Academic literature on the topic 'Technique chirurgicale de pie-crusting'

AbstractMedial collateral ligament (MCL) pie-crusting technique in total knee arthroplasty (TKA) is one of the methods of medial release. The effects and risks of blade pie-crusting have been reported in previous studies. However, only a few have reported the safety and efficacy of needle pie-crusting. In this cadaveric study, we quantitatively evaluated the amount of gap change by MCL needle pie-crusting. We investigated five knees of four fresh human cadavers and performed posterior-stabilized TKA. Only deep MCL release as the medial release was conducted. We punctured the MCL from the deep layer to the superficial layer using a 18 G needle in a 90-degree flexion position for 0, 10, 20, 50, 75, and 100 times. Medial and lateral gaps were measured accurately with a balancer at determined times in 0 and 90-degree flexion positions. Changes in medial and lateral gaps were not significant differences in flexion and extension position. However, in 90-degree flexion, medial gap changes were tended to be larger than lateral gap changes. A 0.6 mm additional medial release and a 0.2 mm additional lateral release were found per 10 times pie crust in flexion position (100 times, p: 0.08). However, large differences existed among the cases. Needle pie-crusting is safer than blade pie-crusting because of the small efficacy of one-time pie crust. MCL needle pie-crusting showed varied effects for each case. This result indicates the risk of relaxation of an unexpected gap. Caution should be taken when choosing between needle pie-crusting and blade pie-crusting.

AbstractKnee arthroscopy may be called the most commonly and increasingly performed orthopaedic procedure. Posterior medial compartment visualization may be quite challenging. The aim of the present study is to detect objective measurement of medial joint space widening with percutaneous “pie crust” release of medial collateral ligament (MCL) during knee arthroscopy. We used this technique for all knees that require any intervention in the posteromedial compartment and for tight knees in which adequate visualization of the posteromedial compartment cannot be obtained. Eighteen patients (18 knees) were included in this study. Patients were evaluated clinically with the Lysholm and Tegner scores at the final office visit. Joint balance, valgus instability, pain or tenderness on MCL region, and numbness over the medial side of the joint were also noted. Measurements of medial joint space (mm) were obtained at three different times with perioperative C-arm images: normal, controlled valgus force, and after pie crusting. The median follow-up time was 9 (6–12) months. Final follow-up Lysholm (p < 0.05) and Tegner scores (p < 0.05) increased significantly compared with preoperative scores. At the final follow-up, there was no pain or tenderness over MCL and there were no signs of saphenous nerve or vein injury. Medial joint space values in after pie crusting increased significantly (p < 0.05) compared with neutral position measurements and controlled valgus force application (p < 0.05). Controlled release of the MCL in knees provided ∼2.45 times wider visualization place. Furthermore, pie crusting of MCL is a safe and effective technique that provides enough space for visualization and instrumentation in knees. This is a Level IV study.

We present the case of a 23-year-old man who developed abdominal compartment syndrome secondary to severe pancreatitis and required decompressive laparotomy and pancreatic necrosectomy. Despite application of a temporary abdominal closure system (ABThera Open Abdomen Negative Pressure Therapy), extensive retroperitoneal oedema and inflammation continued to contribute to loss of domain and prevented primary closure of the skin and fascia. The usual course of action would have involved reapplication of ABThera system until primary closure could be achieved or sufficient granulation tissue permitted split-thickness skin grafting. Though a safe option for abdominal closure, application of a skin graft would delay return to baseline functional status and require eventual graft excision with abdominal wall reconstruction for this active labourer. Thus, we achieved primary closure of the skin through the novel application of abdominal wall ‘pie-crusting’, or tension-releasing multiple skin incisions, technique.

<p class="abstract"><strong>Background:</strong> Fixed valgus deformity presents a major challenge in total knee arthroplasty (TKA), especially in moderate or severe cases. In knee arthritis, fixed-varus deformity (50 to 55%) is three times more frequent than fixed-valgus deformity (10 to 15%). Valgus deformity occurs more commonly in rheumatoid arthritis and also in osteoarthritis with hypoplasia of the lateral femoral condyle. Valgus deformity is often associated with flexion or external rotation contracture of the knee. In this study we aim to study the surgical outcome of total knee replacement in valgus deformity via standard medial parapatellar approach using various techniques like Pie –Crusting release of lateral structures or combined technique of pie crusting and standard release of lateral structures. Aim: To evaluate surgical outcome of various surgical techniques via standard medial parapatellar approach in fixed valgus deformity in Total Knee Arthroplasty.</p><p class="abstract"><strong>Methods:</strong> The present study involved both male and female patients with osteoarthritis of knee with valgus deformity. In present series, 26 consecutive patients of osteoarthritis with valgus deformity operated with total knee replacement were included. Previously operated cases of high tibial osteotomy and patients having contraindication for TKA were excluded from the study.<strong></strong></p><p class="abstract"><strong>Results:</strong> Valgus angle in this study was between 13 to 27 degree with average 17.84 degree. These results were comparable to many such similar studies. In our study, post operatively, knee society score was average 87.69 and function knee score was 82.5. Mean range of motion was 105 degree. In our study, mean tibiofemoral alignment improved from 17.84 valgus to 4.7 valgus.</p><p class="Default"><strong>Conclusions:</strong> Knee society score is excellent with both techniques and there is no difference in both techniques Iliotibial band and posterolateral capsule are most common structures that require release. Initial ligament balancing should be done with pie crusting and then sequential lateral release if require. </p>

Les pathologies du genou liées au sport sont nombreuses et impliquent, pour partie, la bandelette iliotibiale (ITT). Il s’agit d’un renforcement d’une partie du fascia profond de la cuisse, nommé fascia lata. Le fascia lata est un tissu conjonctif fibreux composé de fibres d’élastine et de réseaux de fibres de collagène présents dans différentes couches de tissu. Il a un rôle stabilisateur de l’articulation et permet le transfert des efforts entre les muscles, mais les propriétés et mécanismes de déformation de ce tissu restent mal connus. Dans ce contexte, les mécanismes de déformation du fascia lata lors de mouvements physiologiques du genou ont été étudiés. Des données quantitatives des champs de déformation du fascia lata ont été obtenues in situ mettant en évidence des mécanismes de déformation en traction, compression et aussi cisaillement. Par conséquent, le comportement mécanique d’échantillons isolés de fascia lata a été analysé avec des essais de cisaillement de type large bande et traction de biais, incluant l'étude de la cinématique des fibres de collagène. Une première contribution à la modélisation en éléments finis du comportement du fascia a également été proposée. Enfin, comme l'état de déformation naturel du fascia lata contribue à une bonne mobilité du genou, une étude in situ a été mise en place pour évaluer l'impact sur les déformations du fascia et mobilités articulaires d'une technique chirurgicale de relâchement des tensions, dite de pie-crusting appliquée à l’ITT et pouvant être recommandée dans des cas pathologiques. L’ensemble du travail réalisé apporte donc de nouveaux éléments dans l'étude du comportement mécanique du fascia lata
There are many sports-related knee injuries, some of which involve the iliotibial band (ITT). This is a thicker part of the deep fascia of the thigh, called fascia lata. The fascia lata is a fibrous connective tissue composed of elastin fibers and networks of collagen fibers present in different layers of tissue. It has a stabilizing role in the joint and allows the transfer of forces between muscles, but its properties and strain mechanisms remain poorly understood. In this context, the strain mechanisms of the fascia lata during physiological knee movements were studied. Quantitative data of fascia lata strain fields were obtained in situ highlighting strain mechanisms in tension, compression, and shear. Therefore, the mechanical behavior of isolated fascia lata samples was analyzed with shear tests such as bias extension tests and traction of a large band tissue. The study of collagen fiber kinematics was also included. A first contribution to the finite element modelling of fascia behavior was also proposed. Finally, as the natural state of deformation of the fascia lata contributes to good knee mobility, an in situ study was set up to evaluate the impact on joint mobility and strain levels on fascia of a surgical tension-release technique, known as pie-crusting, applied to the ITT and which may be recommended in pathological cases. All the work carried out therefore provides new elements in the study of the mechanical behavior of fascia lata