The Outside-In, Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy

The outside-in, percutaneous release of the medial collateral ligament (MCL) is a technique used to increase the medial tibiofemoral joint space during arthroscopy to facilitate the use of instrumentation and improve visualization without causing iatrogenic cartilage damage. A recent systematic review of the literature has shown this technique to be efficacious and safe, with no evidence of associated short- or long-term complications. This technique has been used for this indication by the senior author without requiring any deviation from our institution’s standard protocol for knee arthroscopy. In an attempt to standardize this technique’s utilization and allow for further evaluation in the literature, the senior author’s method for this percutaneous, outside-in approach of “pie crusting” the MCL is described.