The pie-crusting technique in knee surgery: Indications, technique, complications and outcomes

Pie-crusting represents a simple and widely utilised technique for controlled medial soft-tissue release across various knee procedures. When applied in a gradual and indication-driven manner, it can improve visualisation, facilitate instrumentation and reduce the risk of iatrogenic cartilage injury without causing clinically significant instability in most cases. However, the role of pie-crusting differs among surgical contexts, including meniscal repair, periarticular osteotomy and knee arthroplasty, and should be tailored to procedure-specific goals rather than applied routinely. Level of Evidence: Level V, expert opinion.