Stiffness and Range of Motion After Minimally Invasive Chevron-Akin and Open Scarf-Akin Procedures

Abstract

Background: Stiffness after open hallux valgus surgery affects 7% to 38% of patients. Minimally invasive surgery (MIS) is thought to decrease this rate by reducing soft tissue trauma. MIS, now in its third generation, is advertised as delivering results superior to open surgery. However, no studies have reported stiffness or range of motion (ROM). Methods: Between January 2014 and December 2015, a total of 50 patients received open scarf-Akin surgery and 48 received minimally invasive Chevron Akin (MICA) surgery. The endpoints were American Orthopaedic Foot & Ankle Society (AOFAS) score, range of motion, visual analog scale for pain, scar length, and subjective foot value. The minimal follow-up time was 2 years. Results: Moderate stiffness occurred in 3 cases in both groups. In MICA, extension increased by 10 degrees while it remained unchanged in scarf. Both groups showed similar improvements in AOFAS score, pain, and subjective foot value. Radiographic evidence of correction was comparable, except for an increased shortening of the first metatarsal by 3 mm in MICA. The scars were smaller in MICA (1.2 cm) than in scarf (5 cm). Wound problems included delayed healing in 10% in scarf and wound infections in 4% in MICA. The rate of recurrence and other complications were comparable, except for reoperations, which were higher in MICA (27% mainly for protruding screws) than in scarf (8% mainly for stiffness). In MICA, 14% were intraoperatively converted to open surgery. Conclusion: MICA showed no advantages over scarf other than a shorter scar. The observed gain in extension could be related to the increased shortening of the first metatarsal because of the size of the burr. Level of Evidence: Level II, prospective cohort (nonrandomized, comparative) study.

Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus

“…However, 14% of the MICA procedures were intraoperatively converted to open surgery. 14 It should be emphasized that the authors of the above studies compare different operative techniques associated with employment of various types of implants. Moreover, when evaluating the results, one should take into consideration the surgeon’s experience in performing percutaneous procedures.…”

“…The literature on the subject includes reports comparing the MIS and open methods in operative hallux valgus treatment. 14,22,23 Nevertheless, to date, no study has been published that compared 2 different stabilization methods as employed in the course of percutaneous correction of hallux valgus.…”

Minimally invasive Chevron-Akin osteotomy

“…While there are some studies demonstrating the promising results of the MICA technique (12)(13)(14) , there is still a lack of scientific evidence proving its superiority over traditional procedures (11) . Moreover, some authors still question the procedure's advantages and reproducibility (15) . It is also important to point out that although there are some case reports using the technique in the literature (12)(13)(14) the majority of authors, including those who have criticized the technique in their papers (15) , included modified versions of the procedure and did not reproduce the technique as originally described by Redfern and Vernois (10) .…”

Response to “Letter Regarding: Stiffness and Range of Motion After Minimally Invasive Chevron-Akin and Open Scarf-Akin Procedures”

“…Our study is the first in the world addressing range of motion (ROM) in MIS vs open hallux valgus surgery. 4 The study shows that the claim that ROM performs better for minimally invasive chevron akin (MICA) is false (see our table 3). In our study, the plantarflexion of the MICA group was significantly greater than for scarf, both preoperatively and postoperatively.…”