Percutaneous Triple and Double Osteotomies for the Treatment of Hallux Valgus

Fernández, Rodrigo Díaz

doi:10.1177/1071100716670403

Cited by 18 publications

(14 citation statements)

References 42 publications

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“…Minimally invasive surgery (MIS), also known as percutaneous surgery, has experienced a sustained growth for the treatment of foot and ankle problems, especially over the last decade. This is supported by numerous studies including clinical series, 3,5,6,8,11,15,18,20,28,33 comparative studies, 7,22,23,38 technical reports 27,41 and radiologic validations. 17…”

mentioning

confidence: 69%

“…Although some MIS procedures do not appear to need lateral release, 4,15,24,26 others only perform the adductor tenotomy and a partial lateral capsule release. 11,34 The precise indications for those who can benefit from this procedure remain a matter of discussion. 7,25 In addition, it should be defined which patients need an adductor tendon release and which ones require an extended lateral release.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

Vecchio

Ghioldi

Uzair³

et al. 2019

Foot Ankle Int.

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Background: Percutaneous surgery is experiencing sustained growth based on third-generation techniques. This cadaveric study was designed with the main goal of exploring the risk of iatrogenic tendon and neurovascular lesions and defining the safe zones in a percutaneous, intra-articular, chevron osteotomy (PeICO) procedure, as well as assessing the accuracy of the osteotomy itself. Methods: Eight feet from below-knee fresh-frozen specimens were selected. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The results of the safety measurements were as follows: (1) distance between portal 1 (P1) and the lateral border of the extensor hallucis longus (EHL) tendon: average 17.6 mm (range 12.7-21.3); (2) distance between P1 and the dorsomedial digital nerve (DMDN): average 7.2 mm (range 1.6-10.4); (3) distance between P1 and the metatarsophalangeal joint: average 15.7 mm (range 9.4-20.5); distance between portal 2 (P2), or the osteosynthesis portal, and the metatarsophalangeal joint: average 25.5 mm (range 22-30.4); distance between P2 and the lateral border of the EHL tendon: average 12.7 mm (range 8-16.7); and distance between P2 and the DMDN: average 4.1 mm (range 1.7-8.2). There were no iatrogenic injuries. The osteotomy angulation in the sagittal plane (reproducibility) average was 85.6 degrees. Conclusion: There were no iatrogenic injuries on this cadaveric study of PeICO. Clinical Relevance: This study will help orthopedic surgeons understand the risks of performing percutaneous surgery by mimicking an accepted open technique (chevron).

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mentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

Vecchio

Ghioldi

Uzair³

et al. 2019

Foot Ankle Int.

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“…There is growing interest in the use of minimally invasive surgical techniques (MIS) for the treatment of hallux valgus (HV), with an increasing number of published studies including clinical series, radiologic validations, cadaveric studies, comparative studies, and technical reports on MIS techniques. 1,4,[8][9][10][15][16][17][18][19][20][21]23,[26][27][28][29][30][31][32][33][34][35][36][39][40][41][42][43]45,55,[59][60][61][62][63][64]66,70 Five recent systematic reviews concluded that MIS is a safe and reliable technique for hallux valgus correction. 6,11,28,44,65 Among the procedures to treat HV, the distal chevron metatarsal osteotomy was first described in 1962 and remains a widely accepted technique.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background: The minimally invasive chevron-Akin (MICA) technique has already demonstrated efficacy compared with other known surgical treatments for mild to moderate hallux valgus (HV). MICA combines percutaneous osteotomies with the benefits of modern, rigid internal fixation. The aim of study was to evaluate the radiographic parameters, clinical improvement, and potential complications in moderate to severe HV cases, operated using the MICA technique. Methods: Retrospective study including 70 feet with HV operated using the MICA technique. The AOFAS hallux MTP-IP score and radiographics for HV evaluation were applied preoperatively, and after 6 months, 1 year, and 2 years of follow-up. The following radiographic parameters were measured: metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), interphalangeal angle (IPA), and intermetatarsal angle (IMA). Results: The average preoperative VAS pain score was 8.2 ± 1.5, which improved to 1.2 ± 2.2 at 24 months. The mean preoperative IMA was 14.8 ± 3.6 degrees compared with a mean of 7.5 ± 2.1 degrees ( P < .01) at 24 months. The preoperative HVA value averaged 30.4 ± 9.8 degrees and at 6 months postoperatively 11.1 ± 6.8 degrees ( P < .01), which remained stable until measured at 24 months. The mean preoperative DMAA was 16.3 ± 8.6 degrees and at the 6-month follow-up was 7.8 ± 5.4 degrees ( P < .01). The mean preoperative IPA was 7.63 ± 4.4 degrees compared with a mean of 6.28 ± 3.5 degrees ( P > .05) at 24 months. Complications included painful hardware (14.28%), neuropathic pain (2.85%), and loss of correction (4.28%). Conclusion: In this retrospective review from a single center, we found the MICA technique to be an effective procedure for correcting moderate to severe HV, with a low rate of recurrence and an acceptable rate of complications. Patients undergoing the surgical procedure in our series showed a significant reduction in radiographic parameters and a significant improvement in clinical scores, maintaining these results over time. Level of Evidence: Level IV, retrospective study.

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“…The most important finding of the study was that the MI LR of the first MTP joint was a safe and reliable technique that was performed in cadavers without damaging any neurovascular structures or articular cartilage. Both the PATR and EPLR techniques aimed to release the adductor tendon, and they were successful in doing so without a significant Carvalho et al, 7 Martínez Nova et al, 30 Kurashige et al 22 Adductor hallucis tendon Biz et al, 4 Díaz Fernández, 15 Martinez Nova et al, 31 Cervi et al, 8 Pichierri et al 34 Adductor hallucis tendon and partial lateral capsule Scala et al 35 Phalangeal head of adductor tendon and adherences between lateral sesamoid and plantar side of the capsule De Lavigne et al 12 Adductor tendon, plantar capsule, and transverse metatarsal ligament Lee et al 23 Lateral part of the plantar plate and lateral phalangeal-sesamoid ligament Gicquel et al 18 Lateral phalangeal-sesamoid ligament and both medial and lateral suspensory ligaments Jowett et al 21 Lateral phalangeal-sesamoid ligament Lucas et al, 26 Crespo Romero et al, 10 Siclari et al, 37 Brogan et al 6 Not specified during technique description Bauer et al, 2,3 Di Giorgio et al 16 "Abductor" tendon transverse head and capsule difference (P = .85). The PATR was successful in achieving a complete release of the tendon, whereas the EPLR achieved a three-fourths release in most of the cases.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Study of Minimally Invasive Lateral Release Techniques for Hallux Valgus Treatment

et al. 2020

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Background: Lateral release (LR) for the treatment of hallux valgus is a routinely performed technique, either by means of open or minimally invasive (MI) surgery. Despite this, there is no available evidence of the efficacy and safety of MI lateral release. Our aim was to study 2 popular techniques for MI LR in cadavers by subsequently dissecting the released anatomical structures. Methods: Twenty-two cadaveric feet were included in the study and allocated into 2 groups, 1 for each procedure: 1 group underwent a MI adductor tendon release (AR), and in the other group, an extensive percutaneous lateral release (EPLR) (adductor tendon, suspensory ligament, phalanx-sesamoid ligament, lateral head of flexor hallucis brevis, and deep transverse metatarsal ligament) was performed. Anatomical dissection was performed to identify neurovascular injuries and to verify the released structures. Results: Both techniques demonstrated to be effective in reproducing a MI LR. A satisfactory release of the adductor tendon was achieved equally in both techniques ( P = .85), being partial in most EPLR cases and full in the majority of AR cases. The EPLR was successful in releasing the intended additional structures ( P < .05). One case of inadvertent complete section of the flexor hallucis longus was identified in the percutaneous adductor tendon release group. No cases of dorsolateral nerve injury were seen with either of the techniques. Conclusion: Percutaneous lateral release was a reliable and accurate technique in this cadaveric model. The MI AR proved to be more effective in fully releasing the adductor tendon while the ER was intended and able to release a number of other structures. Clinical Relevance: MI LR is a safe procedure that could obviate the need for open surgery to achieve the same surgical goal. It can be associated to either open or MI osteotomies in the correction of hallux valgus.

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Percutaneous Triple and Double Osteotomies for the Treatment of Hallux Valgus

Abstract: Level IV, retrospective case series.

Cited by 18 publications

References 42 publications

Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

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

Anatomical Study of Minimally Invasive Lateral Release Techniques for Hallux Valgus Treatment

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