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Percutaneous Partial Outside-In Release of Medial Collateral Ligament for Arthroscopic Medial Meniscus Surgery With Tight Medial Compartment by Finding a "Magic Point".

ABSTRACT: The medial meniscus is one of the more commonly injured structures as compared with the lateral meniscus. In patients with tight medial joint space, it is difficult to visualize the posterior horn and posterior root of medial meniscus and even more difficult to use instrumentation for surgical procedures. Normally, the mean medial joint space (4.74 ± 0.75 mm) is less than the mean lateral joint space width (5.63 ± 0.86). Forceful instrumentation in a tight and a narrow medial joint compartment may cause damage to the articular cartilage, which may increase chances of arthritis in future. To increase the opening of the medial compartment after valgus extension stress position of the knee, different techniques of medial collateral ligament release have been described in the literature. However, the majority of articles describe a multiple-puncture method to the medial collateral ligament called the "pie-crusting" method, not explaining the exact point or precise location of release. Here, we describe a simple and reliable method of medial collateral ligament release by finding the exact release point, a "magic point" to increase the medial joint compartment width to facilitate better visualization and instrumentation for surgical procedures.

SUBMITTER: Chernchujit B

PROVIDER: S-EPMC7372310 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo quantify intraoperative joint space widening afforded by the outside-in, percutaneous release of the medial collateral ligament (MCL) and to evaluate its impact on medial compartment width and functional outcomes at 6-week follow-up for patients undergoing a partial medial meniscectomy without postoperative bracing.MethodsPatients with posteromedial meniscus tears and no evidence of ipsilateral knee pathology, undergoing partial medial meniscectomy, were enrolled. Intraoperatively, medial compartment width was quantified with fluoroscopy before and after the percutaneous MCL release with an 18-gauge spinal needle proximal to the joint line. At 6-week follow-up, valgus stress radiographs re-evaluated medial compartment width. International Knee Documentation Committee (IKDC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were completed preoperatively and at 6-week follow-up to evaluate functional outcomes. A paired sample t test performed at a 95% confidence interval (CI) was used to compare these variables.ResultsForty-two patients, mean (± standard deviation) age 55.3 ± 10.7 years, were available for analysis of intraoperative medial compartment widening. Medial compartment width increased from 5.95 ± 1.32 to 11.09 ± 1.74 mm intraoperatively after MCL release. At 6-week follow-up, radiographic assessment demonstrated a mean medial compartment width of 5.85 ± .99 mm, which represented an insignificant change compared with the preoperative value (CI -0.68 to .33, P = .474). PROMIS and IKDC scores significantly improved from baseline, with increases of 6.9 ± 12.4 (CI 2.0 to 11.8, P = .008) and 11.7 ± 17.8 (CI 4.7 to 18.8, P = .002), respectively.ConclusionsPercutaneous MCL release during knee arthroscopy improves visualization and facilitates instrumentation by providing an almost 2× wider working space within the medial tibiofemoral joint. In this study, the performance of percutaneous MCL release did not result in any complications. Radiographic and clinical resolution of iatrogenic laxity was demonstrated by 6-weeks postoperatively, without the use of postoperative bracing.Level of evidenceIV, therapeutic case series.

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Percutaneous Partial Outside-In Release of Medial Collateral Ligament for Arthroscopic Medial Meniscus Surgery With Tight Medial Compartment by Finding a "Magic Point".

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