ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2016
The pie-crusting technique using a blade knife for medial collateral ligament release is unreliable in varus total knee arthroplasty.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 51 citations in OpenAlex.
- Comparison of Outcomes After Total Knee Arthroplasty Involving Postoperative Neutral or Residual Mild Varus Alignment: A Systematic Review and Meta-analysis.Orthopaedic surgery · 2022Pooled it
- The pie-crusting technique in knee surgery: Indications, technique, complications and outcomes.Journal of experimental orthopaedics · 2026Review
- Robotic-assisted bone cuts guided by intraoperative load sensors for ligament balancing in restricted kinematic alignment total knee arthroplasty: A retrospective study with 2-year follow-up.Journal of experimental orthopaedics · 2026Article
- Unrestricted Kinematic Alignment Is a Feasible Strategy for Lateral Compartment Osteoarthritis: Short-Term Outcomes of a Contralateral Knee-Referenced Approach.Journal of clinical medicine · 2026Article
- Feasibility and reliability of shear wave elastography-guided collateral ligament balancing during total knee arthroplasty : an ex vivo study on porcine knees.Bone & joint research · 2025Article
- A new parameter in the era of robotic total knee arthroplasty: Coronal alignment at 90° of flexion impacts clinical outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- A novel grid-assisted pie-crusting technique for achieving soft tissue balance in total knee arthroplasty.Frontiers in surgery · 2025Article
- Complete Release of the Superficial Medial Collateral Ligament in Total Knee Arthroplasty.Arthroplasty today · 2024Article
- Precision soft tissue balancing: grid-assisted pie-crusting in total knee arthroplasty.Frontiers in surgery · 2024Article
- Using sequential bone cutting to titrate soft tissue balance in total knee arthroplasty effectively minimizes soft tissue release.BMC musculoskeletal disorders · 2023Article
- Risk Factors and Preventive Strategies for Perioperative Distal Femoral Fracture in Patients Undergoing Total Knee Arthroplasty.Medicina (Kaunas, Lithuania) · 2023Article
- Pie-Crusting Technique of Medial Collateral Ligament for Total Knee Arthroplasty in Varus Deformity: A Systematic Review.Advanced biomedical research · 2023Review
- Intraoperative repair for iatrogenic MCL tear due to medial pie-crusting in TKA yields satisfactory mid-term outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Article
- [Prevention and treatment of iatrogenic medial collateral ligament injuries in total knee arthroplasty].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2021Article
- Recognizing the Role of the Posterolateral Corner in Patients Undergoing Total Knee Arthroplasty for Fixed Varus Deformity.Orthopedic research and reviews · 2021Article
- Selective medial release using multiple needle puncturing with a spacer block in situ for correcting severe varus deformity during total knee arthroplasty.Archives of orthopaedic and trauma surgery · 2020Article
- A geometric ratio to predict the flexion gap in total knee arthroplasty.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2020Article
- Arthroscopic pie-crusting release of the posteromedial complex of the knee for surgical treatment of medial meniscus injury.BMC musculoskeletal disorders · 2020Article
- Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- Bone resection for mechanically aligned total knee arthroplasty creates frequent gap modifications and imbalances.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeDespite the documented clinical efficacy of the pie-crusting technique for medial collateral ligament (MCL) release in varus total knee arthroplasty, its quantitative effects on medial gaps and safety remain unclear. This study was undertaken to determine the efficacy (quantitative effect and consistency of the number of punctures) and the safety (frequency of early over-release) of the pie-crusting technique for MCL release.
methodsFrom ten pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo pie crusting in extension (group E) or in flexion (group F). Pie crusting was performed in the superficial MCL using a blade until over-release occurred. After every puncture, the incremental medial gap increase was recorded, and the number of punctures required for 2- or 4-mm gap increases was assessed.
resultsIn group E, the extension gap increased from 0.8 to 5.0 mm and the flexion gap increased from 0.8 to 3.0 mm. In group F, the extension gap increased from 1.0 to 3.0 mm and the flexion gap increased from 2.6 to 6.0 mm. However, the gap increments were inconsistent with those that followed the preceding blade punctures, and the number of punctures required to increase the gaps by 2 or 4 mm was variable. The number of punctures leading to over-release in group E and group F was 6 ± 1 and 3 ± 1 punctures, respectively. Overall, 70% of over-release occurred earlier than the average number of punctures leading to over-release.
conclusionsPie crusting led to unpredictable gap increments and to frequent early over-release. Surgeons should decide carefully before using the pie-crusting technique for MCL release and should be cautious of performing throughout the procedure, especially when performing in a flexed knee. LEVEL OF EVIDENCE: Therapeutic study, Level I.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.