Results of Medial Collateral Ligament percutaneous fenestration versus Arthroscopic release in arthroscopic partial medial meniscectomy

Background: The posterior horn of the medial meniscus is still the single greatest source of errors in knee arthroscopy, despite the great advancement in arthroscopic techniques and instruments. Most errors occur in tight knees that have hidden lesions at the periphery of the posterior horn of the medial meniscus. In knee joints with a narrow medial joint space, there is a risk that cartilage may be damaged by the resection instruments, even by an arthroscopy specialist. Even superficial cartilaginous lesions due to hits or scratches caused by instruments and affecting the cartilage of the posterior femoral condyle and the tibial plateau do not heal with normal hyaline cartilage. They may predispose to osteoarthritis of the knee joint, especially if extensive partial menisectomy is performed simultaneously. This work aimed to compare the efficacy of percutaneous release of the MCL versus arthroscopic release using 3 mm special knife in widening medial joint space and the complications of both techniques when implicated in arthroscopy of the knee in partial medial menisectomy in knees with tight medial compartment. Methods: A prospective randomized analytical clinical study. The material of this study includes thirty (30) patients with torn posterior horn of the medial meniscus with tight medial compartment of the knee.  Results: Both techniques provided good visualization and instrumentation of the PHMM. Pre-operative lyshom score in group A was 50.6 (between 35- 65) while in group B, it was 52 (between 36- 68). Post-operative lyshom score in group A was 85.4 (between 75- 95) while in group B, it was 87 (between 79- 96). On comparing both groups' pre and post operatively according to lyshom score, it was found that, there was no statistical difference between them. Post-operative valgus stress test in complete extension was the same in both groups and was the same comparing was that tested pre operatively. Post-operative valgus stress test in 30 degree flextion was affected more in group A than group B but without statistical significant difference. (P- Value = 0.483). Two patients (13.3%) were affected in group A and no patient (0.0%) was affected in group B. Saphenous nerve injury and hematoma formation were more in group A than group B but without statistical significant difference. Conclusion: In cases with tight knees, the Pie-crusting technique and arthroscopic deep MCL release technique are safe and efficient for visualization of the posterior horn of the medial meniscus. It allows the avoidance of causing iatrogenic chondral damage or fracture of the medial femoral condyle. MCL laxity, saphenous nerve injury and hematoma formation were more in Pie crusting technique without significant statistical difference.