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The pie-crusting technique using a blade knife for medial collateral ligament release is unreliable in varus total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Despite the documented clinical efficacy of the pie-crusting technique for medial collateral ligament (MCL) release in varus total knee arthroplasty, its quantitative effects on medial gaps and safety remain unclear. This study was undertaken to determine the efficacy (quantitative effect and consistency of the number of punctures) and the safety (frequency of early over-release) of the pie-crusting technique for MCL release.

Methods

From ten pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo pie crusting in extension (group E) or in flexion (group F). Pie crusting was performed in the superficial MCL using a blade until over-release occurred. After every puncture, the incremental medial gap increase was recorded, and the number of punctures required for 2- or 4-mm gap increases was assessed.

Results

In group E, the extension gap increased from 0.8 to 5.0 mm and the flexion gap increased from 0.8 to 3.0 mm. In group F, the extension gap increased from 1.0 to 3.0 mm and the flexion gap increased from 2.6 to 6.0 mm. However, the gap increments were inconsistent with those that followed the preceding blade punctures, and the number of punctures required to increase the gaps by 2 or 4 mm was variable. The number of punctures leading to over-release in group E and group F was 6 ± 1 and 3 ± 1 punctures, respectively. Overall, 70 % of over-release occurred earlier than the average number of punctures leading to over-release.

Conclusions

Pie crusting led to unpredictable gap increments and to frequent early over-release. Surgeons should decide carefully before using the pie-crusting technique for MCL release and should be cautious of performing throughout the procedure, especially when performing in a flexed knee.

Level of evidence

Therapeutic study, Level I.

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Acknowledgments

We thank Sung Ju Kim, MPH for his assistance with statistical analysis. We also thank Su Gu Chai BS, Do Young Choi BS, and Jong Hwan Lee BS for their assistance in the preparation and testing of donor specimens. Smith & Nephew, South Korea, kindly provided the surgical instruments used in this study. We also thank the donors and their families.

Conflict of interest

No benefits in any form have been or will be received from a commercial party directly or indirectly related to the subject of this article. The Catholic Medical Center Research Foundation made in the programme year of 2014 was received in support of this study.

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Authors and Affiliations

  1. Catholic Institute for Applied Anatomy, The Catholic University of Korea College of Medicine, Seoul, 137-701, Korea

    Dai-Soon Kwak

  2. Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea

    Yong In, Han Suk Cho & In Jun Koh

  3. Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, 137-701, Korea

    Yong In, Han Suk Cho & In Jun Koh

  4. Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 463-707, Korea

    Tae Kyun Kim

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  1. Dai-Soon Kwak
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Correspondence to In Jun Koh.

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Kwak, DS., In, Y., Kim, T.K. et al. The pie-crusting technique using a blade knife for medial collateral ligament release is unreliable in varus total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24, 188–194 (2016). https://doi.org/10.1007/s00167-014-3362-1

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