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...

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Veröffentlicht in:The knee 2016-03, Vol.23 (2), p.251-255
Hauptverfasser: Claret, Guillem, Montañana, Jordi, Rios, José, Ruiz-Ibán, Miguel-Ángel, Popescu, Dragos, Núñez, Montse, Lozano, Lluis, Combalia, Andres, Sastre, Sergi
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container_end_page 255
container_issue 2
container_start_page 251
container_title The knee
container_volume 23
creator Claret, Guillem
Montañana, Jordi
Rios, José
Ruiz-Ibán, Miguel-Ángel
Popescu, Dragos
Núñez, Montse
Lozano, Lluis
Combalia, Andres
Sastre, Sergi
description 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. Description of technique 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. Patients and 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. Conclusion 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.
doi_str_mv 10.1016/j.knee.2015.07.013
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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. Description of technique 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. Patients and 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. Conclusion 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.</description><identifier>ISSN: 0968-0160</identifier><identifier>EISSN: 1873-5800</identifier><identifier>DOI: 10.1016/j.knee.2015.07.013</identifier><identifier>PMID: 26652573</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adolescent ; Adult ; Arthroscopy - methods ; Chondral iatrogenic lesion ; Collateral Ligaments - diagnostic imaging ; Collateral Ligaments - surgery ; Female ; Follow-Up Studies ; Humans ; Knee ; Knee Injuries - diagnosis ; Knee Injuries - physiopathology ; Knee Injuries - surgery ; Ligament release ; Ligaments ; Male ; Medial collateral ligament ; Menisci, Tibial - surgery ; Meniscus ; Middle Aged ; Orthopedics ; Patients ; Pie crust ; Range of Motion, Articular - physiology ; Retrospective Studies ; Surgery ; Surgical apparatus &amp; instruments ; Time Factors ; Young Adult</subject><ispartof>The knee, 2016-03, Vol.23 (2), p.251-255</ispartof><rights>Elsevier B.V.</rights><rights>2015 Elsevier B.V.</rights><rights>Copyright © 2015 Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-6376793e67eeb626b87d1317fa963473a4ddcca38c4100f0e80d5aff2bdb5fea3</citedby><cites>FETCH-LOGICAL-c439t-6376793e67eeb626b87d1317fa963473a4ddcca38c4100f0e80d5aff2bdb5fea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.knee.2015.07.013$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26652573$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Claret, Guillem</creatorcontrib><creatorcontrib>Montañana, Jordi</creatorcontrib><creatorcontrib>Rios, José</creatorcontrib><creatorcontrib>Ruiz-Ibán, Miguel-Ángel</creatorcontrib><creatorcontrib>Popescu, Dragos</creatorcontrib><creatorcontrib>Núñez, Montse</creatorcontrib><creatorcontrib>Lozano, Lluis</creatorcontrib><creatorcontrib>Combalia, Andres</creatorcontrib><creatorcontrib>Sastre, Sergi</creatorcontrib><title>The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome</title><title>The knee</title><addtitle>Knee</addtitle><description>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. Description of technique 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. Patients and 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. Conclusion 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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Arthroscopy - methods</subject><subject>Chondral iatrogenic lesion</subject><subject>Collateral Ligaments - diagnostic imaging</subject><subject>Collateral Ligaments - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Knee</subject><subject>Knee Injuries - diagnosis</subject><subject>Knee Injuries - physiopathology</subject><subject>Knee Injuries - surgery</subject><subject>Ligament release</subject><subject>Ligaments</subject><subject>Male</subject><subject>Medial collateral ligament</subject><subject>Menisci, Tibial - surgery</subject><subject>Meniscus</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Pie crust</subject><subject>Range of Motion, Articular - physiology</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical apparatus &amp; 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Montañana, Jordi ; Rios, José ; Ruiz-Ibán, Miguel-Ángel ; Popescu, Dragos ; Núñez, Montse ; Lozano, Lluis ; Combalia, Andres ; Sastre, Sergi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-6376793e67eeb626b87d1317fa963473a4ddcca38c4100f0e80d5aff2bdb5fea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Arthroscopy - methods</topic><topic>Chondral iatrogenic lesion</topic><topic>Collateral Ligaments - diagnostic imaging</topic><topic>Collateral Ligaments - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Knee</topic><topic>Knee Injuries - diagnosis</topic><topic>Knee Injuries - physiopathology</topic><topic>Knee Injuries - surgery</topic><topic>Ligament release</topic><topic>Ligaments</topic><topic>Male</topic><topic>Medial collateral ligament</topic><topic>Menisci, Tibial - surgery</topic><topic>Meniscus</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Pie crust</topic><topic>Range of Motion, Articular - physiology</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical apparatus &amp; instruments</topic><topic>Time Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Claret, Guillem</creatorcontrib><creatorcontrib>Montañana, Jordi</creatorcontrib><creatorcontrib>Rios, José</creatorcontrib><creatorcontrib>Ruiz-Ibán, Miguel-Ángel</creatorcontrib><creatorcontrib>Popescu, Dragos</creatorcontrib><creatorcontrib>Núñez, Montse</creatorcontrib><creatorcontrib>Lozano, Lluis</creatorcontrib><creatorcontrib>Combalia, Andres</creatorcontrib><creatorcontrib>Sastre, Sergi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The knee</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Claret, Guillem</au><au>Montañana, Jordi</au><au>Rios, José</au><au>Ruiz-Ibán, Miguel-Ángel</au><au>Popescu, Dragos</au><au>Núñez, Montse</au><au>Lozano, Lluis</au><au>Combalia, Andres</au><au>Sastre, Sergi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome</atitle><jtitle>The knee</jtitle><addtitle>Knee</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>23</volume><issue>2</issue><spage>251</spage><epage>255</epage><pages>251-255</pages><issn>0968-0160</issn><eissn>1873-5800</eissn><abstract>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. Description of technique 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. Patients and 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. Conclusion 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.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>26652573</pmid><doi>10.1016/j.knee.2015.07.013</doi><tpages>5</tpages></addata></record>
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source Elsevier ScienceDirect Journals Complete - AutoHoldings; MEDLINE
subjects Adolescent
Adult
Arthroscopy - methods
Chondral iatrogenic lesion
Collateral Ligaments - diagnostic imaging
Collateral Ligaments - surgery
Female
Follow-Up Studies
Humans
Knee
Knee Injuries - diagnosis
Knee Injuries - physiopathology
Knee Injuries - surgery
Ligament release
Ligaments
Male
Medial collateral ligament
Menisci, Tibial - surgery
Meniscus
Middle Aged
Orthopedics
Patients
Pie crust
Range of Motion, Articular - physiology
Retrospective Studies
Surgery
Surgical apparatus & instruments
Time Factors
Young Adult
title The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome
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