Abstract
Purpose
Visualization and surgery of tears in the posterior medial meniscus are difficult in tight knees. Iatrogenic chondral lesions might cause serious morbidity, and residual tears may result in inadequate symptom relief. We evaluated the clinical and radiological results of superficial medial collateral ligament (MCL) release during arthroscopic medial meniscectomy in tight knees.
Methods
Eighteen patients [median age: 43 years (22–59); median follow-up: 8.3 months (6–12)] who underwent arthroscopic meniscectomy were included in the study. Patients with ligamentous injuries, severe chondral damage or meniscal repairs were excluded. Preoperatively, anteroposterior knee radiographs were obtained with 11-kg valgus stress using a specialized instrument. During the operation, if opening of the medial knee in 30° flexion under 11-kg valgus stress was inadequate, controlled release of the posterior portion of the MCL was performed using a 16-gauge needle. Intraoperative valgus stress was monitored using a specially designed lateral support with mounted load cell. MCL injury was evaluated both with magnetic resonance imaging (MRI) and valgus stress radiographs, which were obtained in the 1st week and 3rd and 6th months postoperatively to monitor healing of the elongated MCL.
Results
In all patients, meniscectomy could be performed with adequate visualization of the posterior medial meniscus and without iatrogenic chondral injury. The median medial joint space width on valgus stress radiographs was 7.1 mm preoperatively and 9.1, 8.0 and 7.2 mm in the 1st week, and 3rd and 6th months, respectively (p < 0.0001). On MRI, the injured structure was the posterior two-thirds of the MCL. Median Lysholm score, which was 42 points before the operation, had increased to 94 points at the final follow-up (p = 0.0002).
Conclusion
Controlled release of the MCL in tight knees allowed easier handling in posterior medial meniscus tears and a better understanding of tear configurations, avoiding iatrogenic chondral lesions. The MCL injury healed uneventfully.
Level of evidence
IV.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Agneskirchner JD, Bernard M, Lobenhoffer P (2005) Verbesserte Ubersicht bei arthroskopischen eingriffen am innenmeniskushinterhorn durch perkutanes needling des innenbandes. Artroskopie 20(7):75–77
Agneskirchner JD, Lobenhoffer P (2004) Arthroscopic meniscus surgery: technical operative methods. Unfallchirurg 107(9):795–801
Ahn JH, Oh I (2004) Arthroscopic partial meniscectomy of a medial meniscus bucket-handle tear using the posteromedial portal. Arthroscopy 20(7):e75–e77
Allum R (2002) Complications of arthroscopy of the knee. J Bone Joint Surg Br 84-B(7):937–945
Ballmer PM, Jakob RP (1988) The non operative treatment of isolated complete tears of the medial collateral ligament of the knee. A prospective study. Arch Orthop Trauma Surg 107(5):273–276
Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20(4):373–378
Bosch U (2006) Percutaneous perforation of the posteromedial capsuloligamentous structures to avoid cartilaginous damage due to arthroscopic intervention at the medial meniscal posterior horn in narrow joints. Oper Orthop Traumatol 18(5–6):481–484
Buckwalter JA (2002) Articular cartilage injuries. Clin Orthop Relat Res 402:21–37
Ciliz D, Ciliz A, Elverici E, Sakman B (2008) Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Clin Imaging 32(3):212–219
DeLee JC (1985) Complications of arthroscopy and arthroscopic surgery: results of national survey. Committee on Complications of AANA. Arthroscopy 1(4):214–220
Fabricant PD, Jokl P (2007) Surgical outcomes after arthroscopic partial meniscectomy. J Am Acad Orthop Surg 15(11):647–653
Gardiner JC, Weiss JA, Rosenberg TD (2001) Strain in the human medial collateral ligament during valgus loading of the knee. Clin Orthop Relat Res 391:266–274
Gardiner JC, Weiss JA (2003) Subject-specific finite element analysis of the human medial collateral ligament during valgus knee loading. J Orthop Res 21(6):1098–1106
Giannotti BF, Rudy T, Graziano J (2006) The non-surgical management of isolated medial collateral ligament injuries of the knee. Sports Med Arthrosc 14(2):74–77
Huber W, Trieb K (2002) Serious consequences of the wrong diagnosis of meniscal lesion in a case of stress fracture of the distal femur. Arthroscopy 18(8):935–938
Jo CH et al (2009) Under-meniscal portal: an alternative portal for an easy access to the medial and lateral menisci. Knee Surg Sports Traumatol Arthrosc 17(11):1344–1346
Kennedy JC, Fowler PJ (1995) Medial and anterior instability of the knee. An anatomical and clinical study using stress machines. Clin Orthop Relat Res 321:3–9
Kim JM, Bin SI, Kim E (2009) Inframeniscal portal for horizontal tears of the meniscus. Arthroscopy 25(3):269–273
Leon HO, Blanco CE, Guthrie TB (2001) Arthroscopic decompressive medial release of the varus arthritic knee: expanding the functional envelope. Arthroscopy 17(5):523–526
Lubowitz JH, Rossi MJ, Baker BS, Guttmann D (2004) Arthroscopic visualization of the posterior compartments of the knee. Arthroscopy 20(7):675–680
Lyu SR (2008) Arthroscopic medial release for medial compartment osteoarthritis of the knee: the result of a single surgeon series with a minimum follow-up of four years. J Bone Joint Surg Br 90-B(9):1186–1192
Moriya H, Sasho T, Sano S (2004) Arthroscopic posteromedial release for osteoarthritic knees with flexion contracture. Arthroscopy 20(10):1030–1039
Nielsen DM, Twyman R (2005) Arthroscopic visualization of the posterior horn of the medial meniscus. Arthroscopy 21(10):1272
Park YS et al (2011) Arthroscopic pullout repair of posterior root tear of the medial meniscus: the anterior approach using medial collateral ligament pie-crusting release. Knee Surg Sports Traumatol Arthrosc 19(8):1334–1336
Spahn G (2003) Arthroscopic revisions in failed meniscal surgery. Int Orthop 27(6):378–381
Tolin BS, Sapega AA (1993) Arthroscopic visual field mapping at the periphery of the medial meniscus: a comparison of different portal approaches. Arthroscopy 9(3):265–271
Acknowledgments
The authors did not receive grants or outside funding in support of their research or for preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fakioglu, O., Ozsoy, M.H., Ozdemir, H.M. et al. Percutaneous medial collateral ligament release in arthroscopic medial meniscectomy in tight knees. Knee Surg Sports Traumatol Arthrosc 21, 1540–1545 (2013). https://doi.org/10.1007/s00167-012-2128-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-012-2128-x