V.

Percutaneous and minimally invasive surgery is one of the greatest advances in the operating field of orthopedic since the late 1990s. The potential advantages include a shorter operative time, quicker recovery, and reduced hospital stay compared with traditional open surgery. However, scientific validation of the safety and efficacy of hallux valgus (HV) percutaneous surgery remains inconclusive. The objective of the present study was to systematically review the published data and clinical evidence for percutaneous HV surgery, evaluate the scientific method of the reports, and clarify the indications, safety, efficacy, and potential risks of these surgical techniques. Two reviewers independently identified the studies using a PubMed search, with the keywords "hallux valgus," "osteotomy," "minimally invasive," and "percutaneous." Quality assessment was performed using the Coleman methodology scale, and each study was assigned a level of evidence and grade of recommendation. Eighteen studies were included and reported a total of 1534 procedures for percutaneous HV surgery on 1397 patients. Of the 18 studies, 14 (77.8%) were level IV, 2 (11.1%) were level III, and 2 (11.1%) were level II. Overall, the average angle correction of the HV deformity improved postoperatively. Regarding the complications, although some investigators revealed no major complications, others described deformity recurrence in 7.8%, stiffness of the first metatarsophalangeal joint in 9.8%, malunion in 4% to 8.7%, and infection rates ranging from 1.9% to 14.3%. The main indication for percutaneous HV surgery is the correction of mild deformities. The complication rate was elevated even in experienced surgeons. In conclusion, future research in percutaneous techniques should include adequately sized randomized control trials, standardization of treatment protocols, and the use of validated tools for the measurement of clinical outcomes.

No abstract

Arthroscopic release of the FHL tendon was a valid procedure. It was a minimally invasive surgery that allowed good visualization of the involved structures and yielded good results. This condition can be related to trauma and is not an exclusive disease of ballet dancers or overuse.

Flexor hallucis longus (FHL) transfer is a well-established treatment option in failed Achilles tendon (AT) repair and has been routinely performed as an open procedure. We detail the surgical steps needed to perform an arthroscopic transfer of the FHL for a chronic AT rupture. The FHL tendon is harvested as it enters in its tunnel beneath the sustentaculum tali; a tunnel is then drilled in the calcaneus as near to the AT footprint as possible. By use of a suture-passing device, the free end of the FHL is advanced to the plantar aspect of the foot. After adequate tension is applied to the construct, the tendon is fixed in place with an interference screw in an inside-out fashion. This minimally invasive approach is a safe and valid alternative to classic open procedures with the obvious advantages of preserving the soft-tissue envelope and using a biologically intact tendon.T he incidence rates of Achilles tendon (AT) rerupture after primary surgical repair vary widely in the literature.1,2 Several treatment options exist, such as V-Y advancement and the Bosworth turn-down repair.3 Other surgical techniques use tendon transfers of the peroneus brevis, flexor digitorum longus, and flexor hallucis longus (FHL). The use of an FHL transfer has been proposed 4,5 because it is a stronger plantar flexor, its axis of contractile force more closely reproduces that of the AT, it fires in phase with the gastrocnemius-soleus complex, and its anatomic proximity avoids iatrogenic lesions of the neurovascular bundle. Another benefit of FHL transfer is plantar flexion strength reinforcement, which is almost always compromised with fascial advancement alone. 6Regarding vascularization of the AT, the FHL muscle belly extends distally into the avascular zone of the AT and allows recruitment of an increased blood supply to the repaired AT. Furthermore, FHL transfer maintains the normal muscle balance of the ankle by transferring a muscle with the same function. In a recent study using magnetic resonance imaging evaluation, Hahn et al. 4 showed complete integration of the FHL tendon in 60% of patients and hypertrophy of the FHL of more than 15% was observed in 80% of patients. Case DescriptionWe present the case of a 34-year-old man with no known pathology and an irrelevant medical history and habits. He was a recreational sports participant and sustained an AT rupture. Primary surgery was performed 2 weeks after the initial trauma by a minimally invasive technique (Achillon System; Integra LifeSciences, Plainsboro, NJ). The patient began physical therapy after 3 weeks of equinus cast immobilization and had good progression until 12 weeks postoperatively, when a rerupture occurred while he was working out on a treadmill. The patient then underwent reoperation with the technique described in this report. Surgical TechniquePosterior ankle endoscopy is performed in a standard fashion. 7 The patient lies prone, and a 2-portal technique using the posterolateral and posteromedial portals is performed (Fig 1). The posterolateral ...