Objective: To explore effectiveness and safety of an inside-out, arthroscopic deep medial collateral ligament pie-crusting release in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.
Methods: From January 2016 to December 2017, 61 patients (61 knees) were underwent arthroscopic partial meniscectomies for PHMM tear in tight medial tibiofemoral compartment of knee joint, who were divided into valgus group and pie-crusting group according to exposure of PHMM region . There were 28 patients in valgus group, including 12 males and 16 females aged from 27 to 60 years old with an average age of (35.75±7.57) years old;who were performed conventional valgused knee to exporsure PHMM region. There were 33 patients in pie-crusting group, including 15 males and 18 females aged from 26 to 58 years old with an average age of (36.06±7.93) years old;who were treated with inside-out, arthroscopic deep MCL pie crusting release technique with MM-Ⅱ meniscus suture package (Smith & Nephew). Operation time, preoperative and postopertaive Lysholm score of knee joint, injury of MCL between two groups were recorded and compared.
Results: All patients were followed up from 12 to 18 months with an average of (15.19±2.22) months. The incisions were healed at stageⅠ. There were no statistical difference in anatomical classification of PHMM between two groups(P>0.05). There was difference in opertaion time between valgus group (83.32±5.01) min and pie-crusting group (50.06±3.67) min (P<0.05). Postopertaive Lysholm score of knee joint at 3 months in two groups were higher than that of before operation (P<0.05), and Lysholm total score of knee joint in pie-crusting group was higher than that of valgus group (P<0.05). Acocording to Lysholm score of knee joint, 7 patients got excellent results, 12 good, 7 moderate and 2 poor in valgus group;19 patients got excellent results, 10 good, 4 moderate in pie-crusting group;and had difference between two groups (P<0.05). MCL injury of valgus group (15 patients with degree 0, 10 patients with degreeⅠ, 3 patients with degreeⅡ, 0 patient with degree Ⅲ) was higher than pie-crusting group(28 patients with degree 0, 5 patients with degreeⅠ, 0 patient with degreeⅡ, 0 patient with degreeⅢ)(P<0.05), while there was no differnce between two groups in MCL injury at 1 month after opertaion (P>0.05) .
Conclusion: The inside-out, arthroscopic deep MCL pie-crusting release for the treatment of posterior horn of medial meniscus tear in tight medial tibiofemoral could expand working apace, shorten operation time, reduce injury to MCL and obtain good clinical efficacy.
Keywords: Arthroscopy; Knee joint; Medial collateral ligament; Medial tibiofemoral compartment; Meniscus.