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Pie-crusting the medial collateral ligament is a safe and effective technique for improving visualisation and access
Satyavenkata Kotipalli1, Benjamin Blackman2, Prushoth Vivekanantha3
1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Purpose:
To assess the safety, effectiveness, and postoperative outcomes of medial collateral ligament (MCL) pie-crusting (PC) in arthroscopic meniscus surgery.
Methods:
This systematic review was conducted in accordance with PRISMA guidelines. Three databases (PubMed, EMBASE and MEDLINE) were searched from inception to 21 January 2025, for studies evaluating the use of MCL PC during arthroscopic meniscus or anterior cruciate ligament (ACL) surgery. Data on patient demographics, medial joint space measurements, postoperative instability, patient reported outcome measures (PROMs), and complications were extracted.
Results:
Fifteen studies comprising 1009 patients were included, with 723 undergoing PC. PC significantly increased medial joint space width by a mean of 5.7 mm intraoperatively (p < 0.05), with no residual laxity reported at mean final follow-up of 16.5 months. The most common complications of PC were transient medial knee pain (12.7%) and ecchymosis (12.9%). There were five reports of saphenous nerve irritation (0.8%), all resolved by final follow-up of 31.6 months. In contrast, iatrogenic chondral injury was reported in 9.0% of patients undergoing meniscal repair without PC.
Conclusion:
MCL PC is a safe and effective technique to improve visualisation and outcomes in arthroscopic meniscus surgery. It is associated with improved joint access and low complication rates without long-term instability. While current evidence supports its use, further high-quality, long-term comparative studies are needed to validate its safety and efficacy, as this study primarily used retrospective data without long-term follow-up.
Level Of Evidence:
Level IV.
Insights
Medial collateral ligament (MCL) pie-crusting (PC) enhances visualization during arthroscopic meniscus surgery, increasing joint space without long-term instability. This safe technique shows promising outcomes with low complication rates.
Area of Science:
- Orthopedic Surgery
- Arthroscopy
- Knee Ligament Reconstruction
Background:
- Medial collateral ligament (MCL) manipulation is crucial for optimal visualization in arthroscopic knee procedures.
- Pie-crusting (PC) is a technique to facilitate MCL access during arthroscopic surgery.
- Assessing the safety and efficacy of MCL PC in arthroscopic meniscus surgery is essential.
Purpose of the Study:
- To evaluate the safety and effectiveness of medial collateral ligament (MCL) pie-crusting (PC).
- To assess postoperative outcomes associated with MCL PC in arthroscopic meniscus surgery.
- To determine the impact of MCL PC on joint space and patient outcomes.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- Searched PubMed, EMBASE, and MEDLINE for studies on MCL PC in arthroscopic meniscus or ACL surgery.
- Extracted data on demographics, joint space, instability, PROMs, and complications.
Main Results:
- Fifteen studies (1009 patients) were included; 723 underwent PC.
- PC significantly increased medial joint space width by 5.7 mm (p < 0.05) with no residual laxity.
- Common complications included transient medial knee pain (12.7%) and ecchymosis (12.9%); saphenous nerve irritation occurred in 0.8%.
Conclusions:
- MCL PC is a safe and effective technique for improving visualization and outcomes in arthroscopic meniscus surgery.
- The procedure offers improved joint access and low complication rates, without causing long-term instability.
- Further high-quality, long-term comparative studies are recommended to confirm safety and efficacy.
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