Radiographic Outcomes Following Lateral Column Lengthening With a Porous Titanium Wedge

Category: Hindfoot; Other Introduction/Purpose: While lengthening of the lateral column through a calcaneal neck osteotomy is an integral component of flatfoot reconstruction in younger patients with flexible planovalgus deformities, concern exists as to the effect of this intra- articular osteotomy on subtalar motion. The purpose of this study is to quantify the alterations in subtalar motion following lateral column lengthening (LCL). Methods: The subtalar motion of 14 fresh frozen cadaveric feet was assessed using a three-dimensional motion capture system and materials testing system (MTS). Following potting of the tibia and calcaneus, optic markers were placed into the tibia, calcaneus and talus. The MTS was used to apply a rotational force across the subtalar joint to a torque of 5Nm. Abduction/adduction, supination/pronation, and plantarflexion/dorsiflexion about the talus was recorded. Specimens then underwent LCL via a calcaneal neck osteotomy which was maintained with a 12mm porous titanium wedge. Repeat subtalar motion analysis was performed and compared to pre-LCL motion using a paired t-test. Results:: No statistically significant differences in subtalar abduction/adduction (10.9O vs. 11.8O degrees, p=.48), supination/pronation (3.5O vs. 2.7O, p=.31), or plantarflexion/dorsiflexion (1.6O vs 1.0O, p=.10) were identified following LCL. Conclusion:: No significant changes in subtalar motion were observed following lateral column lengthening in this biomechanical cadaveric study. While these findings do not obviate concerns of clinical subtalar stiffness following planovalgus deformity correction, they suggest that diminished postoperative subtalar motion may be due to soft tissue scarring rather than alterations of joint anatomy.

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A Retrospective Radiographic Evaluation of a Modified Method of Lateral Column Lengthening

Foot & Ankle Specialist ◽

10.1177/1938640020919187 ◽

2020 ◽

pp. 193864002091918

Author(s):

Keith Wapner ◽

Erik Freeland ◽

Gregory Kirwan ◽

Keith Baldwin

Keyword(s):

Weight Bearing ◽

Case Series ◽

Stage Ii ◽

Radiographic Evaluation ◽

Retrospective Case ◽

Lateral Column ◽

Modified Method ◽

Radiographic Outcomes ◽

Alternative Approach ◽

Lateral Column Lengthening

Background: Lateral column lengthening (LCL) is a commonly performed procedure for patients with stage II adult-acquired flatfoot deformity (AAFD) to correct forefoot abduction. This procedure is frequently completed concomitantly with both soft-tissue and bony procedures, including a medial slide calcaneal osteotomy to further reduce hindfoot valgus. The purpose of this study is to investigate and identify the radiographic outcomes of a modified step-cut LCL utilized as an alternative approach for correction of stage II AAFD. Methods: A retrospective radiographic review was performed on 15 feet in 14 patients who underwent correction of stage II AAFD using a step-cut LCL between August 2009 and January 2012. Two independent examiners utilizing 6 radiographic parameters evaluated preoperative and postoperative weight-bearing radiographs of the foot. Results: At a mean follow-up of 13.4 (range 12-16) weeks, weight-bearing radiographs demonstrated a significant median decrease in the lateral talometatarsal angle of 14.4° (P < .001), lateral talocalcaneal angle of 7° (P < .001), anteroposterior talometatarsal angle of 14.5° (P < .001), anteroposterior talocalcaneal angle of 5.5° (P < .001), and talonavicular coverage angle of 26.5° (P < .001). Additionally, a significant median increase in calcaneal pitch of 8.5° (P < .001) was noted. Conclusion: This study demonstrates statistically significant improvement of radiographic outcomes with use of a modified step-cut LCL as an alternative approach for correction of stage II AAFD. Levels of Evidence: Level IV: Retrospective case series

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Comparison of Radiographic Outcomes Between Dynamic Medial Column Stabilization and Lateral Column Lengthening

Foot & Ankle Orthopaedics ◽

10.1177/2473011416s00068 ◽

2016 ◽

Vol 1 (1) ◽

pp. 2473011416S0006

Author(s):

Woo-Chun Lee ◽

Ji-Beom Kim ◽

Young Yi ◽

Jae-Young Kim

Keyword(s):

Lateral Column ◽

Radiographic Outcomes ◽

Lateral Column Lengthening

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Do We Really Need to Worry About Calcaneocuboid Subluxation During Lateral Column Lengthening for Planovalgus Foot Deformity?

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00244 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0024

Author(s):

Brittany Hedrick ◽

Anthony Riccio ◽

Matthew Siebert ◽

Claire Shivers ◽

Mitchell Harris ◽

...

Keyword(s):

Articular Surface ◽

Three Dimensional ◽

Porous Titanium ◽

Ct Imaging ◽

Plain Radiography ◽

Matched Pair ◽

Cross Sectional ◽

Lateral Column ◽

Lateral Column Lengthening ◽

Rotatory Subluxation

Category: Midfoot/Forefoot; Other Introduction/Purpose: While lengthening of the lateral column through a calcaneal neck osteotomy is an integral component of flatfoot reconstruction in younger patients with flexible planovalgus deformities, the procedure has been implicated in iatrogenic calcaneocuboid (CC) subluxation and subsequent degenerative changes at the CC articulation. The purpose of this study is to characterize alterations at the CC joint following lateral column lengthening (LCL) as well as to determine if Steinman pin stabilization of the CC joint prior to distraction maintains a normal CC relationship. Methods: Seven matched pairs of fresh frozen cadaveric feet underwent pre-procedure plain radiography and cross-sectional computed tomography (CT) imaging. LCL via a calcaneal neck osteotomy was then performed. One foot of each matched pair had a single smooth Steinman pin placed centrally across the CC joint prior to osteotomy distraction. Distraction across each osteotomy was then performed and maintained with a 12mm porous titanium wedge. Repeat imaging was obtained and compared to pre-procedure studies to quantify sagittal and rotational differences at the CC articulation Results: Following LCL, plain radiography demonstrated statistically significant increases in the percentage of the calcaneal articular surface dorsal to the superior aspect of the cuboid in both the pinned (8.2% vs 17.6%, p=0.02) and unpinned (12.5% vs 16.3%, p=0.04) specimens. No difference in the percentage of subluxation was found between the two groups following LCL. CT imaging demonstrated statistically significant increases in rotation between the calcaneus and cuboid following LCL in both the pinned (7.6O +- 5.6O, p=0.01) and unpinned (17O +- 12.3O, p=0.01) specimens. Though a greater degree of rotation was present in the unpinned specimens following LCL, this difference was not statistically significant (p=0.28). Conclusion: Both sagittal and rotatory subluxation seem to occur at the CC joint following LCL regardless of pin stabilization. As a single pin would be expected to limit pure translation while having little effect on rotation, it is possible that the rotational changes identified on three-dimensional imaging are interpreted as dorsal translation when viewed two dimensionally using plain radiography. Consideration should therefore be given to CC stabilization with two pins during LCL to prevent this rotatory subluxation.

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Porous Titanium Wedges in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity

Foot & Ankle Specialist ◽

10.1177/1938640017735890 ◽

2017 ◽

Vol 11 (4) ◽

pp. 347-356 ◽

Cited By ~ 1

Author(s):

Spencer H. Moore ◽

S. Evan Carstensen ◽

M. Tyrrell Burrus ◽

Truitt Cooper ◽

Joseph S. Park ◽

...

Keyword(s):

Case Series ◽

Deformity Correction ◽

Porous Titanium ◽

Common Procedure ◽

Lateral Column ◽

Metatarsal Angle ◽

Valgus Angle ◽

Significant Correction ◽

Lateral Column Lengthening ◽

Adult Acquired Flatfoot Deformity

Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult-acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 to October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo–first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was measured. Patients were followed from a minimum of 6 months up to 4 years (mean 16.1 months). Postoperative radiographs demonstrated significant correction in all 3 radiographic criteria and the hindfoot valgus angle. We had no cases of nonunion, no wedge migration, and no wedges have been removed to date. The most common complication was calcaneocuboid joint pain (14.7%). Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications. Levels of Evidence: Level IV: Case series

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Radiographic Outcomes in the Treatment of Type II Adult Acquired Flatfoot Deformity Following Lateral Column Lengthening with a Titanium Wedge versus Autograft or Allograft

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00370 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0037

Author(s):

Casey M. O’Connor ◽

Afshin Anoushiravani ◽

Kyle Richardson ◽

Matthew Anderson ◽

Andrew J. Rosenbaum

Keyword(s):

Surgical Procedure ◽

Weight Bearing ◽

Bone Substitutes ◽

Wedge Osteotomy ◽

Foot Deformity ◽

Flat Foot ◽

Lateral Column ◽

Radiographic Outcomes ◽

Patient Reported ◽

Lateral Column Lengthening

Category: Midfoot/Forefoot Introduction/Purpose: Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction occurring in patients with stage IIB Adult Acquired Flat Foot Deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus which is then filled with autograft, allograft, or a titanium wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes in the setting of stage IIB AAFD with the use of LCL. Methods: All patients who underwent LCL from October 2008 until October 2018 were retrospectively reviewed. Preoperative weight bearing radiographs, initial postoperative radiographs and 1-year weight bearing radiographs were reviewed. The following radiographic measurements were recorded: talonavicular uncoverage angle, incongruency angle, and calcaneal pitch. Results: A total of 44 patients were included in our study. The mean age of the cohort was 54 (range 18-74). The study cohort was divided into two groups. There were 17 (38.7%) patients that received a titanium wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (p=0.006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (p=0.013). There were no significant differences in post-operative talonavicular uncoverage angle, incongruency angle or calcaneal pitch at 6 months or 1 year. Conclusion: Adult acquired flat foot deformity is a difficult disorder to treat surgically. Lateral column lengthening is a common surgical procedure used to treat forefoot abduction that occurs. Our results show that at 6 months and 1 year no radiographic difference exists between autograft/allograft bone substitutes versus titanium wedge in LCL. Future research should evaluate the differences in patient reported outcomes between autograft/allograft versus titanium wedge bone substitutes. [Table: see text]

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Porous Titanium Wedges are an Alternative in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00184 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0018

Author(s):

Samuel Carstensen ◽

Spencer Moore ◽

Joseph Park ◽

M. Truitt Cooper ◽

Venkat Perumal

Keyword(s):

Deformity Correction ◽

Porous Titanium ◽

Treatment Modalities ◽

Posterior Tibial Tendon ◽

Lateral Column ◽

Metatarsal Angle ◽

Valgus Angle ◽

Significant Correction ◽

Lateral Column Lengthening ◽

Adult Acquired Flatfoot Deformity

Category: Hindfoot Introduction/Purpose: Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. Methods: A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 – October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo-first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was also obtained. Results: Patients were followed from a minimum of six months up to 48 months (mean 16.1 months). Patients underwent concomitant procedures including medial displacement calcaneal osteotomy (94.1%), flexor digitorum longus transfer (70.6%), posterior tibial tendon tenolysis (64.7%), gastrocnemius recession (20.6%), and cotton osteotomy (4.9%). Postoperative radiographs demonstrated significant correction in all three radiographic criteria as well as the hindfoot valgus angle compared to their preoperative measurements. There were no cases of nonunion, no wedge migration, no infections, and no patients required removal of hardware. The most common complication was calcaneocuboid joint pain (14.7%). Conclusion: AAFD is a problem with various treatment modalities. Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications.

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Effect of Lateral Column Lengthening on Subtalar Motion in a Cadaveric Model

Foot & Ankle International ◽

10.1177/1071100720970189 ◽

2020 ◽

pp. 107110072097018

Author(s):

Mitchell C. Harris ◽

Brittany N Hedrick ◽

Jacob R. Zide ◽

Danielle M. Thomas ◽

Claire Shivers ◽

...

Keyword(s):

Deformity Correction ◽

Porous Titanium ◽

Testing System ◽

Materials Testing ◽

Lateral Column ◽

3 Dimensional ◽

Fresh Frozen ◽

Lateral Column Lengthening ◽

Cadaveric Model ◽

Paired T Test

Background: Although lengthening of the lateral column through a calcaneal neck osteotomy is an integral component of flatfoot reconstruction in younger patients with flexible planovalgus deformities, concern exists as to the effect of this intra-articular osteotomy on subtalar motion. The purpose of this study was to quantify the alterations in subtalar motion following lateral column lengthening (LCL). Methods: The subtalar motion of 14 fresh-frozen cadaveric feet was assessed using a 3-dimensional motion capture system and materials testing system (MTS). Following potting of the tibia and calcaneus, optic markers were placed into the tibia, calcaneus, and talus. The MTS was used to apply a rotational force across the subtalar joint to a torque of 5 Nm. Abduction/adduction, supination/pronation, and plantarflexion/dorsiflexion about the talus were recorded. Specimens then underwent LCL via a calcaneal neck osteotomy, which was maintained with a 12-mm porous titanium wedge. Repeat subtalar motion analysis was performed and compared to pre-LCL motion using a paired t test. Results: No statistically significant differences in subtalar abduction/adduction (10.9 vs 11.8 degrees, P = .48), supination/pronation (3.5 vs 2.7 degrees, P = .31), or plantarflexion/dorsiflexion (1.6 vs 1.0 degrees, P = .10) were identified following LCL. Conclusion: No significant changes in subtalar motion were observed following lateral column lengthening in this biomechanical cadaveric study. Clinical Relevance: Although these findings do not obviate concerns of clinical subtalar stiffness following lateral column lengthening for planovalgus deformity correction, they suggest that diminished postoperative subtalar motion, when it occurs, may be due to soft tissue scarring rather than alterations of joint anatomy.

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Comparative Outcomes Between Step-Cut Lengthening Calcaneal Osteotomy vs Traditional Evans Osteotomy for Stage IIB Adult-Acquired Flatfoot Deformity

Foot & Ankle International ◽

10.1177/1071100717732723 ◽

2017 ◽

Vol 39 (1) ◽

pp. 18-27 ◽

Cited By ~ 16

Author(s):

Stuart M. Saunders ◽

Scott J. Ellis ◽

Constantine A. Demetracopoulos ◽

Anca Marinescu ◽

Jayme Burkett ◽

...

Keyword(s):

Deformity Correction ◽

Categorical Variables ◽

Distributed Data ◽

Level Of Evidence ◽

Lateral Column ◽

Calcaneal Osteotomy ◽

Outcome Scores ◽

Lateral Column Lengthening ◽

Adult Acquired Flatfoot Deformity ◽

Lateral Pain

Background: The forefoot abduction component of the flexible adult-acquired flatfoot can be addressed with lengthening of the anterior process of the calcaneus. We hypothesized that the step-cut lengthening calcaneal osteotomy (SLCO) would decrease the incidence of nonunion, lead to improvement in clinical outcome scores, and have a faster time to healing compared with the traditional Evans osteotomy. Methods: We retrospectively reviewed 111 patients (143 total feet: 65 Evans, 78 SLCO) undergoing stage IIB reconstruction followed clinically for at least 2 years. Preoperative and postoperative radiographs were analyzed for the amount of deformity correction. Computed tomography (CT) was used to analyze osteotomy healing. The Foot and Ankle Outcome Scores (FAOS) and lateral pain surveys were used to assess clinical outcomes. Mann-Whitney U tests were used to assess nonnormally distributed data while χ2 and Fisher exact tests were used to analyze categorical variables (α = 0.05 significant). Results: The Evans group used a larger graft size ( P < .001) and returned more often for hardware removal ( P = .038) than the SLCO group. SLCO union occurred at a mean of 8.77 weeks ( P < .001), which was significantly lower compared with the Evans group ( P = .02). The SLCO group also had fewer nonunions ( P = .016). FAOS scores improved equivalently between the 2 groups. Lateral column pain, ability to exercise, and ambulation distance were similar between groups. Conclusion: Following SLCO, patients had faster healing times and fewer nonunions, similar outcomes scores, and equivalent correction of deformity. SLCO is a viable technique for lateral column lengthening. Level of Evidence: Level III, retrospective cohort study.

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