The percutaneous learning curve of 3rd generation minimally-invasive Chevron and Akin osteotomy (MICA)

Toepfer, Andreas; Strässle, Michael

doi:10.1016/j.fas.2022.07.006

Cited by 25 publications

(21 citation statements)

References 47 publications

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“…Overall, studies have reported similar outcomes with effective deformity correction, short learning curve, low complication rate, low symptomatic recurrence, low postoperative opioid use, and high patient satisfaction. 3,9,[11][12][13][14][15]17,18,22 Although this study focused on a third-generation technique with rigid, permanent fixation, there are multiple techniques for the percutaneous Akin throughout the Reports of undesired lateral cortex fracture are ubiquitous throughout the literature. 1,[7][8][9] Lateral hinge fractures have been thought to contribute to osteotomy instability and secondary displacement.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The mean IPA in the unfractured group improved from 13.9 (11)(12)(13)(14)(15)(16)(17) degrees to 3.9 (3-8) degrees postoperatively. In the group with lateral cortex fracture, the mean first-to-second IMA angle preoperatively was 13.3 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) degrees and improved postoperatively to 3.8 (1-6) degrees. The preoperative HVA was 29.3 degrees and improved to 7.1 (4-12) degrees postoperatively.…”

Section: Primary Outcomesmentioning

confidence: 92%

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Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Marciano,

Ashinsky,

Mysore

et al. 2023

Foot Ankle Int.

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Background: Intraoperative fracture of the lateral cortex is common during Akin osteotomy. In a recent study, lateral cortex fracture did not impede healing or result in loss of correction in a combined cohort of open and percutaneous osteotomies stabilized by K-wire fixation. We hypothesize that undesired lateral cortex fracture will not affect radiographic correction and patient-reported outcomes in a percutaneous cohort stabilized by permanent, rigid screw fixation. Methods: Consecutive patients with hallux valgus who underwent first metatarsal osteotomy and percutaneous Akin osteotomy stabilized by permanent, rigid screw fixation between May 2020 and January 2022 were retrospectively reviewed. Patients were stratified based on fractured lateral cortex (FC) or its absence (nonfractured cortex [NFC]). Visual analog scale (VAS) and Foot Function Index (FFI) were used to assess pain and patient-reported outcomes at 1-year follow-up. Patients were polled for satisfaction at 1-year follow-up by yes/no survey. Results: Ninety-eight patients (89% female) were reviewed (98 feet; 43 NFC, 55 FC). Mean age was 48.3 years (range, 18-83 years). Mean preoperative VAS score was 7.5 and 7.7 in NFC and FC groups, which significantly decreased to 0.6 ( P < .01) and 0.6 ( P < .01), respectively. Mean total FFI was 53.9 and 54.2 and decreased to 17.9 ( P < .01) and 17.2 ( P < .01) in the NFC group and FC group, respectively. Overall, 97.8% of the NFC group and 96.4% of the FC group reported satisfaction. Mean HVA improved from 27.2 (16-42) degrees to 10.7 degrees (4-12) postoperatively in the NFC group. And in the FC group, HVA improved from 29.3 (19-39) degrees to 7.1 (4-12) degrees postoperatively. Postoperative HVA was significantly lower in the FC group ( P < .05). Conclusion: In an exclusively percutaneous surgical cohort with correction maintained by rigid screw fixation, fracture of the lateral cortex is associated with improved postoperative radiologic alignment without detriment to patient-reported outcomes. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Primary Outcomesmentioning

confidence: 92%

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Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Marciano,

Ashinsky,

Mysore

et al. 2023

Foot Ankle Int.

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“…Minimally invasive hallux valgus correction is a technically demanding procedure and has a steep learning curve. 36,37 This curve may be flattened by surgeon training and lab practice. Recently, a number of orthopedic implant companies have released intraoperative guides that may facilitate deformity correction and hardware placement.…”

Section: Possible Concerns Future Of the Techniquementioning

confidence: 99%

Fourth Generation Hallux Valgus Correction

Acevedo,

Garcia,

Queen

et al. 2023

Techniques in Foot &Amp; Ankle Surgery

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The surgical method described in this paper has shown numerous benefits when compared with traditional minimally invasive surgery (MIS) techniques for the correction of hallux valgus. Although modern, third-generation MIS techniques have been widely adopted for this purpose due to perceived improvements in patient outcomes, those can be largely attributed to the incorporation of a novel system of rigid internal fixation allowing for a reduced risk of surgical complications. By incorporating the second-generation MIS technique of transverse osteotomy with third-generation fixation techniques, the authors have been able to devise a hybrid, fourth-generation MIS technique that shows improvements both in terms of patient recovery and ease of surgical operation. Level of Evidence: The mechanism-based reasoning used in this study classifies it as diagnostic level V in accordance with the OCEBM 2011 Levels of Evidence. For a complete description of levels of evidence, see Instructions for Authors.

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“…Classically, distal and diaphyseal osteotomies are used for mild to moderate deformities; the remaining deformities can be corrected with proximal osteotomies or a modified Lapidus arthrodesis. The minimally invasive Chevron/Akin osteotomy (MICA) is a modern, third-generation MIS (minimally invasive surgery) procedure [2,3,15,16]. Due to the possibility of extreme displacement of the first metatarsal head (MTH), the indication for MICA can be expanded to correct even severe hallux valgus deformities [18].…”

Section: Introductionmentioning

confidence: 99%

The distal metatarsal screw is not always necessary in third-generation MICA: a case–control study

Harrasser

Hinterwimmer

Baumbach³

et al. 2022

Arch Orthop Trauma Surg

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Introduction To evaluate the clinical and radiological results after fixation of the first metatarsal head (MTH) with one or two screws as part of the third-generation minimally invasive Chevron–Akin osteotomy (MICA) for hallux valgus deformities. Materials and methods Between August 2020 and November 2021, 55 MICA procedures (50 patients, male:female = 7:43), 22 with two (MICA2), 33 with one screw (MICA1) were performed for mild to severe hallux valgus deformities. Exclusion criteria were a concomitant pes adductus (Sgarlato angle > 20°) or hindfoot/midfoot deformities requiring treatment. In 27 cases, additional procedures on the forefoot (small toe corrections or metatarsal osteotomies II–V) were necessary. Pre- and post-operatively, hallux valgus angle (HVA) and intermetatarsal I/II angle (IMA) were measured. Clinically, subjective satisfaction, range of motion (ROM) of the first metatarsophalangeal joint (MTPJ), and pain level (NRS score) were evaluated. The minimum follow-up was 12 months. Results Displacement of MTH was 70–90% on average, all osteotomies showed full consolidation at latest follow-up. In one case of either group, a slight subsidence of MTH was documented. The radiological and clinical parameters showed no differences between the groups. The pain level improved by an average of three points. The mobility of the MTPJ showed a slight reduction in nine cases after three months (4 MICA2, 5 MICA1) which persisted in three cases. Fifty-two of 55 patients (95%) would opt again for the operation. Conclusions Fixation of the first MTH with a single bicortical screw in MICA with moderate lateralization of MTH shows stable anchoring and good clinical results. The routine use of a second metatarsal screw can be omitted.

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The percutaneous learning curve of 3rd generation minimally-invasive Chevron and Akin osteotomy (MICA)

Cited by 25 publications

References 47 publications

Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Fourth Generation Hallux Valgus Correction

The distal metatarsal screw is not always necessary in third-generation MICA: a case–control study

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