ABSTRACT: 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. Technique Video Video 1 We outline some of the surgical tips and techniques for a controlled percutaneous medial collateral ligament (MCL) release during knee arthroscopy through a case-based approach. First, we outline the relevant surface anatomy and the location of our adjuvant percutaneous MCL release. Next, we display our starting point on a sectioned anatomic model, showing the nearby saphenous nerve and saphenous vein, which must be avoided. In addition, we present our patient positioning and setup for the procedure, as well as our preference for portal placement. Following this, recorded arthroscopic footage of our procedure is presented. We confirm our starting point both arthroscopically and through the use of the relevant surface anatomy as described. We then perform our adjuvant percutaneous MCL release through sequential pie crusting and display the increased medial-compartment space arthroscopically. Finally, we review our group’s experience with this procedure and describe our postoperative protocol. We do not routinely use postoperative bracing.
