Abstract
Medial collateral ligament (MCL) pie-crusting technique in total knee arthroplasty
(TKA) is one of the methods of medial release. The effects and risks of blade pie-crusting
have been reported in previous studies. However, only a few have reported the safety
and efficacy of needle pie-crusting. In this cadaveric study, we quantitatively evaluated
the amount of gap change by MCL needle pie-crusting. We investigated five knees of
four fresh human cadavers and performed posterior-stabilized TKA. Only deep MCL release
as the medial release was conducted. We punctured the MCL from the deep layer to the
superficial layer using a 18 G needle in a 90-degree flexion position for 0, 10, 20,
50, 75, and 100 times. Medial and lateral gaps were measured accurately with a balancer
at determined times in 0 and 90-degree flexion positions. Changes in medial and lateral
gaps were not significant differences in flexion and extension position. However,
in 90-degree flexion, medial gap changes were tended to be larger than lateral gap
changes. A 0.6 mm additional medial release and a 0.2 mm additional lateral release
were found per 10 times pie crust in flexion position (100 times, p: 0.08). However, large differences existed among the cases. Needle pie-crusting is
safer than blade pie-crusting because of the small efficacy of one-time pie crust.
MCL needle pie-crusting showed varied effects for each case. This result indicates
the risk of relaxation of an unexpected gap. Caution should be taken when choosing
between needle pie-crusting and blade pie-crusting.
Keywords
total knee arthroplasty - medial collateral ligament - needle pie-crusting - gap -
cadaveric study
