Pie-crusting technique may be safe for isolated medial meniscal root repair
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Key takeaways:
- Pie-crusting yielded significantly higher IKDC scores beginning 6 months postoperatively and continuing through 2-years.
- A higher percentage of patients in the non-pie-crusting group experienced recurrent tears.
NEW ORLEANS — Results presented here showed use of the percutaneous pie-crusting technique may be safe for patients undergoing isolated medial meniscal root repair and have similar outcomes to patients who did not undergo pie-crusting.
“We did see that, in early results, there was some improvement in some of the clinical findings that we looked at with the pie-crust and the non-pie-crust [groups], but long-term studies are necessary to determine the actual outcome of these patients,” Kostas J. Economopoulos, MD, said in his presentation at the Arthroscopy Association of North America Annual Meeting.
Economopoulos and colleagues categorized patients who underwent isolated medial meniscal root repairs between 2013 and 2019 into groups based on whether they underwent the pie-crusting technique.
“The decision to do a pie-crust was the surgeon’s determination and what I based it on is whether I can see the capsule just above the posterior horn of the meniscus,” Economopoulos said.
Researchers retrospectively reviewed IKDC and Lysholm scores at 2-year follow-up and calculated the percentage of recurrent meniscal root tears, as well as the conversion to total knee arthroplasty.
“We examined these patients in the clinic looking at their [medial collateral ligament] MCL laxity for about 6 months after the surgery,” Economopoulos said. “We also obtained plain imaging of all of these patients at 6-month intervals.”
Among the 45 patients in the non-pie-crusting group and 52 patients in the pie-crusting group, Economopoulos noted patients in the pie-crusting group had significantly higher IKDC scores beginning at 6 months postoperatively which continued through the 2-year period.
“When we looked at the Lysholm scores, we also saw the same type of pattern where, after 6 months, patients who had pie-crusting had higher scores than those who did not have their MCL pie-crusted,” Economopoulos said.
He noted patients in the pie-crusting group had a higher percentage of minimal clinically important difference and patient-acceptable symptomatic state for IKDC score at 3- to 6-months postoperatively. Although the two groups had no differences in progression of arthritic changes or conversion to TKA, Economopoulos said a higher percentage of patients in the non-pie-crusting group experienced recurrent tears.
“Laxity was higher in patients who underwent pie-crusting in the first 6 weeks,” Economopoulos said. “However, 3 months after that, the difference was not significant. And at the 6-month period, there were no signs of MCL laxity.”
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Economopoulos KJ, et al. MCL pie-crusting during isolated medial meniscal root repairs leads to improved outcomes. Presented at: Arthroscopy Association of North America Annual Meeting; May 4-6, 2023; New Orleans.
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