Pie-crusting the medial collateral ligament is a safe and effective technique for improving visualisation and access in arthroscopic meniscal surgery: A systematic review.
Satyavenkata Kotipalli, Benjamin Blackman, Prushoth Vivekanantha et al.
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In 30 seconds
This PRISMA-guided systematic review assessed medial collateral ligament (MCL) pie-crusting to improve access during arthroscopic meniscal or ACL surgery. Fifteen studies included 1009 patients, 723 of whom underwent pie-crusting. The technique increased medial joint-space width by a mean of 5.7 mm intraoperatively (p < 0.05); no residual laxity was reported at mean final follow-up of 16.5 months. Transient medial knee pain and ecchymosis were the most common reported complications. The authors concluded that pie-crusting improves access with low complication rates, while noting that the evidence is mainly retrospective and requires stronger, longer-term comparative studies.
Key findings
- Pie-crusting increased medial joint-space width by a mean of 5.7 mm intraoperatively (p < 0.05).
- No residual laxity was reported at mean final follow-up of 16.5 months.
- Transient medial knee pain occurred in 12.7% and ecchymosis in 12.9% of patients undergoing pie-crusting.
- Saphenous nerve irritation was reported in 0.8%; all cases resolved by final follow-up of 31.6 months.
Why it matters
Restricted medial compartment access can complicate arthroscopic meniscal procedures. This review suggests that MCL pie-crusting can widen the joint space and improve access, with reported complications generally resolving and no residual laxity reported at the stated follow-up. These findings may inform consideration of the technique, but the evidence base does not establish long-term comparative safety or efficacy.
What to keep in mind
The evidence was primarily retrospective, and the authors identify a need for high-quality comparative studies with longer-term follow-up.