Two year outcomes of minimally invasive hallux valgus surgery

Chan, Chloe Xiaoyun; Gan, Jonathan Zhi-Wei; Chong, Hwei Chi; Singh, Iqbal; Ng, Sean; Koo, Kevin

doi:10.1016/j.fas.2017.09.007

Cited by 40 publications

(49 citation statements)

References 26 publications

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“…11,26 Another method is the percutaneous, intra-articular, chevron osteotomy (PeICO) that is a modification of the method of Bösch and employs internal fixation with an internal compression screw introduced from the dorsal-median approach. 12 A somewhat different operative technique was employed by Chan et al 9 ; their method is based on creating the percutaneous subcapital chevron osteotomy of the first metatarsal and, following the translation of the distal bone fragment, achieving fixation with 1 screw introduced into the distal fragment from the medial-dorsal side. The study authored by Chan et al is a retrospective analysis of 13 feet (5 patients had simultaneous bilateral procedures) and demonstrates very good radiologic results (HVA improvement from 30.4 to 10.9 degrees and IMA, from 13.9 to 10.2 degrees), as well as clinical outcomes (the mean AOFAS score increased from 59.0 points to 93.7 points).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus

Liszka

Gądek

2020

Foot Ankle Int.

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Background: The objective of the study was evaluation of the clinical and radiologic outcomes and complications following the minimally invasive chevron procedure employing the Akin osteotomy with percutaneous transosseous suture as compared to screw fixation. Methods: Between 2018 and 2019, the authors performed 103 minimally invasive chevron (MIC) with Akin osteotomies. In 54 patients, the Akin osteotomy was performed with screw stabilization (group A), and in 49 with percutaneous transosseous suture (group B). Preoperatively and 1 year later, the authors employed anteroposterior and lateral weightbearing radiographs of the feet to evaluate interphalangeal angle (IPA), distal phalangeal articular angle (DPAA), proximal phalangeal articular angle (PPAA), intermetatarsal angle (IMA), hallux valgus angle (HVA), and functional result using the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. Furthermore, all additional procedures and complications were recorded. Results: Both groups demonstrated a statistically significant decrease of the value of HVA (group A: from 34.1° to 14.0°, group B: from 33.6° to 13.0°), DPAA (group A: from 12.1° to 4.0°, group B: from 11.5° to 3.4°), PPAA (group A: from 4.6° to 1.7°, group B: from 4.3° to 1.5°), IMA (group A: from 15.1° to 8.0°, group B: from 14.7° to 7.5°) and IPA (group A: from 14.1° to 6.3°, group B: from 12.9° to 5.1°). Functional improvement as measured using the AOFAS scale was achieved in both groups (group A: from 42 to 90 points, group B: from 40 to 89 points). No cases of bone nonunion or delayed union and permanent damage to the medial dorsal cutaneous nerve were seen. Two group B patients underwent conversion of the fixation of the Akin osteotomy to screws, 3 patients had their MICA screws and 1 Akin screw removed in the outpatient setting. Conclusion: The minimally invasive chevron osteotomy with transosseous suture stabilization of the Akin osteotomy was a safe method with good functional results that were comparable to the outcomes achieved when using screw fixation. Level of Evidence: Level III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus

Liszka

Gądek

2020

Foot Ankle Int.

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“…9 In the last decade, there has been a growing interest in the use of minimally invasive surgery for the correction of HV. 3,4 In percutaneous techniques, correction of the deformity can be obtained with different osteotomies, surgical approaches, and fixation devices. 4 There is not much variation in outcome and complication rates among the 5 more widespread minimally invasive techniques to correct HV (Bosch, chevron-Akin, Reverdin-Isham, Endolog, and distal soft tissue release and fixation).…”

mentioning

confidence: 99%

“…3,4 In percutaneous techniques, correction of the deformity can be obtained with different osteotomies, surgical approaches, and fixation devices. 4 There is not much variation in outcome and complication rates among the 5 more widespread minimally invasive techniques to correct HV (Bosch, chevron-Akin, Reverdin-Isham, Endolog, and distal soft tissue release and fixation). 11 The most common complication following minimally invasive foot procedures is recurrence of the deformity.…”

mentioning

confidence: 99%

Preliminary Experience With a Minimally Invasive Technique for Hallux Valgus Correction With No Fixation

Lucattelli¹,

Catani²,

Sergio³

et al. 2019

Foot Ankle Int.

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Background: Percutaneous operative techniques for hallux valgus (HV) correction are less damaging to soft tissues and the first metatarsophalangeal joint, and they carry a lower risk of wound complications. We report our preliminary results using a percutaneous technique that allowed correction of the deformity without internal fixation. Methods: One hundred ninety-five consecutive patients with isolated symptomatic HV were surgically treated using a percutaneous technique without any form of internal fixation, with a mean follow-up of 34.6 months. The American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale score was used for clinical assessment. Radiographic evaluation included pre- and postoperative assessment of the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and sesamoid position in weightbearing radiographs. Results: According to the AOFAS score, the patients improved from a preoperative median of 54.7 to 89.6 at 2 years’ follow-up ( P = .002). Patients were satisfied or very satisfied in 94% of cases at the latest follow-up. A mean radiographic correction of the HVA of 15.5 degrees, of the IMA of 5.4 degrees, and of the DMAA of 5.4 degrees was achieved. The AOFAS global score and every individual parameter improved significantly between pretreatment and latest follow-up ( P > .01). A total of 19 (9.7%) complications were reported. Conclusion: This percutaneous technique, which did not use any form of internal fixation described, produced durable results for the correction of HV, reliably correcting the deformity and resulting in significant improvement in function and decrease of pain. Level of Evidence: Level IV, retrospective case series.

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“…Chan et al reported a 7.7% rate of paresthesia around the operative site and medial hallux; however, this numbness resolved at the 1-year follow-up mark. 11 Brogan et al reported a paresthesia rate of 8.1% at 31-month follow-up in their MIS group. 4 Yang et al reported only a 2.4% paresthesia rate in MIS hallux valgus correction.…”

Section: Discussionmentioning

confidence: 91%

Structures at Risk During Percutaneous Extra-Articular Chevron Osteotomy of the Distal First Metatarsal

McGann

Langan

Brandão

et al. 2019

Foot & Ankle Specialist

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Background. Minimally invasive surgery of the forefoot has regained popularity as an alternative to traditional open procedures. Minimally invasive hallux valgus surgery has been shown to be effective and reproducible for the treatment of mild to moderate hallux valgus. The aim of this study is to identify vital structures that are at risk for iatrogenic damage while performing a minimally invasive distal chevron osteotomy due to limited direct visualization. Methods. Ten fresh-frozen below knee cadavers were used for this study. A minimally invasive distal chevron osteotomy and medial eminence resection with a 2.2 mm × 22 mm Shannon burr was performed on each cadaver. Each specimen was dissected to expose the potential structures at risk for injury during the procedure. Structures evaluated included the medial neurovascular bundle, first metatarsophalangeal joint capsule, extensor hallucis longus tendon, flexor hallucis longus tendon, abductor hallucis tendon, and the sesamoid apparatus. Results. Ten specimens were evaluated. The dorsal medial cutaneous nerve was directly injured in 5 of the 10 cadaver specimens and intact/uninjured in the remaining 5 specimens. The flexor hallucis longus, extensor hallucis longus, adductor tendon, sesamoid apparatus, and first metatarsophalangeal joint capsule were uninjured in all specimens. Conclusion. Minimally invasive chevron distal osteotomy and medial eminence resection has a high learning curve. The resection of the medial eminence may iatrogenically injure the dorsal medial cutaneous nerve. The incidence is higher in this study than prior reported cadaveric studies and may warrant extra care to protect vital structures. Level of Evidence: Level IV: Cadaver study

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Two year outcomes of minimally invasive hallux valgus surgery

Cited by 40 publications

References 26 publications

Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus

Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus

Preliminary Experience With a Minimally Invasive Technique for Hallux Valgus Correction With No Fixation

Structures at Risk During Percutaneous Extra-Articular Chevron Osteotomy of the Distal First Metatarsal

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