Does medial collateral ligament pie-crusting induce residual laxity in arthroscopic management of medial meniscus tears? A prospective study of 40 cases - 22/08/18
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Abstract |
Introduction |
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.
Hypothesis |
Medial collateral ligament pie-crusting alters radiographic laxity at 6 weeks.
Material and methods |
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.
Results |
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).
Discussion |
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.
Level of evidence |
IV, prospective study without control group.
Le texte complet de cet article est disponible en PDF.Keywords : Knee, Arthroscopy, Medial collateral ligament, Laxity, Medial meniscus, Pie-crusting
Plan
Vol 104 - N° 5
P. 707-711 - septembre 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.