Minimally invasive Chevron-Akin osteotomy

Abstract

Objective: To present the clinical and radiographic results of surgical treatment of patients with moderate to severe hallux valgus (HV) by minimally invasive Chevron - Akin osteotomy (MICA). Methods: The case series comprises 25 patients (30 feet) with diagnoses of moderate to severe HV treated surgically with the MICA technique. All patients answered the American Orthopedic Foot and Ankle Score (AOFAS) and rated pain on visual analogue scale (VAS) at preoperative assessment and at the last follow-up consultation. Radiological assessment included measurement of the valgus angles of the hallux (HVA) and the 1st and 2nd ray intermetatarsal angle (IMA). Complications and satisfaction ratings were also documented. Results: Mean follow-up was 14.6 months. Mean AOFAS increased from 42.8 to 90 and VAS reduced from 8.6 to 1.7. Mean HVA reduced from 31.7o to 8.4o and IMA from 14o to 5o. All these improvements were statistically significant (p<0.001). The most common complication observed was discomfort caused by hardware, affecting five feet (16.6%). Two patients (6.6%) had transitory neurapraxia and one patient (3.3%) developed reflex sympathetic dystrophy. There were no cases of infection, relapse, pseudarthrosis, or malunion of osteotomies. Subjective satisfaction ratings classified 93.3% of results as good or excellent. Conclusion: Minimally invasive Chevron-Akin osteotomy is a safe and reproducible technique that achieves good clinical and radiographic results for treatment of moderate to severe hallux valgus. Level of Evidence IV; Therapeutic Studies; Case Series.

Minimally Invasive Chevron-Akin for Correction of Moderate and Severe Hallux Valgus Deformities: Clinical and Radiologic Outcomes With a Minimum 2-Year Follow-up

“…We present similar results regarding the AOFAS hallux MTP-IP and VAS scores to the studies carried out by Nunes et al 52 in a recent study with 25 patients with a mean follow-up of 14.6 months, Chan et al 12 with a series of cases of 13 feet but with an average follow-up of 48 months. and Holme et al 25 in a study with 40 patients and a 12-month follow-up.…”

“…In 14.28% of the cases (10 feet), it was necessary to remove the painful screws in the first 6 months after surgery, with complete resolution of pain after the removal procedure. This same type of complication was reported by Nunes et al 52 and Robinson and Lam. 57 with removal of the painful hardware allowing complete improvement of the clinical condition.…”

“…Our clinical results compared positively with previous studies in the literature in the initial postoperative scores and show that good results are maintained in the long term when compared to studies with long follow-up. 7,12,25,37,52,63…”

“…The mean values of preoperative IMA and HVA and correction of postoperative deformity in this study were comparable to studies carried out in other studies (Table 4). 7,10,23,25,29,41,46,50,52…”

“…These screws sit flush against the bone (Figure 2), reducing the likelihood of irritation of the soft tissues and allowing the surgeon to verify proper screw position against the medial cortex using intraoperative fluoroscopy. 25,52,55,57…”