Adjuvant Medial Collateral Ligament Release at the Time of Knee Arthroscopy: A Controlled Percutaneous Technique

The posterior horn of the medial meniscus can be challenging to view during arthroscopy because the medial femoral condyle obstructs vision, especially in tight medial compartments. Previous studies have described techniques for improving access, one being a percutaneous medial collateral ligament (MCL) release. This technique allows for increased medial compartment space, which offloads a tight medial compartment, minimizes iatrogenic chondral injury, incomplete meniscal resection, uncontrolled MCL rupture, and allows for accurate diagnosis and management. Studies have proven the safety of the controlled percutaneous MCL release, with no significant postoperative MCL laxity on stress views, no subjective patient instability, fewer iatrogenic cartilage lesions, and no saphenous neurovascular injury. Furthermore, retrospective studies have shown improved postoperative patient-reported outcomes with a controlled percutaneous MCL release in comparison to standard of care without a release. We hypothesize that a controlled percutaneous release of the MCL effectively alleviates some of the pressure within the medial compartment, which could potentially explain the improved postoperative clinical outcomes. This technique also facilitates improved visualization, a decreased risk of iatrogenic chondral injury, and a more complete meniscal resection. The purpose of this Technical Note is to describe our surgical technique and provide surgical pearls for a controlled percutaneous MCL release during knee arthroscopy.