Summary
Pie crusting of the MCL, performed at the time of ACLR does not appear to adversely affect the functional post-operative outcomes.
Abstract
Background
Medial collateral ligament (MCL) “pie-crusting” (selective release of the superficial MCL to improve arthroscopic access to the posterior horn of the medial meniscus) has been shown not to adversely affect outcomes of isolated meniscal surgery. However, whether MCL pie-crusting (PC), to address concomitant meniscal lesions during anterior cruciate ligament reconstruction (ACLR) surgery, adversely affects post-operative outcomes is unknown. The aim of this study was to compare the functional outcomes of patients undergoing PC of the MCL, to address meniscal pathology at the time of ACLR, with those undergoing isolated ACLR.
Methods
55 consecutive patients (33 male and 22 female), with minimum 2 year follow-up, who had undergone MCL PC with concomitant primary ACLR (PC group) were retrospectively matched on the basis of age, sex and follow-up with 55 patients who underwent isolated primary ACLR. Post-operative outcome measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, Tegner activity score, the EuroQol five-dimension health questionnaire and EuroQol visual analogue scale.
Results
The two groups’ median postoperative EQ 5D-VAS, EQ 5D-index and Tegner scores were similar. The median post op IKDC score was 84 in the PC group and compared with 90 in the isolated ACLR group. However, the difference between pre-operative and post-operative IKDC scores was higher in patients in the PC group (40, IQR= 25-49) than in the isolated ACLR group (32, IQR=19.6-46.8, p<0.05). The difference between pre-operative and post-operative KOOS score was similar for the two group for all subscales except the ADL subscale which was higher in the PC group (24, IQR= 6-32) than in the isolated ACLR group (5, IQR= 0-9.74, p<0.05).
Conclusion
PC of the MCL, performed at the time of ACLR does not appear to adversely affect the functional post-operative outcomes.