Primary Repair of Intraoperative Medial Collateral Ligament Tear during Medial Pie-Crusting Technique in Total Knee Arthroplasty with Varus Deformity

In total knee arthroplasty (TKA), the optimum kinematic and functional outcomes are achieved by restoring the balance between the medial and lateral compartment. In case of encountering varus alignment, the medial collateral ligament (MCL) and medial soft tissue release are often required to obtain the balance (1). Using the pie-crusting technique for MCL release for varus deformity correction during TKA has gained popularity among some surgeons recently (2-4). However, algorithmic medial pie-crusting technique has not become widespread achieving balanced medial and lateral soft tissue during TKA due to the risk of technique induced mid-substance superficial medial collateral ligament (sMCL) tear. Moreover, progressive mechanical weakening of the MCL can result in knee instability (5, 6). However, there is no clinical data available to validate the safety of this technique.