Multiple Needle Puncture Of Pie-crusting Technique Releasing Medial Collateral Ligament In TKA Surgery

Objective1 For the using of pie-crusting technique TKA cases, different inner tension often require different puncture times, analysis the relationship among the inside and outside of the knee gaps, KSS score and puncture times. To avoid little puncture times lead to incomplete release and much times lead to over release, we expect to give the theory basis of how to use MCL pie-crusting technique in TKA surgery.2 For the cases used MCL pie-crusting technique, to evaluate the surgical effect, we analysis the difference of KSS score and knee mobility between post-operative and pre-operative.3 To analysis the influence of MCL pie-crusting technique of TKA surgery, we give a comparation of KSS score and knee mobility between the TKA cases which used MCL pie-crusting technique and the TKA cases not used this technique.MethodsThe TKA were selected from June 1st,2013 and August 15th of,2014, and patients were divived into control group (n=32) and study group (n=29) according to whether the MCL pie-crusting technique was used. ① In study group, we give a correlation analysis among the flexion and extension of the knee gaps, KSS score and puncture times. ② Analysis the difference of KSS score and knee mobility between post-operative and pre-operative.③ Analysis the difference of KSS score and knee mobility of post-operative between two groups.Results① There is positive correlation relationship between flexion and extension of the knee gaps and puncture times (flexion:P=0.000<0.05, correlation coefficient=0.64; extension:P=0.004<0.05, correlation coefficient=0.51), but there is significant negative relationship between KSS score and puncture times (P=0.000<0.05, correlation coefficient=-0.72). ② All the cases got a Soft tissue balance, with the three months of follow-up after surgery, KSS score increased from 43.2±8.4 to 70.8±6.9, and the knee mobility increased 80.5°8.1°rom to 113.8°±8.0°.③ There is no difference both on the KSS score and knee mobility between two groups (KSS score: study group 70.8±6.9 control group 73.8±6.0, P=0.11>0.05; Knee mobility:study group 113.8°±8.0° control group 109.7±°9.3°, P=0.07>0.05).Conclusions① The use of number 9 needle to puncture the MCL could releasing it significantly, all the cases of study group got a good Soft tissue balance, and there is no over releasing and MCL tearing cases, with the three months of follow-up after surgery, no case got a knee instability; ② MCL contracture extent determine the tension of the medial gap, it also decide how many puncture times could get a good Soft tissue balance. According to our study, there is positive correlation relationship between flexion and extension of the knee gaps and puncture times, but there is significant negative relationship between KSS score and puncture times;③ With the 3 months of follow-up, compared with pre-operation, the knee joint function were obviously improved in the study group. The study also showed us that the MCL pie-crusting technique will not affect the curative effect of TKA surgery and the improvement of patients’life quality; ④ With the 3 months of follow-up, we found that there is no significant difference both on the KSS score and knee mobility between two groups, it means that MCL pie-crusting technique will not affect the curative effect of TKA surgery. To get the soft tissue balance, MCL pie-crusting technique could extension MCL gradually by gaining puncture times, especially for the seriously interior tension (interior gaps was little more than 3mm than lateral). The proficiency use of MCL pie-crusting technique could balance soft tissue safety and effective, and get a satisfactory clinical results eventually.