medial collateral ligament (MCL) of the knee during arthroscopy via a "pie-crusting" technique.
Methods:
A search of the literature was performed using the MEDLINE and Web of Science databases to identify studies examining the morbidity of percutaneous MCL release during arthroscopy. Only English-language articles were included; technical articles and studies not focused on the use of this technique were omitted. Two independent reviewers performed the literature search, data extraction, and quality assessment. The outcomes analyzed included resultant knee instability, functional outcome scores, visual analog scale pain scores, and saphenous nerve or greater saphenous vein injury.
Results:
Six studies met the eligibility criteria. The studies included a total of 234 knees undergoing MCL release, with a mean patient age of 41.1 years. 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.
Conclusions:
Percutaneous MCL release during knee arthroscopy is a method of increasing the medial tibiofemoral joint space without causing any significant short- or long-term complications including residual valgus instability, pain, loss of function, or damage to surrounding structures.
Level Of Evidence:
Level IV, systematic review of Level IV studies.
Insights
Percutaneous medial collateral ligament (MCL) release during knee arthroscopy is safe. This technique effectively increases joint space without significant short- or long-term complications like instability or pain.
Area of Science:
- Orthopedic Surgery
- Arthroscopic Knee Procedures
- Biomechanical Analysis
Background:
- The medial collateral ligament (MCL) can limit joint space during knee arthroscopy.
- Percutaneous release techniques aim to improve visualization and access.
- The
Purpose of the Study:
- To evaluate the morbidity associated with percutaneous MCL release during knee arthroscopy.
- To summarize existing data on the safety and outcomes of this technique.
Main Methods:
- Systematic review of English-language studies.
- Literature search of MEDLINE and Web of Science databases.
- Analysis of knee instability, functional scores, pain, and neurovascular injury.
Main Results:
- Six studies with 234 knees were included.
- Percutaneous MCL release typically caused transient Grade I laxity.
- No significant differences in functional outcomes or pain compared to no release.
- Zero incidence of saphenous nerve or vein injury.
Conclusions:
- Percutaneous MCL release is a safe adjunct to knee arthroscopy.
- It effectively increases medial tibiofemoral joint space.
- No significant short- or long-term complications were observed.
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