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. 2022 Nov 18;11(12):e2365-e2370.
doi: 10.1016/j.eats.2022.08.043. eCollection 2022 Dec.

Percutaneous Lateral Collateral Ligament Release for Arthroscopic Procedures of the Knee: The "Lateral Pie-Crusting"

Gonzalo Samitier  1 , Joel Gambín  2 , Iván Saenz  3   4 , Gustavo Vinagre  5   6
Affiliations

Percutaneous Lateral Collateral Ligament Release for Arthroscopic Procedures of the Knee: The "Lateral Pie-Crusting"

Gonzalo Samitier et al. Arthrosc Tech. .

Abstract

Arthroscopy of the knee is among the most frequent procedures worldwide in orthopaedic surgery. To avoid iatrogenic cartilage injury, adequate visualization and working space are mandatory to perform complex procedures. Narrow femorotibial joint space is often encountered, and it is challenging to obtain consistent satisfactory results. Medial collateral ligament release is safe and reliable for facilitating medial joint widening. Current clinical studies support lateral collateral ligament (LCL) healing capacity in isolated injuries. This article describes a simple, safe, and reproducible technique of LCL release through a multiple-puncture method to facilitate lateral compartment visualization and instrumentation, the so-called lateral pie-crusting.

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Figures

Fig 1
Fig 1
The patient is positioned supine and a leg holder is used to hold the right knee in a “figure-of-4” position. The arthroscope is placed in a standard anterolateral (AL) viewing portal of the right knee. (A) Before the lateral collateral ligament (LCL) pie-crusting: Incomplete meniscal visualization with probable iatrogenic cartilage damage with a 4.2-mm shaver (arrow). (B) After the LCL pie-crusting: Increased lateral joint space with safe and proper shaver utilization.
Fig 2
Fig 2
Anatomic cadaveric dissection of the lateral side of the knee (lateral view, right knee, extended position): lateral collateral ligament (LCL) and popliteus tendon (PT) and their relation to the lateral epicondyle (LE) and biceps tendon (BT).
Fig 3
Fig 3
Anatomic cadaveric dissection of the lateral femoral condyle and lateral collateral ligament (LCL) at 90° of flexion (lateral view, right knee). The popliteus tendon (PT) starts to enter the popliteal sulcus and gets tight.
Fig 4
Fig 4
Lateral pie-crusting technique in a cadaveric model. The right thigh is held at a 30° flexion angle while applying gentle and constant varus force. Lateral (A) and frontal (B) views show an 18-gauge needle pointing into the femoral attachment of the lateral collateral ligament (LCL) (arrows), which is slightly proximal and posterior to the lateral epicondyle (LE). The popliteus tendon (PT) femoral attachment is in the opposite direction—anterior and distal—18.5 mm from the LCL attachment. An arthroscopic view can also serve as a guide to avoiding PT injuries.
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