Does medial collateral ligament pie-crusting induce residual laxity in arthroscopic management of medial meniscus tears? A prospective study of 40 cases

Abstract

Arthroscopic meniscectomy and medial meniscal repair are frequent procedures, liable to be complicated by iatrogenic cartilage lesions, especially in tight knee. Medial collateral ligament pie-crusting was developed to counter this, but, although the technique is employed, its impact on medial laxity has not been precisely determined. We therefore conducted a prospective observational study to compare radiographic laxity preoperatively versus 6 weeks following pie-crusting. Medial collateral ligament pie-crusting alters radiographic laxity at 6 weeks. Between December 2015 and February 2017, 40 patients (33 male, 7 female) underwent surgery with pie-crusting for isolated medial meniscal lesion. Mean age was 39 years (range, 20-54 years). Meniscectomy was performed in 33 cases (82.5%) and repair in 7 (17.5%). Pie-crusting used an intramuscular needle under arthroscopic control, adjacent to the medial meniscus at the posterior two-thirds junction of the compartment, until opening was deemed satisfactory. Laxity was compared on preoperative versus 6 weeks stress valgus views (Telos ™), by 2 independent observers, on 2 measurements: opening angle, and medial tibiofemoral joint space height. Each measurement was taken twice at a 2-week interval by each observer. Inter- and intra-observer concordance was excellent on both measurements: intraclass correlation coefficient was 0.82 (95% CI, 0.73-0.89) and 0.91 (95% CI, 0.86-0.94) pre- and post-operatively for opening angle, and 0.87 (95% CI, 0.79-0.92) and 0.88 (95% CI, 0.82-0.92) for joint space height. Tibiofemoral joint space opening was significantly greater at 6 weeks on both measurements: 0.9±1° [range, -1° to 4°] (p<0.0001) and 1.1±1mm [range, -0.6 to 3.2mm] (p<0.0001). Medial collateral ligament pie-crusting led to a moderate but significant increase in medial laxity at 6 weeks. A longer-term study is needed to assess progression. IV, prospective study without control group.