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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.
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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
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Izzo A, Vallefuoco S, Basso MA, Ray R, Smeraglia F, Cozzolino A, Mariconda M, Bernasconi A. Role of lateral soft tissue release in percutaneous hallux valgus surgery: a systematic review and meta-analysis of the literature. Arch Orthop Trauma Surg 2023; 143:3997-4007. [PMID: 36352268 PMCID: PMC10293432 DOI: 10.1007/s00402-022-04693-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND It is unclear whether lateral soft tissue release (LSTR) is required as part of percutaneous hallux valgus (PHV) surgery. The primary aim of this systematic review was to assess whether LSTR reduces the risk of recurrence of hallux valgus deformity. The secondary aims were to assess if LSTR increases the risk of complications, improves the clinical outcome and leads to a greater radiographic correction. METHODS We performed a PRISMA-compliant PROSPERO-registered systematic review, pooling clinical papers reporting results after PHV surgery into two categories (PHV with (Group 1, G1) and without LSTR (Group 2, G2)) and comparing them. Data regarding the study design, demographics, the surgical procedure and the clinical and radiological outcome were extracted and compared. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). RESULTS Sixteen studies were selected (G1:594 feet; G2:553 feet). The pooled proportion of recurrence at a minimum 21-month follow-up (2%, 95%CI 0-3 vs 2%, 95%CI 0-5; p = 0.70) did not differ in the two groups. Similarly, the pooled proportion of complications (27%, 95%CI 17-38 vs 25%, 95%CI 12-37; p = 0.79) was similar. The pre- (p = 0.23) and post-operative AOFAS scores (p = 0.16), the pre-(HVA: p = 0.23) (IMA: p = 0.94) and post-operative radiological angles (HVA: p = 0.47) (IMA: p = 0.2) and the methodological quality of studies (p = 0.2) did not differ either between G1 and G2. CONCLUSION There is no evidence that LSTR performed during percutaneous HV surgery reduces the risk of recurrence of the deformity at a mean 4-year follow-up nor improves the clinical and radiological outcome. LEVEL OF EVIDENCE Level IV systematic review of Level I to IV studies.
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Affiliation(s)
- Antonio Izzo
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Salvatore Vallefuoco
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Morena Anna Basso
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Robbie Ray
- King’s Foot and Ankle Unit, King’s College Hospital NHS Foundation Trust, London, UK
| | - Francesco Smeraglia
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Andrea Cozzolino
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Massimo Mariconda
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Alessio Bernasconi
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
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Ghioldi ME, Chemes LN, Dealbera ED, De Prado M, Del Vecchio JJ. Modified Bösch Osteotomy Combined With a Percutaneous Adductor Tendon Release for the Treatment of Hallux Valgus Deformity: Learning Curve. Foot Ankle Spec 2022:19386400221079198. [PMID: 35236146 DOI: 10.1177/19386400221079198] [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: 11/16/2022]
Abstract
PURPOSE The expression "learning curve" indicates the relation between the time needed to learn a new technique and the technique-related outcome. Percutaneous surgery (also called "minimally invasive surgery") has experienced sustained and respectable growth, especially in forefoot deformities. The main purpose was to assess the number of feet necessary to become skilled in a specific minimally invasive surgery (MIS) procedure. METHODS From January 2015 to June 2018, 46 consecutive patients were evaluated and included in the study. Patients were divided into 2 groups according to the surgery period: first 30 feet (Group 1), and subsequent 30 feet (Group 2) from the whole population evaluated. Age, body mass index, and operative time were evaluated. Hallux valgus angle and the 1 to 2 intermetatarsal angle were also measured. Patients were assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scale, the Foot and Ankle Ability Measure activities of daily living (FAAM ADL) subscale and the visual analog scale (VAS). RESULTS The comparison of the 2 groups showed statistically significant differences in hallux valgus angle (HVA) but not in intermetatarsal angle (IMA). The mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS score in Group 1 were 12.83, 3.93, and 24.77 points, respectively. In Group 2, the mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS scores were 15.19, 4.3, and 24.5 points, respectively. The differences between groups in FAAM ADL score was statistically significant (P = 0.0364). Group 1 showed a global complication rate of 16.67% (n = 5) while group 2 showed 3,3% (n = 1). CONCLUSION After the first 30 cases, radiographic, clinical, and functional outcomes substantially improved, and the level of the perioperative complications decreased. The results suggest that the learning curve plateau for performing a percutaneous subcapital osteotomy can be reached after 30 surgeries. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
| | - Lucas Nicolás Chemes
- Foot and Ankle Section, Fundación Favaloro-Hospital Universitario, Buenos Aires, Argentina
| | - Eric Daniel Dealbera
- Foot and Ankle Surgery and Limb Salvage Fellowship, Foot and Ankle Section, Orthopaedics Department, Hospital Universitario-Fundación Favaloro, Ciudad Autónoma de Buenos Aires, Argentine
| | - Mariano De Prado
- Hospital Quironsalud Murcia, Director del Servicio de Traumatología y Cirugía Ortopédica, Murcia, Spain
| | - Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro-Hospital Universitario, Buenos Aires, Argentine
- Department of Kinesiology and Physiatry, Universidad Favaloro, Ciudad Autónoma de Buenos Aires, Argentina
- Minimally Invasive Foot and Ankle Society (MIFAS by GRECMIP), Negrevergne, Merignac, France
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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.
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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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Sutherland JM, Mok J, Liu G, Crump T, Wing K, Younger A, Penner M, Veljkovic A. Cost-Utility Study of the Economics of Bunion Correction Surgery. Foot Ankle Int 2019; 40:336-342. [PMID: 30557044 DOI: 10.1177/1071100718815663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Bunion correction surgery is a very common procedure to improve patients' pain and physical function attributable to a misaligned first metatarsophalangeal joint. The objective of this study was to apply a health utility framework to estimate the cost utility of bunion correction surgery. METHODS: Patients were prospectively recruited from the population of patients seen in a lower-extremity orthopedic clinic and scheduled for isolated bunion surgery. Participants completed EuroQoL's EQ-5D(3L) to measure patients' current general health preoperatively and 6 months postoperatively. Participants' change in quality-adjusted life years (QALYs) were calculated by comparing the difference between postoperative utility values and preoperative utility values. The study had 95 patients representing 53% of eligible patients. RESULTS: The mean preoperative utility value was 0.6816 and the mean postoperative value was 0.7451, a statistically significant difference denoting an improvement in self-reported health. The cost per QALY, assuming gains in health accrued for 15 years, was $4911 (the 95% confidence interval ranged from $4736 to $5088). The cost per QALY was highest among the oldest patients. Assuming gains in health accrued for 20 years, the cost per QALY was $3922. CONCLUSION: This study demonstrated that bunion correction surgery was inexpensive relative to its gains in health compared with commonly applied thresholds for women and men in all age groups, though the gains were not uniformly distributed across age categories. Future research should examine the impact of recurrence on the robustness of these findings. LEVEL OF EVIDENCE: Level III, comparative study.
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Affiliation(s)
- Jason M Sutherland
- 1 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Janice Mok
- 1 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Guiping Liu
- 1 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Trafford Crump
- 2 Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kevin Wing
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Alastair Younger
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Murray Penner
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Veljkovic
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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