Percutaneous Chevron Osteotomy: A Prospective Randomized Controlled Trial

Abstract

Introduction: Minimally invasive surgical techniques for hallux valgus have gained popularity, showing good results characterized by smaller postoperative scars, less pain, lower infection risk, and fewer wound complications. Given the lack of evidence available in our country regarding this subject, especially about this type of surgical technique, our paper aims to compare open and MIS approaches for chevron osteotomy. We evaluated the outcome and complications after 12 months. Materials and Methods: We undertook a prospective, randomized, controlled, single-center study between October 2017 and December 2020. The patients were randomized into two groups: one group that received percutaneous chevron osteotomy (MIS), and the other, open chevron osteotomy (OC). For clinical assessment, we determined the function and the level of pain using the Visual Analogue Scale (VAS) and The American Orthopaedic Foot and Ankle Surgery score (AOFAS). The VAS scale was measured before the surgical procedure, at discharge, and at 3 weeks, 6 weeks, 6 months, and 12 months after surgery. The AOFAS score was calculated preoperatively and after 6 months. The hallux angle (HVA) and intramedullary angle (IMA) were measured preoperatively, and at 6 weeks, 6 months and 12 months. Results: We included 26 cases in the open chevron osteotomy group (24 female, 2 male) and 24 in the MIS group (24 female, 0 male). Both groups demonstrated improvements regarding the IMA and HVA at the last follow-up without any significant differences between the groups at the final assessment. The VAS showed significantly better post-operative results for the MIS group at discharge (p < 0.001) and 3 weeks (p < 0.001), 6 weeks (p < 0.001), and 6 months (p = 0.004) post-surgery. The AOFAS showed no significant differences either before or after surgery. Four cases with screw prominence were reported, three of which belonged to the MIS group. Only one case with metatarsalgia was found in the OC group. Conclusions: This paper demonstrates that minimally invasive chevron osteotomy has comparable results with open chevron osteotomy, even though surgical time and radiological exposure are significantly longer. More studies are required to evaluate the complications and the risk of recurrences.

Is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? A meta-analysis

“…Therefore, the interference of PTS needs to be reduced in all knee surgeries. As per reports, PTS increase after OWHTO [ 42 , 43 ] may be due to the unique anatomical features of the proximal tibia [ 37 , 44 ]. PTS may also be increased when the osteotomy plane is not level with the sagittal tibial articular plane, the osteotomy gap is wide in the front and narrow at the back, and in cases of hinge fracture [ 45 ].…”

Does Minimally Invasive Surgery Provide Better Clinical or Radiographic Outcomes Than Open Surgery in the Treatment of Hallux Valgus Deformity? A Systematic Review and Meta-analysis

“…A study with a high risk of bias and inconsistent data reporting was excluded from our analysis [39]. Seven studies were included in the qualitative and quantitative data synthesis [10-12, 23, 25, 42, 52].…”

“…As opposed to other minimally invasive techniques, the minimally invasive chevron-akin osteotomy uses cannulated screws to achieve stable internal fixation and adheres to the principles of the Arbeitsgemeinschaft für Osteosynthesefragen group for internal fixation [44]. Kaufmann et al [23] and Dragosloveanu et al [10] used a single dorsal screw fixation technique, whereas Lee et al [25] used two medial-to-lateral screws. Frigg et al [11] used a combination of these techniques.…”

“…The evaluation of the individual domains for each study is visualized by a risk of bias graph and a risk of bias summary figure that was generated using robvis [33]. We found that three studies [11, 23, 25] had low risks of bias, four [10, 12, 42, 52] had an intermediate risk, and one [39] had a high risk (Fig. 2).…”

“…The AOFAS score was reported in seven studies [10-12, 23, 25, 42, 52]. To further evaluate pain, we extracted the VAS score from four studies [10, 11, 23, 25].…”