title: Is the pie-crusting technique safe for MCL release in varus deformity correction in total knee arthroplasty?
abstract: Established for lateral release in TKA, the pie-crusting technique has not been studied for the medial collateral ligament (MCL). In cadaveric knees the MCL was release with a pie-crusting technique in one and traditional technique in the contralateral knee. Along with a control group, each MCL was subjected to mechanical testing. The stiffness, force and stress required to cause ligament elongation were less in the pie-crusting group (p < 0.05) compared to the control group, but were not statistically different than the traditional group. The pie-crusting group demonstrated a characteristic "stair-step" failure mode at the joint line, whereas the traditional group failed elastically at the tibial insertion. MCL pie-crusting is likely technique dependent since failure occurs within the ligament itself and further study is warranted.
authors.affiliation: Department of Orthopaedic Surgery, Indiana University Health Physicians, Indiana University School of Medicine, Indianapolis, Indiana 46037, USA.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Meneghini
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Daluga
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Sturgis
authors.forename: Jay R
authors.initials: JR
authors.lastname: Lieberman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D016916:Joint Deformities, Acquired / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000601:surgery*; D008875:Middle Aged; D013314:Stress, Mechanical; D054159:Torsion, Mechanical
keywords: medial collateral ligament; pie-crusting; release; total knee arthroplasty; total knee replacement