Five-Year Follow-up of Minimally Invasive Distal Metatarsal Chevron Osteotomy in Comparison with the Open Technique

Abstract

Background: The aim of the present prospective randomized study was to evaluate the long-term outcomes of minimally invasive chevron osteotomy as compared with open distal chevron osteotomy for the correction of hallux valgus deformity. Methods: A randomized controlled design was applied. The following parameters were assessed at 6 and 12 weeks, 9 months, and 5 years postoperatively: the American Orthopaedic Foot & Ankle Society (AOFAS) Forefoot Score, a visual analog scale (VAS) score for pain, and a patient-satisfaction score. In addition, several radiographic parameters for hallux valgus correction and joint degeneration were collected. Range of motion was also assessed. Thirty-nine of 47 feet were available for analysis at the time of the latest follow-up. Results: During the 5-year study period, the outcomes of the minimally invasive technique were comparable with those of the open technique. No significant differences were seen between the 2 groups within 5 years postoperatively in terms of clinical outcomes (VAS, AOFAS, satisfaction), radiographic outcomes, joint degeneration, or range of motion. Conclusions: Five years after treatment, the outcome following minimally invasive distal chevron osteotomy is comparable with that for the open technique for hallux valgus surgery. Levels of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Outcomes and Surgical Strategies of Minimally Invasive Chevron/Akin Procedures

“…Kaufmann et al 13 looked at long-term outcomes (5-year follow-up) with minimally invasive bunion surgery; they performed a randomized controlled trial comparing 25 open chevron procedures to 19 minimally invasive chevron procedures. Of note, the fixation method for the MIS bunion patients was a single 1.2-mm K-wire that was left under the skin.…”

“…The MICA technique has been well described. 13 The mini C-arm machine was positioned on the right side of the patient and an optional calf tourniquet was placed high on the calf; placement low on the calf has been seen to impinge on the angle needed for proper pin/drill placement. Regional anesthesia (ankle or popliteal block) along with intravenous sedation was administered.…”

Midterm Results Following Minimally Invasive Distal Chevron Osteotomy: Comparison With the Minimally Invasive Reverdin-Isham Osteotomy by Means of Meta-analysis

“…Outcome parameters. For all examined patients clinical outcome in terms of 1) range of motion (ROM) of the first metatarsophalangeal joint, categorized in three groups (group 1: ROM <30˚; group 2: ROM 31˚-75˚; group 3: ROM >75˚), 2) a pain score (visual analogue scale -VAS 0-10), 3) and the AOFAS (American Orthopaedic Foot & Ankle Society) Forefoot Scale was assessed as it has been described previously (14,15). Radiographic outcome was measured on weightbearing radiographs in digital manner using the Icoview software (syngo.share, ITH icoserve healthcare GmbH, Siemens, Innsbruck, Austria) in the form of a single researcher single measurement approach (MB).…”

“…The corrective power and its stability, as well as the clinical outcome of different MIS techniques are discussed controversially to date (11)(12)(13). Recently, two prospective randomized studies comparing the MIS and the open distal chevron osteotomy were published with comparable clinical and radiographic outcomes after short-and long-term followup (14,15). Whereas most studies presented good clinical and radiological results (9,(14)(15)(16), the group of Crespo-Romero found insufficient radiographic hallux valgus angle (HVA) correction (17).…”

“…Recently, two prospective randomized studies comparing the MIS and the open distal chevron osteotomy were published with comparable clinical and radiographic outcomes after short-and long-term followup (14,15). Whereas most studies presented good clinical and radiological results (9,(14)(15)(16), the group of Crespo-Romero found insufficient radiographic hallux valgus angle (HVA) correction (17). Nevertheless, in various systematic review studies of MIS hallux valgus correction a clear recommendation could not be made although early results were encouraging (18)(19)(20)(21)(22).…”