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.
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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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