Pie-crusting the medial collateral ligament (MCL)
Pie-crusting may be performed on the medial collateral ligament in order to better visualise the back of the knee cavity on that side. It may allow trimming of the back of the medial meniscus, repair of ramp lesion, repair of meniscal root avulsions and seating of a meniscal allograft.
How is pie-crusting performed?
While observing the back of the medial compartment of the knee through the arthroscope, the surgeon uses a needle to poke holes through the skin into the medial collateral ligament. During this procedure the surgeon will observe how well the back of the knee opens up to visualisation.
Is the MCL damaged during pie-crusting?
Pie-crusting does damage the MCL, but it is equivalent to a sprain and will heal itself in due course.