Abstract
BACKGROUND: This study aims to conduct a systematic review and meta-analysis of the existing literature concerning the percutaneous medial collateral ligament release technique, assessing its effectiveness during medial meniscal arthroscopy, with a particular focus on clinical outcomes and radiological impacts. METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing a PRISMA checklist. A comprehensive electronic search was conducted using PubMed, EMBASE, and Cochrane Library databases to identify studies involving percutaneous medial collateral ligament release during arthroscopic knee surgery with reported postoperative outcomes. Only articles published in English or Chinese were included, while studies related to total knee arthroplasty, cadaveric specimens and concomitant knee injuries were excluded. Literature screening, data extraction, and risk of bias assessments were meticulously executed by two independent authors to ensure the robustness and reliability of the findings. The outcome measures were the Lysholm Score, the IKDC Score, and joint space width. RESULTS: Among the 180 studies initially identified, 13 studies met the predetermined inclusion criteria and were subsequently incorporated into this systematic review and meta-analysis. The pie-crusting group exhibited significantly higher Lysholm and IKDC scores at 24 months compared to non-pie-crusting controls (p = 0.001 and p = 0.0006, respectively). Additionally, there was no statistically significant difference in joint space width observed between the preoperative measurements and those collected at the 24-month follow-up (p = 0.73). No complications or adverse effects associated with the pie-crusting procedure were reported. CONCLUSION: This systematic review and meta-analysis provide compelling evidence for the clinical effectiveness of percutaneous medial collateral ligament release during arthroscopic meniscal surgery for patients with a narrow medial joint space. The pie-crusting technique enhances surgical visualization and improves postoperative clinical outcomes, all while maintaining a favorable safety profile with no increase in the risk of complications or joint instability. These findings collectively underscore the safety and efficacy of the pie-crusting technique as an adjunctive procedure in medial meniscal arthroscopy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-025-09338-9.