Variability in Elongation and Failure of the Medial Collateral Ligament After Pie-Crusting With 16- and 18-Gauge Needles

Needle size was not the influencing factor. Variability in number of punctures, regardless of needle size, to elongate or fail the MCL shows the difficulty in developing a reproducible pie-crusting technique. This suggests that a standard number of punctures do not achieve controlled MCL lengthening for all patients, but that the number of punctures needed can be calculated for an individual knee based on the initial elongation after 10 punctures.