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Pie-crusting technique is effective and safe to release superficial medial collateral ligament for total knee arthroplasty.

ABSTRACT: Pie-crusting technique is a damage-control soft tissue balance skill of total knee arthroplasty (TKA). The outcome of this technique to release lateral soft tissue is reasonable. A limited number of studies have focused on medial collateral ligament release with pie-crusting technique in the past years because of concerns about its efficacy and safety.All cases underwent superficial medial collateral ligament (SMCL) release with either pie-crusting technique or traditional technique (39 knees in each group) between January 1, 2014 and August 31, 2015. A comparison study between two techniques was performed; meanwhile, 23 patients (26 knees) in pie-crusting group were followed up. Data including knee function, radiographic result and complications were analysed.Comparison study demonstrates that pie-crusting technique can achieve a comparable or even better effect of alignment correction. Data of follow-up patients are reasonable. The mean postoperative flexion contracture is 1.2 ± 3.6°. The mean postoperative motion arrange is 104.0 ± 14.4°. The mean postoperative hospital for special surgery knee score point is 82.0 ± 7.4 points. The mean postoperative femoral tibial angle is 172.4 ± 2.0°. The level of joint line elevates around 2.1 ± 1.9 mm. There are four knees that use brace after operation, and none of them present unstable knee. No severe complication has been reported, and most patients were satisfied with life quality.Using pie-crusting technique to release SMCL for TKA is effective and safe.Although pie-crusting technique has been used in TKA for years, it is seldom chosen to release medial collateral ligament, especially to release SMCL, which is a vital step of malalignment correction. This study aims to evaluate the efficacy and safety of this technique in total knee arthroplasty patients.

SUBMITTER: He X

PROVIDER: S-EPMC5892387 | biostudies-other | 2018 Apr

REPOSITORIES: biostudies-other

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Pie-crusting technique is effective and safe to release superficial medial collateral ligament for total knee arthroplasty.

He Xuan X Cai Hong H Zhang Ke K

Journal of orthopaedic translation 20180312

<h4>Background</h4>Pie-crusting technique is a damage-control soft tissue balance skill of total knee arthroplasty (TKA). The outcome of this technique to release lateral soft tissue is reasonable. A limited number of studies have focused on medial collateral ligament release with pie-crusting technique in the past years because of concerns about its efficacy and safety.<h4>Method</h4>All cases underwent superficial medial collateral ligament (SMCL) release with either pie-crusting technique or ...[more]

PMID: 29662789

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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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Pie-crusting technique is effective and safe to release superficial medial collateral ligament for total knee arthroplasty.

Publications

Pie-crusting technique is effective and safe to release superficial medial collateral ligament for total knee arthroplasty.

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