Quick Tips: Pie-Crusting the MCL to Improve Access to the Medial Knee Compartment

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Sanford Health - The University of South Dakota School of Medicine: Orthopaedics and Sports Medicine

Sanford Health and the University of South Dakota School of Medicine are national leaders in orthopaedic care. Our large rural health system is centrally located in the upper Midwest of the USA. We have several national and international centers for healthcare collaboration. The Health System focuses on comprehensive, cutting-edge, and compassionate patient care. The orthopaedic group specializes in all areas of patient care, research, education, and advocacy. Thank you for visiting our channel.

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Quick Tips: Pie-Crusting the MCL to Improve Access to the Medial Knee Compartment

By PEARL in Sports Medicine FEATURING Nathan Skelley

5,681 views

October 12, 2023

Dr. Skelley demonstrates a method for improving access to the medial compartment of the knee. ...
read more ↘ Important steps with this technique include being above the joint line and in the posterior medial region of the femur. The arthroscopic camera light can assist with finding the correct location. With the leg in a valgus position to put the MCL on stretch, enter the skin at one location with the 18 gauge needle. Do not make multiple skin punctures. Through the one poke hole in the skin, feel for a "gritty" sensation while walking the needle anterior and posterior. The needle tip will periodically contact the bone and pie-crust the MCL in the process to improve medial compartment arthroscopic visualization. This technique has not led to any clinical MCL laxity or medial sided knee pain at final follow-up in our experience. Pie-crusting has many benefits beyond improved visualization. The technique also allows for protecting the medial compartment structures while using instruments and it facilitates performing various procedures as demonstrated in this video.

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