Lateral Column Lengthening For Flexible Adult Acquired Flatfoot: Systematic Review and Meta-Analysis

Modha, Ravi Krishān; Kilmartin, Timothy E.

doi:10.1053/j.jfas.2021.02.015

Cited by 11 publications

(9 citation statements)

References 32 publications

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“…The most common minor complications we encountered were sinus tarsi syndrome (2.7%), lateral column overload (4.2%), and development of adjacent joint arthritis (2.7%). Within the available literature on all LCL grafts, there is a correlation between larger graft sizes and the incidence of lateral column pain and CCJ arthritis [6,23,[28][29][30][31]. The findings of this systematic review of PTW for LCL demonstrate a similar complication rate and similar non-union rate as previously published data on allograft or autograft wedges.…”

Section: Discussionsupporting

confidence: 63%

Outcomes and Complications Associated with Lateral Column Lengthening Using Porous Titanium Wedges for Flexible Flatfoot Deformity Correction: A Systematic Review

Zachary P,

Joseph R,

Ross T

et al. 2024

Int J Foot Ankle

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Numerous graft materials have been utilized and described to achieve deformity correction in lateral column lengthening procedures (LCL) including autograft, allograft, xenograft, and porous titanium wedges (PTW). PTWs offer a potentially advantageous substitute for traditional grafts. Evidence regarding outcomes and complications of these grafts remains limited. This systematic review aims to describe functional outcomes and complications associated with LCL using PTWs. A standard methodology for performing a systematic review was followed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. PubMed, Google Scholar, OVID, Embase, and Cochrane were searched. Publications with 1-year follow-up and LCLs performed with PTWs were included. Non-English articles and those that did not perform LCL with PTWs were excluded. 508 articles were identified. 7 studies met the inclusion criteria following our review. 246 LCLs (236 patients) using PTWs were reported. The Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL) score measured at 80.45 (80.0-80.9) post-operatively. FAAM Sports subscale measured at 58.5 (50.0-66.9) postoperatively. VAS pain score decreased from 5.45 (5.0-5.9) pre-operatively to 2.43 (1.6-3.0) post-operatively. The total complication rate was found to be 15.2% (36/236). Major complications including non-union, reoperation, deep infection, and chronic regional pain syndrome (CRPS) were 2.1% (5/236). The evidence from this systematic review suggests that LCL with PTWs can be an effective and viable option for correcting flexible flatfoot deformities. The use of PTWs appears to offer comparable functional results and complication rates to traditional allograft or autograft wedges.

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Section: Discussionsupporting

confidence: 63%

Outcomes and Complications Associated with Lateral Column Lengthening Using Porous Titanium Wedges for Flexible Flatfoot Deformity Correction: A Systematic Review

Zachary P,

Joseph R,

Ross T

et al. 2024

Int J Foot Ankle

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“…17,18,21,22 Surgeries usually include realignment using corrective osteotomies and soft tissue tensioning. 15,23,26 Lateral column lengthening (LCL) is one of the most frequently used osteotomies in PCFD alignment correction. 7,23 The original surgical technique described by Evans (E-LCL) consists of a calcaneal osteotomy that begins 10-14 mm proximal from the calcaneal cuboid joint.…”

Section: Introductionmentioning

confidence: 99%

“…15,23,26 Lateral column lengthening (LCL) is one of the most frequently used osteotomies in PCFD alignment correction. 7,23 The original surgical technique described by Evans (E-LCL) consists of a calcaneal osteotomy that begins 10-14 mm proximal from the calcaneal cuboid joint. 11 It runs parallel to the joint and crosses between the middle and anterior articular surfaces.…”

Section: Introductionmentioning

confidence: 99%

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Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening

Efrima,

Barbero,

Ramalingam

et al. 2023

Foot Ankle Int.

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Background: Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets and endangers specific os calcis subtalar joint (OCST) subtypes without distinct facets. H-LCL is oriented between the posterior and middle facets and should be suitable for all OCSTs. Both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between 2 articular surfaces represented by color patterns. This study aims to measure the safe zones for LCL using 3-dimensional (3D) models and DM; we hypothesize that it could be measured with high reproducibility. Methods: Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. Four angles were measured independently. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies; similarly, the proximal and distal extents of the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. Consequently, the surface available for safe osteotomies were calculated. An interclass correlation was used to assess the agreement between the 2 raters. Additionally, analysis of variance and Mann-Whitney U test were used to compare the safe zones between OCSTs. Results: The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees from a line parallel to the lateral border of the calcaneus, respectively, and the proximal and distal extent of the ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. There were no statistically significant differences between the OCSTs. Two raters measured the angles with good to excellent interrater and intrarater agreement. In 18 cases, we were unable to plan for H-LCL or E-LCL osteotomies. Conclusion: Distance mapping could be used to measure the safe zone, tailor a preoperative plan, and potentially reduce the risk for iatrogenic damage in LCL. 3D models and DM can increase the reliability of preoperative plans in bones with complex 3D structures. Level of Evidence: Level III, retrospective comparative study.

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“…Surgical management of Johnson and Strom’s 3 , 13 , 14 type IIB AAFD varies among surgeons. Lateral column lengthening (LCL) osteotomy, described initially by Evans in 1975, 9 , 20 , 25 is the standard joint-sparing surgical option for correcting the forefoot abduction. The osteotomy site is traditionally filled with iliac crest autograft or allograft.…”

Section: Introductionmentioning

confidence: 99%

Radiographic Outcomes of Titanium Augment vs Bone Graft in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity

Stamatos

Murasko

Richardson

et al. 2023

Foot & Ankle Orthopaedics

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Background: Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction and, in theory, also increases the longitudinal arch by plantarflexion of the first ray through tensioning the peroneus longus for patients with stage IIB adult acquired flatfoot deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus, which is then filled with autograft, allograft, or a porous metal wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes following LCL for stage IIB AAFD. Methods: We conducted a retrospective review of all patients who underwent LCL from October 2008 until October 2018. Preoperative weightbearing radiographs, initial postoperative radiographs, and 1-year weightbearing radiographs were reviewed. The following radiographic measurements were recorded: incongruency angle, talonavicular coverage angle (TNCA), talar–first metatarsal angle (T-1MT), and calcaneal pitch. Results: A total of 44 patients were included in our study. The mean age of the cohort was 54 (range, 18-74). The study cohort was divided into 2 groups. There were 17 (38.7%) patients who received a titanium metal wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (59 vs 47 years old, P = .006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (32 vs 27 degrees, P = .013). There were no significant differences in postoperative TNCA, incongruency angle, or calcaneal pitch at 6 months or 1 year. Conclusion: At 6 months and 1 year, no radiographic differences were found between autograft/allograft bone substitutes vs titanium wedge in LCL. Level of Evidence: Level III, retrospective cohort study.

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Lateral Column Lengthening For Flexible Adult Acquired Flatfoot: Systematic Review and Meta-Analysis

Cited by 11 publications

References 32 publications

Outcomes and Complications Associated with Lateral Column Lengthening Using Porous Titanium Wedges for Flexible Flatfoot Deformity Correction: A Systematic Review

Outcomes and Complications Associated with Lateral Column Lengthening Using Porous Titanium Wedges for Flexible Flatfoot Deformity Correction: A Systematic Review

Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening

Radiographic Outcomes of Titanium Augment vs Bone Graft in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity

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