Time To Maximum Clinical Improvement Following Minimally Invasive Chevron And Akin Osteotomies (MICA) in Hallux Valgus Surgery

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

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Letter Regarding: Biomechanical Comparison of 2 Common Techniques of Minimally Invasive Hallux Valgus Correction

Foot & Ankle International ◽

10.1177/1071100721992753 ◽

2021 ◽

Vol 42 (3) ◽

pp. 381-382

Author(s):

Thomas L. Lewis ◽

Robbie Ray ◽

Peter Robinson ◽

Paul M. C. Dearden ◽

Thomas J. Goff ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Biomechanical Comparison

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Minimally invasive Hallux valgus Correction with Internal Hallux Fixator® - A comparative Cadaver Study

Foot and Ankle Surgery ◽

10.1016/j.fas.2021.05.002 ◽

2021 ◽

Author(s):

Natalia Gutteck ◽

Melina Ulbricht ◽

Karl-Stefan Delank ◽

Heike Kielstein ◽

Sebastian Schilde

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Cadaver Study

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Short-term, Retrospective Radiographic Evaluation Comparing Pre- and Postoperative Measurements in the Chevron and Minimally Invasive Distal Metatarsal Osteotomy for Hallux Valgus Correction

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2021.04.019 ◽

2021 ◽

Author(s):

Noman A. Siddiqui ◽

Brittany E. Mayer ◽

Jessica N. Fink

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Radiographic Evaluation ◽

Metatarsal Osteotomy ◽

Short Term ◽

Distal Metatarsal Osteotomy

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Risk of Damaging Anatomical Structures During Minimally Invasive Hallux Valgus Correction (Bösch Technique): An Anatomical Study

Foot & Ankle International ◽

10.1177/1071100718786883 ◽

2018 ◽

Vol 39 (11) ◽

pp. 1355-1359 ◽

Cited By ~ 7

Author(s):

Martin Kaipel ◽

Lukas Reissig ◽

Lukas Albrecht ◽

Stefan Quadlbauer ◽

Joachim Klikovics ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Complication Rate ◽

Metatarsal Osteotomy ◽

Anatomical Structures ◽

Intensive Training ◽

Increased Risk ◽

Significant Difference ◽

Group A ◽

Group B

Background: Percutaneous, transverse distal metatarsal osteotomy with K-wire fixation (the Bösch technique) is an established technique for hallux valgus correction. Nevertheless, the risk of damaging the anatomical structures during the operation is unknown. Methods: Forty fresh-frozen anatomical foot specimens with hallux valgus deformity underwent a percutaneous corrective procedure. Specimens of group A (n = 20) were operated by an experienced surgeon while specimens of group B (n = 20) were done by untrained residents. Results: The dorsal cutaneous nerve was injured in 1 of 20 cases in group A and 6 of 20 cases in group B ( P = .037). There was a significant difference in overall complication rate between specimens of group A and group B ( P = .043). Conclusions: The results show an increased risk of perioperative injury of the dorsal cutaneous branch of the deep peroneal nerve as well as a significant effect of the surgeon’s experience on the overall complication rate. Clinical Relevance: Results of this study are highly relevant for all surgeons who perform percutaneous, minimally invasive hallux valgus surgery to avoid damage to the peripheral nerves. In addition, the data suggest an intensive training for surgeons before minimally invasive hallux valgus surgery is performed without supervision.

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Minimally Invasive Hallux Valgus Correction, Perspective 1

Minimally Invasive Surgery in Orthopedics ◽

10.1007/978-3-319-15206-6_71-1 ◽

2015 ◽

pp. 1-11

Author(s):

Sandro Giannini ◽

Roberto Bevoni ◽

Francesca Vannini ◽

Matteo Cadossi

Keyword(s):

Minimally Invasive ◽

Hallux Valgus

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Hallux Valgus Surgery: The Minimally Invasive Bunion Correction

Minimally Invasive Surgery in Orthopedics ◽

10.1007/978-1-4614-0893-2_17 ◽

2011 ◽

pp. 129-139

Author(s):

Sandro Giannini ◽

Roberto Bevoni ◽

Francesca Vannini ◽

Matteo Cadossi

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Bunion Correction

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Third-Generation Minimally Invasive Chevron-Akin Osteotomy for Hallux Valgus Produces Similar Clinical and Radiological Outcomes as Scarf-Akin Osteotomy at 2 Years: A Matched Cohort Study

Foot & Ankle International ◽

10.1177/10711007211049193 ◽

2021 ◽

pp. 107110072110491

Author(s):

Adriel You Wei Tay ◽

Graham S. Goh ◽

Kevin Koo ◽

Nicholas Eng Meng Yeo

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Physical Component Score ◽

Control Group ◽

Component Score ◽

Vas Score ◽

Sf 36 ◽

Significant Difference ◽

Akin Osteotomy ◽

New Generation

Background: The minimally invasive chevron-Akin (MICA) osteotomy is an increasingly popular technique for the correction of hallux valgus. However, there is a paucity of literature comparing it with traditional open techniques. The purpose of this study was to compare the clinical and radiological outcomes of the MICA osteotomy using a new-generation MICA screw and scarf-Akin osteotomy for hallux valgus correction. Methods: Thirty cases of MICA osteotomy were propensity score matched 1:1 with a control group of 30 scarf-Akin osteotomy cases. The groups were matched for age, sex, body mass index, preoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal-interphalangeal (MTP-IP) score, 36-Item Short-Form Health Survey (SF-36) physical component score (PCS) and mental component score (MCS), preoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), and concomitant procedures. Outcomes were compared at 6 and 24 months postoperatively. Early postoperative VAS scores were also compared. Results: Both groups demonstrated significant improvements in VAS score, AOFAS score, and SF-36 PCS and MCS at 6 and 24 months postoperatively. For the MICA group, HVA improved from 23.5 to 7.7 degrees, and IMA improved from 13.5 to 7.5 degrees. For the scarf-Akin osteotomy group, HVA improved from 23.7 to 9.3 degrees, and IMA improved from 13.6 to 7.8 degrees. The first 24-hour postoperative VAS score was significantly lower in the MICA group compared with the scarf-Akin group (2.0 ± 2.0 vs 3.4 ± 2.6, P = .029). However, there was no significant difference in clinical or radiological outcomes between the groups at 6 and 24 months. Conclusion: The MICA procedure with the new-generation MICA screw is an attractive option for the correction of hallux valgus, yielding similar midterm radiological and clinical outcomes compared with the well-established scarf-Akin osteotomy. The first 24-hour postoperative VAS score in the MICA group was also statistically lower, although its clinical significance remains to be determined. Level of Evidence: Level III, retrospective comparative study.

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