title: The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome.
abstract: BACKGROUND
  Pie crusting (PC) of the medial collateral ligament (MCL) in the knee has been used empirically to achieve more space in the medial compartment during knee arthroscopy. However, there are no reported studies analyzing the functional results of the application of the PC technique to the MCL in patients undergoing arthroscopic meniscectomy of the medial meniscus, and to determine the rate of iatrogenic injury and associated morbidity.
  
  
  METHODS
  The patient was in a supine position with a tourniquet and a side post. Percutaneous controlled release of the posterior part of the MCL was performed using an intramuscular needle, and a mild valgus force was applied while viewing with the arthroscope of the controlled progressive gain in medial compartment space.
  
  
  METHODS
  A retrospective clinical study of 140 patients undergoing arthroscopic meniscectomy with or without MCL PC was conducted. Tegner and Lysholm tests and visual analogue scales were used to assess pain and functional results.
  
  
  RESULTS
  The patients in the group with meniscectomy and PC had higher scores on the Lysholm scale, less pain at rest after two months, and achieved significantly better pain control during physical activity at six months. No complication, residual instability, or iatrogenic injury to the cartilage were observed in the meniscectomy plus PC group.
  
  
  CONCLUSIONS
  The MCL PC technique for medial meniscectomy is a safe and effective way to reduce iatrogenic injury to the cartilage and does not affect knee stability. Decompression of the medial compartment results in better functional outcomes at two months and lesser pain during physical activity at six months.
authors.affiliation: Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Catalonia, Spain.
authors.forename: Guillem
authors.initials: G
authors.lastname: Claret
authors.affiliation: Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Catalonia, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Montañana
authors.affiliation: Stadistic Department, IDIBAPS, Hospital Clínic de Barcelona, Catalonia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Rios
authors.affiliation: Unidad de Cirugía Artroscópica, Departamento de COT, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Miguel-Ángel
authors.initials: MÁ
authors.lastname: Ruiz-Ibán
authors.affiliation: Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Catalonia, Spain.
authors.forename: Dragos
authors.initials: D
authors.lastname: Popescu
authors.affiliation: Rheumatology Department, IDIBAPS, Hospital Clínic de Barcelona, Catalonia, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Núñez
authors.affiliation: Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Catalonia, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Lozano
authors.affiliation: Hospital Clinic de Barcelona, Orthopaedics and Traumatology Surgery Department, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: Combalia
authors.affiliation: Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Catalonia, Spain. Electronic address: ssastre@clinic.ub.es.
authors.forename: Sergi
authors.initials: S
authors.lastname: Sastre
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D017885:Collateral Ligaments / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Chondral iatrogenic lesion; Ligament release; Medial collateral ligament; Meniscus; Pie crust