Minimally Invasive Chevron Akin: Locking The Metatarsal-Cuneiform Joint

Nunes, Gustavo Araújo; Ferreira, Gabriel Ferraz; Baumfeld, Tiago; Filho, Miguel Viana Pereira; Baumfeld, Daniel; Lam, Peter

doi:10.1177/19386400221079155

Cited by 9 publications

(12 citation statements)

References 30 publications

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“…We found that there was minimal recurrence of HV deformity, which has been reported in other studies and believe this is due to the combination of a bony correction combined with “medially locking out” the TMT joint to prevent any further increase in the IMA. 43 The proximal IMA in this series increased by 6.3 degrees, which is comparable to Nunes et al 43 who found an increase of 4.8 degrees following MIS HV surgery. The final proximal IMA in this study (20.3 degrees) was also comparable to their study, which found a proximal IMA of 19.0 degrees.…”

Section: Discussionsupporting

confidence: 82%

“…The intermetatarsal angle between the proximal fragment of the osteotomy and the second ray ("proximal IMA") as described by Nunes et al 43 was measured on postoperative radiographs to assess if there was an increase in the proximal IMA following surgery. Deformity correction was assessed in terms of "percentage head shift" (PHS) as shown and defined in Figure 5.…”

Section: Variables Outcome Measures and Study Endpointmentioning

confidence: 99%

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Fourth-Generation Minimally Invasive Hallux Valgus Surgery With Metaphyseal Extra-Articular Transverse and Akin Osteotomy (META): 12 Month Clinical and Radiologic Results

et al. 2023

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Background: Fourth-generation minimally invasive surgery (MIS) includes the multiplanar rotational deformity correction achieved through manipulation of an extra-articular distal first metatarsal osteotomy that is held with rigid fixation using 2 fully threaded screws, of which one must be bicortical to provide rotational and biomechanical stability. The aim of this study is to report the clinical and radiologic outcomes of an evolved fourth-generation MIS hallux valgus technique. Methods: A prospective single-surgeon series of consecutive patients undergoing fourth-generation MIS was performed using a distal transverse osteotomy with a minimum 12-month follow-up. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ), a validated clinical patient-reported outcome measure (PROM). Secondary outcomes included radiographic deformity correction, clinical assessment, and EuroQol-5D-5L PROMs. Results: Between September 2019 and June 2021, 50 feet underwent fourth-generation MIS. The mean age was 55.8±15.3 years with a mean follow-up of 1.4 years. Preoperative and minimum 12-month primary outcome data were available for 100% of feet. There was a significant improvement in all MOXFQ domain scores, with the index domain improving from 53.4 to 13.1 ( P < .001). There was a significant improvement ( P < .001) in hallux valgus angle (32.7 to 7.9 degrees), intermetatarsal angle (14.0 to 4.2 degrees) and distal metatarsal articular angle (18.5 to 5.6 degrees). There was a significant improvement in general health-related quality of life EQ-5D-5L index and EQ-VAS scores ( P < .05). Conclusion: The fourth-generation MIS technique is a safe and effective approach to hallux valgus deformity correction with significant improvement in clinical and radiographic outcomes. Level of Evidence: Level IV, prospective case series.

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Section: Discussionsupporting

confidence: 82%

Section: Variables Outcome Measures and Study Endpointmentioning

confidence: 99%

Fourth-Generation Minimally Invasive Hallux Valgus Surgery With Metaphyseal Extra-Articular Transverse and Akin Osteotomy (META): 12 Month Clinical and Radiologic Results

et al. 2023

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“… 2 , 17 , 27 One study did not report AOFAS or any comparable score. 29 Preoperative and last follow-up visual analog scale (VAS) score was reported in 7 studies, and in 5 it was reported as statistically significant. The average score improved from 4.9 (range 3-8.2) to 0.8 (range 0-1.9).…”

Section: Resultsmentioning

confidence: 99%

Minimally Invasive Surgery Using a Shannon Burr for the Treatment of Hallux Valgus Deformity: A Systematic Review

Gonzalez

Encinas

Johns

et al. 2023

Foot & Ankle Orthopaedics

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Background: Recently there has been an increase in minimally invasive surgery (MIS) for the correction of hallux valgus deformity. This systematic review aims to evaluate and present the current literature on MIS hallux valgus correction in studies reporting the use of the Shannon burr with distal metatarsal osteotomies to help establish evidence-based guidelines for surgeons using this technique. Methods: Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2008 to 2022 and included the use of the Shannon burr during distal metatarsal osteotomies MIS for hallux valgus and at least 12-month follow-up. The MINORS score criteria was used to evaluate the strength and quality of 17 studies by 3 authors. Statistical analysis and meta-analysis were not performed because of the heterogeneity of the included studies and the data being descriptive. Results: A total of 17 studies were reviewed. A total of 911 subjects were included, and 1088 MIS procedures were performed. The average follow-up was 23.8 (12-59.1) months. American Orthopaedic Foot & Ankle Society scale and visual analog scale scores improved from 52.1 (41-62.5) to 90.3 (83.3-97.1) and 4.9 (3-8.2) to 0.8 (0-1.9). Satisfaction rates were very high among the studies that reported it. The hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle improved from 31.4 (23.5-44.1) to 11.1 (7-17.2), 13.4 (8.1-18.6) to 7.3 (4.2-10.3), and 12.3 (9-16.3) to 4.1 (1-6.7), respectively. The complication rate was 16.6%, and recurrence was 2.2%. Nonunion comprised 0.4%, infections 1.1%, nerve injury 2.2%, avascular necrosis 0%, hallux varus 0.09%, transfer metatarsalgia 0.1%, and hardware removal 6.2%. Conclusion: MIS for the treatment of hallux valgus using the Shannon burr appears to be a safe and effective therapy, with appropriate correction of the hallux valgus deformity, improvement in functional outcomes, high patient satisfaction, low recurrence, and acceptable complication rates. Level of Evidence: Level II, systematic review.

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“…Other authors have described the aim of the technique being to “lock” the first TMT joint in a maximally translated position, which should theoretically decrease the risk of recurrence. 23 However, continued translation at the joint nonetheless remains a mechanism of recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Other authors have described the aim of the technique being to "lock" the first TMT joint in a maximally translated position, which should theoretically decrease the risk of recurrence. 23 However, continued translation at the joint nonetheless remains a mechanism of recurrence. Theoretical advantages of the Lapidus bunionectomy over MIS chevron bunionectomy include the ability to directly correct metatarsal pronation.…”

Section: Discussionmentioning

confidence: 99%

Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy Compared to the Modified Lapidus Procedure

Cody

Caolo

Ellis

et al. 2022

Foot & Ankle Orthopaedics

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Background: Minimally invasive (MIS) bunion surgery has become increasingly popular. Although early reports on outcomes have been encouraging, no study to date has compared outcomes from the MIS chevron and Akin procedures to the modified Lapidus procedure. Our primary aim was to compare early radiographic outcomes of the MIS chevron and Akin osteotomies to those of the modified Lapidus procedure in patients with comparable deformities, and secondarily to compare clinical outcomes. Methods: Patients were retrospectively reviewed for inclusion from a prospectively collected foot and ankle registry. Patients were eligible if they underwent either the MIS bunionectomy or modified Lapidus procedure and had preoperative and minimum 5-month postoperative weightbearing radiographs. Forty-one patients who underwent MIS bunionectomy were matched to 41 patients who underwent Lapidus bunionectomy based on radiographic parameters. Demographics, radiographic parameters, complications, reoperations, and PROMIS scores were compared between groups. Results: Both groups achieved similar radiographic correction. There was no significant difference in pre- or postoperative PROMIS scores between groups. Procedure duration was significantly faster in the MIS group ( P < .001). Bunion recurrence (hallux valgus angle ≥20 degrees) occurred in 1 MIS patient and 2 Lapidus patients, with all patients asymptomatic. The most common reason for reoperation was removal of hardware (4 patients in the MIS group, 2 patients in the Lapidus group). Conclusion: This is the first study to our knowledge to compare early radiographic outcomes between MIS bunionectomy and the modified Lapidus procedure in patients matched for bunion severity. We found that patients with similar preoperative deformities experience similar radiographic correction following MIS chevron and Akin osteotomies vs modified Lapidus bunionectomy. Further research is needed to investigate satisfaction differences between the procedures, longer-term outcomes, and which deformities are best suited to each procedure. Level of Evidence: Level III, Retrospective case control study.

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Minimally Invasive Chevron Akin: Locking The Metatarsal-Cuneiform Joint

Cited by 9 publications

References 30 publications

Fourth-Generation Minimally Invasive Hallux Valgus Surgery With Metaphyseal Extra-Articular Transverse and Akin Osteotomy (META): 12 Month Clinical and Radiologic Results

Fourth-Generation Minimally Invasive Hallux Valgus Surgery With Metaphyseal Extra-Articular Transverse and Akin Osteotomy (META): 12 Month Clinical and Radiologic Results

Minimally Invasive Surgery Using a Shannon Burr for the Treatment of Hallux Valgus Deformity: A Systematic Review

Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy Compared to the Modified Lapidus Procedure

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