1
|
Shah M, Stirling B, Jackson JB, Gonzalez T. Utilization of the Modified Lapidus Procedure for Correction of Moderate to Severe Hallux Valgus Deformity With Increased Distal Metatarsal Articular Angle. Foot Ankle Spec 2024; 17:352-357. [PMID: 35608239 DOI: 10.1177/19386400221093859] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hallux valgus, a common deformity treated by orthopaedic foot and ankle surgeons, can frequently present with an increased distal metatarsal articular angle (DMAA), which may require correction in addition to the hallux valgus deformity. Thus, we investigated the efficacy of the modified Lapidus procedure, a triplanar correction, in correcting the DMAA in hallux valgus surgery. METHODS A retrospective chart review was performed on patients who underwent the hallux valgus reconstruction with a modified Lapidus procedure between April 26, 2018, and November 19, 2020. Exclusion criteria included patients with inadequate follow-up. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and DMAA were measured on preoperative weight-bearing, 2-week postoperative non-weight-bearing, and at final follow-up weight-bearing radiographs. RESULTS The study included a total of 99 cases of modified Lapidus procedure for hallux valgus on 85 subjects. On radiologic assessment, the average DMAA decreased from 17.72 ± 6.18 degrees preoperatively to 9.19 ± 5.19 degrees 2 weeks postoperatively (P < .0001) and 9.79 ± 4.62 degrees at the final follow-up (P < .0001). The average HVA decreased from 31.34 ± 10.39 degrees preoperatively to 13.34 ± 6.16 degrees 2 weeks postoperatively (P < .0001) and 15.05 ± 7.43 degrees at final follow-up (P < .0001). Last, the IMA decreased from 14.99 ± 3.82 degrees preoperatively (P < .0001) to 4.66 ± 2.59 degrees 2 weeks postoperatively and 6.62 ± 3.46 degrees at final follow-up (P < .0001). The recurrence rate was 3.03%. CONCLUSION The modified Lapidus procedure is an effective procedure in correcting the HVA, IMA, and DMAA in hallux valgus surgery without the need for additional distal or proximal metatarsal osteotomies. Surgeons should consider this technique in patients with moderate to severe hallux valgus deformity who may require correction of their DMAA. LEVEL OF EVIDENCE Level IV-Retrospective comparative study.
Collapse
Affiliation(s)
- Milaan Shah
- Department of Orthopaedics, Prisma Health/University of South Carolina School of Medicine, Columbia, South Carolina
| | - Brianna Stirling
- Department of Orthopaedics, Prisma Health/University of South Carolina School of Medicine, Columbia, South Carolina
| | - J Benjamin Jackson
- Department of Orthopaedics, Prisma Health/University of South Carolina School of Medicine, Columbia, South Carolina
| | - Tyler Gonzalez
- Department of Orthopaedics, Prisma Health/University of South Carolina School of Medicine, Columbia, South Carolina
| |
Collapse
|
2
|
Sanchís-Soria V, Nieto-González E, Nieto-García E, Fernández-Ehrling N, Ferrer-Torregrosa J, Lorca-Gutiérrez R. Radiological and functional outcomes of Reverdin Isham osteotomy in moderate Hallux Valgus: a systematic review and meta-analysis. Sci Rep 2024; 14:14781. [PMID: 38926591 PMCID: PMC11208448 DOI: 10.1038/s41598-024-65440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
This systematic review and meta-analysis addresses the effects of minimally invasive surgical techniques, specifically the Reverdin Isham osteotomy, on functional and radiological outcomes in patients with moderate Hallux Valgus, a common foot deformity. The review included randomized and non-randomized controlled trials, as well as case reports, assessing the osteotomy in adults with moderate to severe Hallux Valgus. Searches were conducted in electronic databases such as MEDLINE and Web of Science up until July 2023, and the Joanna Briggs Institute's critical appraisal tool was used to assess the risk of bias. Meta-analytical analyses employed a random-effects model with small-sample correction, presenting results as standardized mean differences and mean differences with 95% confidence intervals. Seven studies involving 554 patients and 643 operated feet were included, showing significant improvements in AOFAS scores (an average improvement of 36 points from 28.61 to 45.16) and reductions in radiological angles such as the distal metatarsal angle and hallux valgus angle post-surgery (IMA improved by - 3.07° from - 4.68 to - 1.46, DMAA by - 6.12° from - 9.52 to - 2.71, and HVangle by - 15.27° from - 17.98 to - 12.57). Despite these positive outcomes, most studies exhibited risks of bias and other methodological limitations, impacting the generalizability of the results. Overall, the findings highlight the efficacy of the Reverdin Isham osteotomy in improving both functional and radiological parameters in patients with moderate Hallux Valgus, although further research is warranted to solidify these results. No specific funding was received for this study, and the protocol was registered on PROSPERO with the number CRD-42023445886.
Collapse
Affiliation(s)
- Victoria Sanchís-Soria
- Doctorate School, Catholic University of Valencia San Vicente Mártir, 46001, Valencia, Spain
| | - Elena Nieto-González
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain
| | - Eduardo Nieto-García
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain
| | - Nadia Fernández-Ehrling
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain
| | - Javier Ferrer-Torregrosa
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain.
| | - Rubén Lorca-Gutiérrez
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain
| |
Collapse
|
3
|
Del Vecchio JJ, Dealbera ED, Chemes LN, Slullitel G, Calvi JP, Dalmau-Pastor M. A Radiologic Triangle Sign for Percutaneous Adductor Tendon Release (PATR): Cadaveric Study and Case Series. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241269. [PMID: 38559393 PMCID: PMC10981861 DOI: 10.1177/24730114241241269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background Combining osteotomies and soft tissue procedures is believed to reduce sesamoids in their anatomical position and maintain long-term correction when treating hallux valgus deformity. This study determines if a radiologic association exists between a radiolucent sign and a full percutaneous adductor tendon release (PATR), including a cadaveric study and a consecutive case series. Another aim was to determine the intra- and interobserver reliability of these observations. Methods A prospective observational study was made between 2018 and 2019. First, a PATR was done on cadaveric specimens and, after the procedures, dissected to correlate what was seen fluoroscopically. The clinical group included 39 feet that presented mild-to-moderate HV deformity and were treated with percutaneous osteotomies associated with PATR. Results Observers 1 and 2 saw a radioscopic radiolucent sign in 100% of cadavers and the patient population. They also observed a triangle-shaped image with an incidence of 75%, which we have named the "triangle sign." Conclusion The triangle sign may be helpful in the intraoperative confirmation of PATR and latero-plantar capsule release using this percutaneous technique. Level of Evidence Level II, development of diagnostic criteria.
Collapse
Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro–Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentina
- Department of Kinesiology and Physiatry, Universidad Favaloro, CABA, Argentina
- MIFAS (Minimally Invasive Foot and Ankle Society) by GRECMIP, Merignac, France
| | - Eric Daniel Dealbera
- Foot and Ankle Section, Fundación Favaloro–Hospital Universitario, Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | - Lucas Nicolás Chemes
- Foot and Ankle Section, Fundación Favaloro–Hospital Universitario, Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | - Gastón Slullitel
- Department of Foot and Ankle Surgery, Institute of Orthopedics “Dr. Jaime Slullitel,” Santa Fe, Argentine
| | - Juan Pablo Calvi
- Department of Foot and Ankle Surgery, Institute of Orthopedics “Dr. Jaime Slullitel,” Santa Fe, Argentine
| | - Miki Dalmau-Pastor
- MIFAS (Minimally Invasive Foot and Ankle Society) by GRECMIP, Merignac, France
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
4
|
Harrasser N, Toepfer A. [Minimally invasive forefoot surgery: concept and techniques]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:69-81. [PMID: 36547727 DOI: 10.1007/s00132-022-04334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Minimally invasive surgery (MIS) has advanced to an established approach in the correction of all deformities of the forefoot. For the first ray the minimally invasive chevron and Akin osteotomy (MICA) shows very good clinical results and provides a broad spectrum of indications in comparison to the classical chevron osteotomy. The minimally invasive treatment of hallux rigidus also seems to achieve comparable results to the open techniques, although the surgical indications must be thoroughly evaluated. Lesser toe deformities are often easier to treat with minimally invasive osteotomy, capsule release and tendon lengthening than with complex open procedures and usually do not require any internal fixation material. Compared to the classical Weil osteotomy, distal metatarsal osteotomy shows a reduced rate of cock-up deformities and does not require internal fixation. In relation to open procedures, minimally invasive approaches should be accepted as a valuable addition and alternative to the classical open techniques due to the reduced rate of wound healing disorders and postoperative pain.
Collapse
Affiliation(s)
- N Harrasser
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. .,ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland.
| | - A Toepfer
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St. Gallen, Rohrschacher Str. 95, 9007, St. Gallen, Schweiz
| |
Collapse
|
5
|
Castellini JLA, Grande Ratti MF, Gonzalez DL. Clinical and Radiographic Outcomes of Percutaneous Third-Generation Double First Metatarsal Osteotomy Combined With Closing-Wedge Proximal Phalangeal Osteotomy for Moderate and Severe Hallux Valgus. Foot Ankle Int 2022; 43:1438-1449. [PMID: 36036667 DOI: 10.1177/10711007221118568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment for severe hallux valgus deformity presents a challenge with high risk of complications. Third generation MIS techniques have increased their publications in recent years. The aim was to compare clinical and radiologic outcomes in moderate and severe cases and report minor and major complications. METHODS Retrospective series of cases with prospective data collection of 156 consecutive feet that underwent percutaneous double first metatarsal osteotomy (PEDO) and first phalanx osteotomy between 2008 and 2019 for moderate (hallux valgus angle [HVA] between ≥20 and <40 degrees and/or intermetatarsal angle [IMA] <16 degrees) and severe (HVA ≥40 degrees and/or IMA ≥16 degrees) hallux valgus deformities. Primary outcomes included radiographic and clinical parameters. Secondary outcomes included minor and major complications. RESULTS A total of 156 procedures were performed in 128 patients. Mean age was 54.3 years (SD 14.3) (range, 19-82 years), median follow-up was 22.6 months (range, 12-96 months). Radiographic changes pre- to postoperation were as follows: HVA changed from 38.2 (SD 10.1) degrees to 11.2 (SD 8.3) degrees (P < .001), IMA from 14.7 (SD 3.2) degrees to 7.9 (SD 3.7) degrees (P < .001), and distal articular metatarsal angle from 19.7 (SD 6.3) degrees to 8.8 (SD 5.7) degrees (P < .001) after PEDO technique. Clinical changes pre- to postoperation were as follows: American Orthopaedic Foot & Ankle Society ankle-hindfoot scale scores improved from 47.3 (SD 16.5) to 87 (SD 11.6) (P < .001) and visual analog scale scores from 5 (2.7) to 0.9 (1.3) (P < .001). The satisfaction rate was 97% in the total sample. Recurrence rate (HVA ≥20 degrees) was 7.7%. Hallux varus (HVA <0 degrees) occurred in 5.8%, acute osteomyelitis in 1.3%, partial avascular necrosis in 0.6%, screw removal in 0.6%, and reoperation in 1.9%. No nonunion was observed. CONCLUSION Clinical and radiographic parameters improved significantly, with a minimum of 12 months of follow-up in moderate and severe hallux valgus. Long experience in percutaneous surgery and specific instruments are needed for this technique. Recurrence was linked to preoperative HVA ≥40 degrees and postoperative tibial sesamoid position; Hallux varus was linked to lateral soft tissue release. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
| | | | - Diego Leandro Gonzalez
- Department of Trauma and Orthopaedic Surgery, Hospital Interzonal General de Agudos, Buenos Aires, Argentina
| |
Collapse
|
6
|
de Carvalho KAM, Baptista AD, de Cesar Netto C, Johnson AH, Dalmau-Pastor M. Minimally Invasive Chevron-Akin for Correction of Moderate and Severe Hallux Valgus Deformities: Clinical and Radiologic Outcomes With a Minimum 2-Year Follow-up. Foot Ankle Int 2022; 43:1317-1330. [PMID: 36000192 DOI: 10.1177/10711007221114123] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The minimally invasive chevron-Akin (MICA) technique has already demonstrated efficacy compared with other known surgical treatments for mild to moderate hallux valgus (HV). MICA combines percutaneous osteotomies with the benefits of modern, rigid internal fixation. The aim of study was to evaluate the radiographic parameters, clinical improvement, and potential complications in moderate to severe HV cases, operated using the MICA technique. METHODS Retrospective study including 70 feet with HV operated using the MICA technique. The AOFAS hallux MTP-IP score and radiographics for HV evaluation were applied preoperatively, and after 6 months, 1 year, and 2 years of follow-up. The following radiographic parameters were measured: metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), interphalangeal angle (IPA), and intermetatarsal angle (IMA). RESULTS The average preoperative VAS pain score was 8.2 ± 1.5, which improved to 1.2 ± 2.2 at 24 months. The mean preoperative IMA was 14.8 ± 3.6 degrees compared with a mean of 7.5 ± 2.1 degrees (P < .01) at 24 months. The preoperative HVA value averaged 30.4 ± 9.8 degrees and at 6 months postoperatively 11.1 ± 6.8 degrees (P < .01), which remained stable until measured at 24 months. The mean preoperative DMAA was 16.3 ± 8.6 degrees and at the 6-month follow-up was 7.8 ± 5.4 degrees (P < .01). The mean preoperative IPA was 7.63 ± 4.4 degrees compared with a mean of 6.28 ± 3.5 degrees (P > .05) at 24 months. Complications included painful hardware (14.28%), neuropathic pain (2.85%), and loss of correction (4.28%). CONCLUSION In this retrospective review from a single center, we found the MICA technique to be an effective procedure for correcting moderate to severe HV, with a low rate of recurrence and an acceptable rate of complications. Patients undergoing the surgical procedure in our series showed a significant reduction in radiographic parameters and a significant improvement in clinical scores, maintaining these results over time. LEVEL OF EVIDENCE Level IV, retrospective study.
Collapse
Affiliation(s)
- Kepler Alencar Mendes de Carvalho
- Carver College of Medicine, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Nossa Senhora do Pari Beneficent Association, São Paulo, SP, Brazil
| | | | - Cesar de Cesar Netto
- Carver College of Medicine, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Anne H Johnson
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Miki Dalmau-Pastor
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,MIFAS By GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| |
Collapse
|
7
|
Choi JY, Suh JS, Cho JH, Park SJ. Outcome of proximal triple derotational metatarsal osteotomy for three-dimensional correction of hallux valgus deformity. INTERNATIONAL ORTHOPAEDICS 2021; 45:3101-3110. [PMID: 34379159 DOI: 10.1007/s00264-021-05170-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To correct hallux valgus deformities in patients with a greater pronation of the first metatarsal, we designed a novel proximal triple derotational metatarsal osteotomy (PTDMO), which could be used to achieve three-dimensional correction of hallux valgus deformities at the proximal metatarsal level. METHODS We prospectively evaluated the radiographic and clinical outcomes of 13 consecutive cases underwent PTDMO between November 2018 and May 2020. The minimum follow-up for inclusion was 12 months. The hallux valgus angle (HVA), first-to-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), relative length of the second metatarsal, and medial sesamoid position on the weight bearing foot anteroposterior radiographs, and the degree of the first metatarsal pronation on forefoot axial radiographs were measured pre-operatively, at six weeks post-operatively, and at the final follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot Ankle Outcome Scores (FAOS) were measured. RESULTS In the comparison of pre-operative and final follow-up parameters, HVA, IMA, and DMAA were significantly improved post-operatively (all, P < 0.001). The relative length of the second metatarsal did not differ significantly post-operatively (P = 0.724). The medial sesamoid was significantly reduced (P = 0.01), and the first metatarsal pronation decreased by 10.16° (P = 0.034). Regarding clinical parameters, the AOFAS score and FAOS in all categories significantly improved post-operatively (all, P < 0.001). CONCLUSION PTDMO resulted in satisfactory radiographic and clinical outcomes with respect to deformity correction and pain relief, with significant post-operative reduced pronation of the first metatarsal.
Collapse
Affiliation(s)
- Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Ho Cho
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Seung Jun Park
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea
| |
Collapse
|
8
|
Del Vecchio JJ, Dalmau-Pastor M. Percutaneous Lateral Release in Hallux Valgus: Anatomic Basis and Indications. Foot Ankle Clin 2020; 25:373-383. [PMID: 32736735 DOI: 10.1016/j.fcl.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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.
Collapse
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.
| |
Collapse
|
9
|
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] [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.
Collapse
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
| |
Collapse
|
10
|
Del Vecchio JJ, Ghioldi ME, Uzair AE, Chemes LN, Manzanares-Céspedes MC, Dealbera ED, Dalmau-Pastor M. Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study. Foot Ankle Int 2019; 40:586-595. [PMID: 30688531 DOI: 10.1177/1071100718820696] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Percutaneous surgery is experiencing sustained growth based on third-generation techniques. This cadaveric study was designed with the main goal of exploring the risk of iatrogenic tendon and neurovascular lesions and defining the safe zones in a percutaneous, intra-articular, chevron osteotomy (PeICO) procedure, as well as assessing the accuracy of the osteotomy itself. METHODS Eight feet from below-knee fresh-frozen specimens were selected. After the procedure, the specimens were dissected, and structures were inspected for damage. RESULTS The results of the safety measurements were as follows: (1) distance between portal 1 (P1) and the lateral border of the extensor hallucis longus (EHL) tendon: average 17.6 mm (range 12.7-21.3); (2) distance between P1 and the dorsomedial digital nerve (DMDN): average 7.2 mm (range 1.6-10.4); (3) distance between P1 and the metatarsophalangeal joint: average 15.7 mm (range 9.4-20.5); distance between portal 2 (P2), or the osteosynthesis portal, and the metatarsophalangeal joint: average 25.5 mm (range 22-30.4); distance between P2 and the lateral border of the EHL tendon: average 12.7 mm (range 8-16.7); and distance between P2 and the DMDN: average 4.1 mm (range 1.7-8.2). There were no iatrogenic injuries. The osteotomy angulation in the sagittal plane (reproducibility) average was 85.6 degrees. CONCLUSION There were no iatrogenic injuries on this cadaveric study of PeICO. CLINICAL RELEVANCE This study will help orthopedic surgeons understand the risks of performing percutaneous surgery by mimicking an accepted open technique (chevron).
Collapse
Affiliation(s)
- Jorge Javier Del Vecchio
- 1 Foot and Ankle Section, Orthopaedics Department, Hospital Universitario-Fundación Favaloro, Buenos Aires, Argentina.,2 Department of Kinesiology and Physiatry, Universidad Favaloro, Buenos Aires, Argentina
| | - Mauricio Esteban Ghioldi
- 1 Foot and Ankle Section, Orthopaedics Department, Hospital Universitario-Fundación Favaloro, Buenos Aires, Argentina
| | | | - Lucas Nicolás Chemes
- 1 Foot and Ankle Section, Orthopaedics Department, Hospital Universitario-Fundación Favaloro, Buenos Aires, Argentina
| | | | - Eric Daniel Dealbera
- 1 Foot and Ankle Section, Orthopaedics Department, Hospital Universitario-Fundación Favaloro, Buenos Aires, Argentina
| | - Miki Dalmau-Pastor
- 4 Human Anatomy and Embryology Unit, Faculty of Medicine and Health Sciences, Hospitalet de Llobregat, University of Barcelona, Spain.,5 Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain.,6 Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, Merignac, France
| |
Collapse
|
11
|
Díaz Fernández R. Use of a percutaneous osteotomy with plate fixation in hallux valgus correction. Foot Ankle Surg 2019; 25:106-112. [PMID: 29409298 DOI: 10.1016/j.fas.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND With hundreds of operative methods described for correction of hallux valgus we can state that the ideal surgical treatment is still controversial. The Bösch technique has been used as a percutaneous way of correcting hallux valgus deformities with the use of a pin fixation. The aim of this study is to evaluate a new method of fixation by using a percutaneous locking plate. METHODS Between June 2013 and January 2015, 24 consecutive percutaneous subcapital osteotomies of the first metatarsal bone were performed for the treatment of painful hallux valgus deformities in 24 patients. Additional surgical procedures included DMMO's (Distal Metatarsal Minimally-Invasive Osteotomies) in 12 of the operated feet (44.44%); minor digits were corrected in 7 cases (25.9%). An Akin procedure was performed in 81% of cases and all cases underwent an adductor hallucis tenotomy. All patients were clinically assessed using the AOFAS score. Radiographic measures included the preoperative and postoperative values of the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), and the Distal Metatarsal Articular Angle (DMAA). RESULTS The mean correction achieved improved for AHV from 36.57±7.1 to 12.22±8.69°, for IMA from 13.8±1.59 to 7.08±2.72 and for DMAA from 13.98±7.38 to 6.07±4.99. Clinically, scores on the AOFAS scale improved from a 45.8±9.6 to 91.29±9.8. Although healing of the osteotomies was observed radiographically within 6 to 12 weeks, two cases (8.3%) exhibited delayed healing. There were no cases of nonunion. There were no superficial or deep infections or wound healing problems. Plate had to be removed in 3 cases (12.5%). CONCLUSION This technique modification is an acceptable procedure to correct hallux valgus in patients with a moderate level of deformity. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Rodrigo Díaz Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Manises, Valencia, Spain; Unidad de Pie y Tobillo, Hospital Quirónsalud, Valencia, Spain.
| |
Collapse
|
12
|
Braito M, Dammerer D, Hofer-Picout P, Kaufmann G. Proximal Opening Wedge Osteotomy With Distal Chevron Osteotomy of the First Metatarsal for the Treatment of Moderate to Severe Hallux Valgus. Foot Ankle Int 2019; 40:89-97. [PMID: 30345808 DOI: 10.1177/1071100718799079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: The aim of this study was to assess radiographic and clinical outcomes after double osteotomy with proximal opening wedge first metatarsal osteotomy and first metatarsal distal chevron osteotomy in the treatment of moderate to severe hallux valgus. METHODS: 33 patients (4 male, 29 female; 36 feet; average age 60.7 years) were included in the study. Radiographic and clinical outcome in terms of intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and the American Orthopaedic Foot & Ankle Society metatarsophalangeal-interphalangeal hallux score (AOFAS MTP-IP hallux score) were investigated at 6 weeks, 6 months, and after an average of 28 (range, 7-123) months postoperatively. RESULTS: Preoperative IMA, HVA, and DMMA showed statistically significant improvement ( P ≤ .05) from 19.1 ± 3.8 (8.9-27.3) degrees, 45.4 ± 8.7 (25.9-60.9) degrees, and 20.8 ± 8.9 (4.5-38.0) degrees to 6.0 ± 3.3 (0.4-12.2) degrees, 9.1 ± 8.9 (-6.7 to 39.0) degrees, and 6.4 ± 5.6 (-6.8 to 21.0) degrees at last follow-up, respectively. Postoperative AOFAS MTP-IP hallux score averaged 88.1 points. Overall, 10 complications were observed: hallux varus (3 feet), hallux valgus recurrence (3 feet), nonunion (1 foot), loss of fixation (1 foot), and wound infection (2 feet). CONCLUSION: Proximal opening wedge first metatarsal osteotomy with distal chevron osteotomy provided powerful correction of each component of moderate to severe hallux valgus but had a substantial rate of complications in terms of over- and undercorrection, nonunion, loss of fixation, and wound infection. LEVEL OF EVIDENCE: Level IV, case series.
Collapse
Affiliation(s)
- Matthias Braito
- 1 Department of Orthopedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- 1 Department of Orthopedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Hofer-Picout
- 2 Department of Medical Statistics, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Kaufmann
- 1 Department of Orthopedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
13
|
Herrera-Perez M, De Prado-Serrano M, Gutiérrez-Morales MJ, Boluda-Mengod J, Pais-Brito JL. Increased rates of delayed union after percutaneous Akin osteotomy. Foot Ankle Surg 2018; 24:411-416. [PMID: 29409208 DOI: 10.1016/j.fas.2017.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/22/2017] [Accepted: 04/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Akin osteotomy is a well-known surgical procedure in forefoot surgery. When performing percutaneously, we have found a lot of delayed unions on follow up X-rays. The objective of this study was to assess the incidence of delayed union when performing a percutaneous Akin osteotomy. METHODS We report a series of 26 cases who underwent minimally invasive (percutaneous) Akin osteotomy. The mean follow-up duration was 17.6 (range 12 to 24) months. We analys-24) months. We analyzed the time to fusion using standard weight bearing radiographs. All the procedures were uneventful and we had only two skin burns that healed without sequelae. RESULTS All the procedures were uneventful and we had only two skin burns that healed without sequelae. The average time to fusion in our series was 4.69 months (2-11): seventeen of the 26 osteotomies (65.4%) were considered radiographically healed at an average time of 2,94 months (2-5), whereas 9 patients (34.6%) sustained a delayed-union and healed at an average of 8 months (7-11). CONCLUSIONS Despite few intraoperative complications and satisfactory clinical and radiological outcomes, our data suggest that a delayed union after Akin osteotomy is very common in the daily practice when performing it through a minimally invasive technique.
Collapse
Affiliation(s)
- Mario Herrera-Perez
- Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain; Universidad de La Laguna, Spain.
| | | | | | - Juan Boluda-Mengod
- Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - José Luis Pais-Brito
- Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain; Universidad de La Laguna, Spain
| |
Collapse
|