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Navarro-Cano E, Carrera A, Konschake M, Guevara-Noriega KA, Reina F. Percutaneous hallux valgus surgery: Anatomical study of its safety and effectiveness. Orthop Traumatol Surg Res 2023; 109:103266. [PMID: 35257947 DOI: 10.1016/j.otsr.2022.103266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 07/13/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although percutaneous hallux valgus surgery is increasing in popularity, concerns about safety regarding neurovascular and tendinous structures remain. The first aim of this body-donor study was to evaluate the safety of three common percutaneous portals. Secondly, to evaluate percutaneous surgery effectiveness in completing adductor tendon release and first ray osteotomies. PATIENTS AND METHODS Twenty body-donor feet were included and underwent three percutaneous procedures, which are commonly performed in combination: distal metatarsal osteotomy, proximal phalanx osteotomy and adductor tendon release. After surgery, the distance between surgical portals and relevant neurovascular structures was measured. Damage to this neurovascular structures, tendons or articular cartilage was noted. Completion of adductor tendon release and osteotomies was verified. RESULTS The medial dorsal digital nerve of the hallux was damaged in two specimens. Mild peritendon damage was observed in two feet. The rest of neurovascular and tendinous structures were intact. No cartilage damage was observed. The distance between the adductor tenotomy portal and the lateral dorsal digital nerve of the hallux and the first dorsal metatarsal artery was 3.3mm (SD 1.4) and 2.4mm (SD 1.8), respectively. Complete adductor tenotomy was achieved in 14 feet. CONCLUSIONS The structure with the highest risk of damage during percutaneous hallux valgus surgery is the medial dorsal digital nerve. The lateral dorsal digital nerve and the first dorsal metatarsal artery might be at risk due to the small distance to the adductor tendon release portal. A deep anatomical knowledge and a meticulous surgical technique are required to avoid lesions to neurovascular and tendinous structures. LEVEL OF EVIDENCE V, Cadaveric study.
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Affiliation(s)
- Ester Navarro-Cano
- Orthopaedic Surgery Department, Sant Celoni Hospital, Sant Celoni, Spain; Department of Medical Sciences, Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Faculty of Medicine, University of Girona, 77 Emili Grahit St, 17003, Girona, Spain.
| | - Ana Carrera
- Department of Medical Sciences, Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Faculty of Medicine, University of Girona, 77 Emili Grahit St, 17003, Girona, Spain
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Francisco Reina
- Department of Medical Sciences, Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Faculty of Medicine, University of Girona, 77 Emili Grahit St, 17003, Girona, Spain
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Del Vecchio JJ, Cordier G, Dealbera ED, Slullitel G, Lopez V, Manzanares-Céspedes MC, Dalmau-Pastor M. Correction Power of Percutaneous Adductor Tendon Release (PATR) for the Treatment of Hallux Valgus: A Cadaveric Study. J Foot Ankle Surg 2021; 60:1103-1109. [PMID: 34039513 DOI: 10.1053/j.jfas.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 01/19/2021] [Accepted: 02/21/2021] [Indexed: 02/03/2023]
Abstract
Osteotomies are commonly used in order to correct hallux valgus deformity. However, soft tissue structures also play an essential role in the etiology, progression, and treatment of hallux valgus (HV). The purpose of the present study was to analyze the correcting power (varus), reduction strength (sesamoid) and rotation of metatarsal and proximal phalanx after percutaneous adductor tendon release (PATR). To date, no study addresses this issue. Eleven cadaveric fresh-frozen below-the-knee cadaveric lower limbs with associated hallux valgus deformity were used. These specimens were subjected to a constant abduction force after PATR. HV and intermetatarsal angles showed statistically significant differences when comparing the preoperative and postoperative periods. PATR showed to be a reliable technique as the adductor tendon was completely released in 9 cases, and 75% released in the remaining 2 feet. The study supports that PATR provides powerful and quantifiable correction of HV deformity and can be accurately performed percutaneously.
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Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro-Hospital Universitario-Solis 461, Ciudad Autónoma de Buenos Aires (CABA), Argentine; Department of Kinesiology and Physiatry, Universidad Favaloro, CABA, Argentina; Minimally Invasive Foot and Ankle Society (MIFAS by Grecmip), Merignac, France.
| | - Guillaume Cordier
- Minimally Invasive Foot and Ankle Society (MIFAS by Grecmip), Merignac, France; Clinique du Sport Bordeaux-Mérignac, Institut du Sport, Merignac, France
| | - Eric Daniel Dealbera
- Foot and Ankle Surgery and Limb Salvage Fellowship, Foot and Ankle Section, Fundación Favaloro-Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Buenos Aires, Argentina
| | - Gastón Slullitel
- Department of Foot and Ankle Surgery, Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
| | - Valeria Lopez
- Department of Foot and Ankle Surgery, Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
| | - Maria Cristina Manzanares-Céspedes
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miki Dalmau-Pastor
- Minimally Invasive Foot and Ankle Society (MIFAS by Grecmip), Merignac, France; Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Abstract
In the last decade, minimally invasive or percutaneous surgery has evolved rapidly through the development of novel techniques. Treatment of hallux valgus deformity is one of the indications for percutaneous surgery, both for bony and soft tissue correction. The release of the structures on the lateral part of the first metatarsophalangeal joint (lateral release) is one of the best indications for percutaneous surgery in the forefoot. In this article, a detailed description of the anatomy of the metatarsophalangeal joint is provided, along with the indications and tips to perform a safe percutaneous lateral release.
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Affiliation(s)
- Jorge Javier Del Vecchio
- GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France; Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro -Hospital Universitario, Solis 461, Ciudad Autónoma de Buenos Aires (CABA) CP 1078, Argentine; Department of Kinesiology and Physiatry, Universidad Favaloro, Av. Entre Ríos 495, CABA CP 1079, Argentina
| | - Miki Dalmau-Pastor
- GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France; Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona. C/ Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Office 5304, Barcelona, Spain.
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Dalmau-Pastor M, Malagelada F, Cordier G, Del Vecchio JJ, Ghioldi ME, Vega J. Anatomical Study of Minimally Invasive Lateral Release Techniques for Hallux Valgus Treatment. Foot Ankle Int 2020; 41:984-992. [PMID: 32456480 DOI: 10.1177/1071100720920863] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral release (LR) for the treatment of hallux valgus is a routinely performed technique, either by means of open or minimally invasive (MI) surgery. Despite this, there is no available evidence of the efficacy and safety of MI lateral release. Our aim was to study 2 popular techniques for MI LR in cadavers by subsequently dissecting the released anatomical structures. METHODS Twenty-two cadaveric feet were included in the study and allocated into 2 groups, 1 for each procedure: 1 group underwent a MI adductor tendon release (AR), and in the other group, an extensive percutaneous lateral release (EPLR) (adductor tendon, suspensory ligament, phalanx-sesamoid ligament, lateral head of flexor hallucis brevis, and deep transverse metatarsal ligament) was performed. Anatomical dissection was performed to identify neurovascular injuries and to verify the released structures. RESULTS Both techniques demonstrated to be effective in reproducing a MI LR. A satisfactory release of the adductor tendon was achieved equally in both techniques (P = .85), being partial in most EPLR cases and full in the majority of AR cases. The EPLR was successful in releasing the intended additional structures (P < .05). One case of inadvertent complete section of the flexor hallucis longus was identified in the percutaneous adductor tendon release group. No cases of dorsolateral nerve injury were seen with either of the techniques. CONCLUSION Percutaneous lateral release was a reliable and accurate technique in this cadaveric model. The MI AR proved to be more effective in fully releasing the adductor tendon while the ER was intended and able to release a number of other structures. CLINICAL RELEVANCE MI LR is a safe procedure that could obviate the need for open surgery to achieve the same surgical goal. It can be associated to either open or MI osteotomies in the correction of hallux valgus.
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Affiliation(s)
- Miki Dalmau-Pastor
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Francesc Malagelada
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.,Department of Trauma and Orthopedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Guillaume Cordier
- GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.,Orthopaedic Department, Mérignac Sports Clinic, Mérignac, France
| | - Jorge Javier Del Vecchio
- GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.,Head Foot and Ankle Section, Orthopaedics Department, Hospital Universitario-Fundación Favaloro, Solis 461, Buenos Aires, Argentina.,Department of Kinesiology and Physiatry, Universidad Favaloro, Buenos Aires, Argentina
| | | | - Jordi Vega
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.,Foot and Ankle Unit, iMove Tres Torres, Barcelona, Spain
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