Correlation of first metatarsal sagittal alignment with clinical and functional outcomes following the Lapidus procedure

Nishikawa, Danilo Ryuko Cândido; Duarte, Fernando Aires; Saito, Guilherme Honda; Miranda, Bruno Rodrigues de; Prado, Marcelo Pires

doi:10.1016/j.fas.2021.08.009

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…The low values observed in the other measurements possibly reflect the difficulty that observers had in accurately identifying the proximal joint surfaces and dorsum of the second metatarsal. In a study that evaluated the first metatarsal sagittal alignment after correction of hallux valgus with the Lapidus technique, Nishikawa et al (2) demonstrate that the first MDA is reproducible with excellent ICC, with mean values of 0.90. Unlike what was observed in our study, Lamm et al (3) obtained high ICC values in the first PMAA (0.739) and the first DMAA (0.814) measurements in the 24-foot analysis.…”

Section: Discussionmentioning

confidence: 99%

“…It is commonly related to forefoot deformities such as hallux valgus and hallux rigidus and other complex foot deformities such as progressive collapsing foot deformity (1) . Under these conditions, it is often necessary to evaluate whether flexion or extension of the first metatarsal is associated with deformity or after its surgical correction (2,3) . However, it is necessary to use measures in which the values are reproducible among surgeons, regardless of the training time (4)(5)(6) .…”

Section: Introductionmentioning

confidence: 99%

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Inter- and intraobserver reliability of the first metatarsal sagittal alignment measurements

Romanholi,

Gobbo,

Said

et al. 2024

J Foot Ankle

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Introdução: as medidas radiográficas são utilizadas para indicar e programar procedimentos ortopédicos no antepé, bem como para seguimento pós-operatório. Com isso, muitas vezes é necessário avaliar se houve alteração no alinhamento sagital do primeiro metatarso (1M). O objetivo desse estudo foi analisar a confiabilidade inter e intraobservador das medidas angulares utilizadas para avaliação do alinhamento sagital do 1M. Secundariamente, avaliar se o tipo anatômico do pé interfere na confiabilidade das medições. Métodos: as medidas angulares utilizadas foram todas aquelas encontradas na literatura, tais como: ângulo de declinação do 1M (AD1M), ângulo plantar distal do 1M (APD1M), ângulo dorsal proximal do 1M (ADP1M), ângulo intermetatarsal lateral (AIML), e o ângulo descrito por Day. Para avaliação da confiabilidade interobservador foi utilizado o Coeficiente de Correlação Intraclasse (CCI) e para avaliação da confiabilidade intraobservador, o Coeficiente de Correlação de Concordância de Lin (CCCL). Resultados: dentre todas as medidas obtidas, AD1M foi o que apresentou os maiores valores de CCI e CCCL nas 40 radiografias avaliadas, independentemente do tipo anatômico do pé. Conclusão: com os resultados observados, podemos estimar que o AD1M parece representar uma ferramenta radiográfica adequada para mensuração do alinhamento sagital do 1M, quando avaliada pelo CCI e CCCL.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inter- and intraobserver reliability of the first metatarsal sagittal alignment measurements

Romanholi,

Gobbo,

Said

et al. 2024

J Foot Ankle

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“…Nishikawa et al also later reported the presence of relative postoperative dorsiflexion of the first metatarsal following conventional modified Lapidus procedure (average 2.5° of dorsiflexion) in 78% of a total of 36 HV patients. They also found a significant correlation between first metatarsal shortening and poorer functional outcomes (SF-12 and Lower Extremity Functional Scale) [ 24 ]. Our understanding is that the results of these reported studies highlight the importance of improving or at least preserving the length and sagittal plane position of the first metatarsal in patients with collapse of the medial longitudinal arch, advocating in favor of the LapiCotton procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Fusion of the first tarsometatarsal joint (TMT), or the modified Lapidus procedure [ 13 ], is a well-accepted and long-lasting advocated procedure that allows correction of the first metatarsal malposition in the axial, coronal and sagittal planes, and potentially reestablishes the structural stability of the medial column [ 14 – 19 ]. However, non-union rate of up to 8% [ 20 ] and relative shortening and dorsiflexion of the first metatarsal are inherent possible limitations and complications associated with the procedure [ 21 – 24 ], with an average of 4.1 mm decrease in absolute length of the first ray being reported in the literature [ 25 , 26 ]. Combination of first ray shortening and dorsiflexion can lead to transfer load to the lesser metatarsals and residual mechanical incompetence of the medial column [ 7 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study

Ehret

Walt

Chinelati

et al. 2022

Arch Orthop Trauma Surg

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Introduction Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column. Methods In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed. Results A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3–12) and median allograft size was 8 mm (range 5–19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7–12.1°; p < 0.0001). Conclusion In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results. Level of evidence Level II, prospective cohort study.

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“…[1][2][3] For cases associated with multiplanar deviations, the Lapidus procedure has been shown to be an effective technique. [4][5][6] In 1934, the original Lapidus procedure (OLP) was described. 7 It consists of first metatarsal (M1) realignment by a fusion of the first tarsometatarsal joint (TMTJ) and M1 to second metatarsal (M2) joint.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Technical Tips to Improve Fusion Between the First and Second Metatarsals in the Original Lapidus Procedure

Nishikawa

Duarte

Saito

et al. 2022

Foot & Ankle Specialist

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The modified Lapidus procedure (MLP), which consists of fusion between the first metatarsal (M1) and medial cuneiform, has been widely performed with satisfactory clinical outcomes, but it has a variable nonunion rate ranging between 4% and 10% and loss of correction in up to 5.8% of the cases. Excessive motion around the site of tarsometatarsal arthrodesis, specially at the intercuneiform joint, is probably the reason. The original Lapidus procedure (OLP), which includes fusion of the M1 to second metatarsal (M2), may be beneficial in preventing nonunion and recurrence. The objective of this study was to describe intraoperative technical tips in the OLP to improve M1 to M2 fusion, which may prevent complications. Since the Lapidus procedure continues to gain popularity, it is the authors opinion that the OLP requires special attention because it is a more technically demanding surgery compared to the MLP. Level of Evidence: Level V: Expert opinion

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Correlation of first metatarsal sagittal alignment with clinical and functional outcomes following the Lapidus procedure

Cited by 6 publications

References 24 publications

Inter- and intraobserver reliability of the first metatarsal sagittal alignment measurements

Inter- and intraobserver reliability of the first metatarsal sagittal alignment measurements

Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study

Intraoperative Technical Tips to Improve Fusion Between the First and Second Metatarsals in the Original Lapidus Procedure

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