Distal Chevron Osteotomy vs The Simple, Effective, Rapid, Inexpensive Technique (SERI) for Mild to Moderate Isolated Hallux Valgus: A Randomized Controlled Study

Abstract Background Hallux valgus is a common foot deformity that leads to functional disability with serious sequelae. Minimally invasive surgery is often used to treat hallux valgus in order to reduce wound complications and improve recovery time. The objective of this study was to compare a Simple, Effective, Rapid, Inexpensive (SERI) technique with a simple Chevron technique in patients with minimum of one-year follow. Methods and Materials Between the years 2014-2015 we performed a prospective study comparing the SERI minimally invasive technique to treat symptomatic hallux valgus with a standard chevron osteotomy technique. All procedures were performed by a single fellowship trained foot and ankle surgeon. Twenty-one patients were randomized to the SERI cohort and 15 to the standard Chevron technique. Results The mean pre-operative intermetatarsal angle (IMA) of the SERI group was 14.8 ± 1.9 (11.9 - 22.9). The mean pre-operative IMA of the Chevron control group was 13.3 ± 2.3 (10.4 -18.2) (p = 0.038). The mean IMA two weeks after surgery was 6.0 ± 2.3 (2.4-12) in the SERI group, and 6.1 ± 3 (2.6-13.1) in the control group. At the two week and one year follow up, there was no significant difference found in the IMA between the two groups (p = 0.871). Neither groups reported symptomatic transfer metatarsalgia throughout the follow up period. The SERI group had increased metatarsophalangeal joint (MTPJ) motion (p < 0.001) however, all other parameters with similar. Conclusion The SERI technique provided comparable outcomes at up to one year follow up when compared to a standard Chevron osteotomy for moderate hallux valgus. This study demonstrated good reproducible results using the SERI technique for moderate hallux valgus.

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One Year Follow-Up of Patient Reported Outcomes Following Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00328 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0032

Author(s):

Thomas L. Lewis ◽

Robbie Ray ◽

David Gordon

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Patient Reported Outcomes ◽

Case Series ◽

Third Generation ◽

Short Term ◽

Patient Reported ◽

The Mean ◽

One Year

Category: Bunion Introduction/Purpose: The aim of this study was to explore the short-term results of third generation (using screw fixation) Minimally Invasive Chevron and Akin osteotomies (MICA) for hallux valgus correction. There is a paucity of published data regarding the outcomes of this relatively new technique. We present the largest series in the literature, using three separate validated patient-reported outcome measures (EQ-5DL, VAS Pain and Manchester Oxford Foot Questionnaire (MOXFQ), for this time point. Methods: A single surgeon case series of patients with hallux valgus underwent primary third generation minimally invasive chevron and akin osteotomies (MICA) for hallux valgus correction. Between August 2015 and January 2019, 430 MICAs were performed in 295 patients that were eligible for 1 year follow up. Baseline and 1 year post-operative patient reported outcomes were collected for 242 feet in 194 patients (182 females; 12 males). Paired t-tests were used to determine the statistical significance of the difference between pre- and post-operative scores. Results: The mean age was 55.9 (range 16.3-84.9, standard deviation (s.d.) 12.5). At one year follow up, the mean MOXFQ scores had improved for each domain: Pain; baseline 41.9 (range 0-100, s.d. 21.8), reduced to 13.8 (range 0-90, s.d. 17.7, p<0.001); Walking; baseline 34.6 (range 0-100, s.d. 24.3) reduced to 9.8 (range 0-89.0, s.d. 18.0, p<0.001); Social interaction; baseline 45.4 (range 0-100, s.d. 22.8), reduced to 8.2 (range 0-75.0, s.d. 14.7, p<0.001). Mean VAS Pain score improved from 29.8 (range 0.0-90.0, s.d. 22.1) to 8.2 (range 0.00-64.0, s.d. 12.8, p<0.001). Mean EQ-5D index score improved from 0.755 (range 0.066-1.000, s.d. 0.136) to 0.891 (range 0.350-1.000, s.d. 0.124, p<0.001). Mean EQ-5D VAS score improved from 83.4 (range 28- 100, s.d. 12.4) to 85.6 (range 0-100, s.d. 14.2, p=0.047). Conclusion: This is the largest prospective case series of short-term patient reported outcomes using a validated assessment method for hallux valgus, following third generation MICA to date. These data show that this technique is effective at improving foot and ankle specific patient reported outcomes at 1 year. This cohort is being followed over the longer term.

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Meniscus Repair Outcomes with and without Bone Marrow Aspiration Concentrate

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00283 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0028 ◽

Cited By ~ 1

Author(s):

Patrick Allan Massey ◽

Andrew Zhang ◽

Christine Bayt Stairs ◽

Stephen Hoge ◽

Trevor Carroll ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Aspiration ◽

Meniscus Repair ◽

Control Group ◽

Pain Level ◽

Average Pain ◽

The Mean ◽

One Year ◽

The One

Objectives: The purpose of the current study is to review the results of meniscus repairs with and without bone marrow aspiration concentrate (BMAC). It is hypothesized that with BMAC, meniscus repair outcomes will be improved when compared to without BMAC at 1 year after surgery. Methods: This is a prospective case control study performed from August 2014 until August 2017. Patients were included if they had a meniscus repair performed with no history of prior meniscus surgery to the operative knee. Patients were excluded if there was a full thickness cartilage tear or International Cartilage Repair Society (ICRS) Grade IV cartilage tear not treated in a single staged surgery. Patients were also excluded if they did not reach the one year follow-up, had a multi-ligamentous knee injury requiring multiple staged procedures. From August 2014 until November 2015, patients had meniscus repair without BMA. Menisci were all repaired arthroscopically using inside-out, outside-in and all-inside techniques. After November 2015, all meniscus repairs were augmented with BMAC. In the BMAC group, all bone marrow was obtained from the ipsilateral femur during the time of surgery. The Biocue BMAC system (Zimmer Biomet, Warsaw Indiana) was used for bone marrow aspiration and BMAC was injected directly into the tear site after repair. Numerical data such as VAS, lysholm and IKDC was analyzed using a 2 sample T-test. Categorical data such as sex, tear location, type of tear and zone of tear were analyzed using a chi-square. Results: A total of 150 patients were initially included in the study. The average age in the control group was 26.3 versus 29.4 in the BMAC group (P=0.27). Thirty seven percent of the control group had an ACL reconstruction versus 40% in the BMAC group (P= .77). The control group improved from an average pain level of 6.1 to 1.2 and the BMAC group improved from an average pain level of 5.9 to 0.7 at the 1 year end point. Both the control group and BMAC group improved with respect to pain with no difference at the 1 year end point (P=.19). There was, however a significantly larger reduction in pain at the 6 week and 3 month time point with BMAC compared to the control group (P=.02 and P=.02 respectively). At the 1-year follow-up, the mean lysholm score improved from 43 to 92 in the control group and 43 to 90 in the BMAC group. The mean IKDC score improved from 37 to 87 in the control group and 36 to 83 in the BMAC group at the one year follow-up. Conclusion: Meniscus repair outcomes were improved at 6 weeks and 3 months post-operatively, when BMAC is used to augment meniscus repair compared to repair without BMAC. Both groups, control group and BMAC meniscus repair group had improved outcomes at 1 year post-operatively with respect to VAS, lysholm and IKDC, with no difference in complication rate.

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Treatment of Moderate Hallux Valgus by Percutaneous, Extra-articular Reverse-l Chevron (PERC) Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000268 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Julien Lucas ◽

Olivier Laffenetre

Keyword(s):

Hallux Valgus ◽

Proximal Phalanx ◽

Subjective Rating ◽

Outpatient Basis ◽

Range Of Movement ◽

Aofas Score ◽

First Metatarsophalangeal Joint ◽

Chevron Osteotomy ◽

The Mean

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a Percutaneous Extra-articular Reverse-L Chevron (PERC) osteotomy. Methods: A total of 38 patients underwent 45 PERC procedures. A medial approach is used just proximal to the flare of the metatarsal head. The osteotomy is performed using a burr, the thickness of which is selected according to the planned correction and shortening. A second dorsolateral approach is then performed and the osteotomy is fixed using a self-drilling, self-tapping 3 mm diameter cannulated and headless compression screw. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. Results: The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Conclusion: Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy. Its main asset is that it maintains an excellent range of movement; other advantages relate to the procedure being performed on an outpatient basis and the absence of tourniquet use.

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TL 18237 - First metatarsophalangeal joint arthrodesis using a minimally invasive technique

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1090 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 112S

Author(s):

Luiz Carlos Ribeiro Lara ◽

Lúcio Carlos Torres ◽

Gabriel Cervone ◽

Juan Antonio Grajales ◽

Fabio Lemos Rodrigues

Keyword(s):

Minimally Invasive ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Percutaneous Technique ◽

First Metatarsophalangeal Joint ◽

The Mean ◽

Larger Sample

Introduction: Metatarsophalangeal joint arthrodesis (MTPA) is a surgical technique indicated for the treatment of hallux rigidus with advanced arthrosis and for rheumatic diseases. This classic surgery is widely used and effective; however, the use of a minimally invasive technique remains mostly unknown. Objective: To present the outcome of MTPA performed using a percutaneous technique. Methods: Hallux MTPA was performed in 8 feet from 4 patients with hallux rigidus and 4 with rheumatoid arthritis, with a higher prevalence of women than men (5 vs. 3) and a mean postoperative follow-up time of 1.5 years. The outcomes were evaluated using a modified version of the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and the union time. Results: All patients who underwent surgery showed improvements in pain and arthrodesis union at approximately 8 weeks. The mean AOFAS score increased to 85 points (of a total of 90 possible points). There were no complications, such as infection, nonunion or persistent pain. Conclusion: The percutaneous technique of hallux MTPA was effective, with satisfactory outcomes, reduced surgical invasiveness, immediate walking, rapid union with “arthrodesis take” and significant improvement in pain. However, a larger sample is required to confirm the outcomes.

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PO 18042 - Surgical treatment of moderate and severe hallux valgus

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.983 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 4S

Author(s):

Rafael Ferreira da Silva ◽

André Donato Baptista ◽

Kepler Alencar Mendes de Carvalho

Keyword(s):

Surgical Treatment ◽

Hallux Valgus ◽

Surgical Techniques ◽

Intermetatarsal Angle ◽

Chevron Osteotomy ◽

The Mean ◽

Invasive Techniques ◽

Severe Hallux Valgus

Introduction: Hallux valgus is a multifactorial disease, and heredity is the main associated factor. Pain and discomfort when using closed-toed shoes occur in many cases, adversely affecting quality of life. Surgical treatment is indicated when pain and disability persist after conservative treatment. Currently, more than 150 surgical techniques are described for hallux valgus correction, with no consensus regarding the best treatment. With the advent of minimally invasive techniques for hallux valgus correction, Vernois developed the percutaneous chevron osteotomy. This technique allows up to 100% lateral translation of the contact area of the osteotomy. Objective: the objective of the present study was to assess the correction of radiographic parameters, clinical improvement and potential complications of the first 30 cases of moderate and severe hallux valgus operated on at our hospital using the percutaneous chevron technique. Methods: A total of 26 patients (30 feet) underwent surgery. The following parameters were measured in the pre- and postoperative periods: the first metatarsophalangeal (MTP) angle, the intermetatarsal angle between the 1st and 2nd metatarsals (IMA), the distal metatarsal articular angle (DMAA) and the pre- and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scores, with a minimum follow-up period of 6 months. Results: The mean age of the patients was 52.3 years. During the preoperative period, the mean AOFAS score was 45.6; it increased to 90.3 after the procedure, indicating a statistically significant improvement. The mean MTP angle, IMA and DMAA were 29.7°, 14.2° and 14.2° before surgery and 12.8°, 8.2° and 11.1° after surgery, respectively. The improvements in the MTP angle and the IMA were also significant. There was no decrease in angles or worsening of AOFAS scores during follow-up. Conclusion: The percutaneous chevron technique was safe and effective for correcting cases of moderate and severe hallux valgus, with significant improvements in clinical and radiological parameters and a low rate of postoperative complications.

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The effect of a modified chevron osteotomy for hallux valgus patients: A five-year follow-up study

10.21203/rs.3.rs-929642/v1 ◽

2021 ◽

Author(s):

Shiyong Zhang ◽

Xue Wang ◽

Tiannan Chen ◽

Chengwei Wang ◽

Jie Wang

Keyword(s):

Hallux Valgus ◽

Analog Scale ◽

Aofas Score ◽

Intermetatarsal Angle ◽

Follow Up Study ◽

Chevron Osteotomy ◽

Vas Scores ◽

The Mean ◽

American Orthopaedic

Abstract Purpose This study aimed to detect the effect of a modified chevron osteotomy on hallux valgus (HV) deformity at five-year follow up. Methods Twenty patients with symptomatic HV who underwent modified chevron osteotomy between June 2014 and January 2016 were included in the present study. The follow-up duration was more than five years. Each patient was evaluated preoperatively, six weeks postoperatively and five years postoperatively using the visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) score and cosmetic and radiological outcomes. Results The AOFAS score improved from 54.40 (± 4.58) preoperatively to 94.30 (± 2.15) six weeks postoperatively (p < 0.001) and 96.95 (± 1.54) five years postoperatively (p < 0.001). The VAS scores decreased from 6.30 (± 1.17)preoperatively to 0.15 (± 0.37) five years postoperatively (p < 0.001). The mean intermetatarsal angle improved from 16.00° (± 2.20°) preoperatively to 4.15° (± 1.22°) six weeks postoperatively (p < 0.001) and 4.40° (± 1.39°) five years postoperatively (p < 0.001). The mean HV angle also improved, from 32.70° (± 5.34°) preoperatively to 4.80° (± 1.40°) six weeks postoperatively (p < 0.001) and 5.20° (± 1.32°) five years postoperatively (p < 0.001). The cosmetic results were either excellent or good in 19 patients (95%). There was no recurrence in this study during the five postoperative years. Conclusion A modified chevron osteotomy can achieve successful correction of moderate-to-severe HV, with excellent outcomes at five-year follow up.

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Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique

Medicina ◽

10.3390/medicina56020075 ◽

2020 ◽

Vol 56 (2) ◽

pp. 75

Author(s):

Liat Chaushu ◽

Gavriel Chaushu ◽

Hadar Better ◽

Sarit Naishlos ◽

Roni Kolerman ◽

...

Keyword(s):

Minimally Invasive ◽

Radiographic Evaluation ◽

Control Group ◽

Insertion Torque ◽

Alveolar Ridge ◽

Marginal Bone Loss ◽

Sinus Augmentation ◽

Ridge Height ◽

The Mean

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients’ files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6–9 months of healing time. Mean follow-up was 17.5 months, range 12–36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm.

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Partial time use of anterior repositioning splints in the management of TMJ pain and dysfunction: a one-year controlled study

Journal of Applied Oral Science ◽

10.1590/s1678-77572005000400006 ◽

2005 ◽

Vol 13 (4) ◽

pp. 345-350 ◽

Cited By ~ 19

Author(s):

Paulo César Rodrigues Conti ◽

João Evandro Silva Miranda ◽

Ana Cláudia C. Ferreira Conti ◽

Luiz Fernando Pegoraro ◽

Carlos dos Reis Pereira de Araújo

Keyword(s):

Time Use ◽

Open Bite ◽

Controlled Study ◽

Control Group ◽

Final Sample ◽

Muscle Tenderness ◽

Tmj Pain ◽

One Year ◽

Articular Pain

This study aimed at evaluating the effectiveness of partial use of anterior repositioning appliances in the management of TMJ pain and dysfunction when compared to stabilization splints and a control group in a one-year follow-up. Sample was initially constituted by 60 patients, randomly divided into three groups: I- stabilization splints, II- repositioning splints and III- no treatment. The whole sample was evaluated by means of TMJ and muscle palpation, mandibular AROM, analysis of occlusal contacts, joint sounds inspection and Visual Analogue Scale (VAS) for one year; 52 patients composed the final sample. A significant (after 15 days) improvement in pain report (VAS) and palpation index was found for group II (p<0.01). The occurrence of occlusal alterations as posterior open bite or gross interferences after the splint therapy and increased muscle tenderness were not problems in this study. Similar results in joint noises reduction were observed for the entire sample. It was concluded that controlled partial use of repositioning splints is a beneficial tool in the management of intra-articular pain and dysfunction, with no risks of irreversible occlusal changes.

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A 1-week online self-compassion training reduces self-criticism and pain endurance in people with non-suicidal self-injury ideation – a randomized-waitlist controlled study

10.31234/osf.io/e7vma ◽

2021 ◽

Author(s):

Sukriti Drabu ◽

Oliver Sündermann ◽

Ryan Y. Hong

Keyword(s):

Training Group ◽

Controlled Study ◽

Control Group ◽

Single Session ◽

The Past ◽

Self Compassion ◽

Self Injury ◽

One Year ◽

The One

Self-criticism has been identified as a key underlying vulnerability that lowers of one’s positive self-regard and pain barriers that prevent individuals from engaging in non-suicidal self-injury (NSSI). Additionally, research suggests that self-compassion may serve as a protective tool in counteracting self-criticism. This study examined the efficacy of a brief online self-compassion training on past year NSSI engagers and ideators in reducing (a) explicit self-criticism, (b) implicit self-criticism, (c) pain endurance and (d) the inclination to engage in NSSI. Sixty-three Singaporean adults who reported the presence of self-injurious thoughts or behaviors in the past one year were randomly assigned to either a 1-week self-compassion training group or a waitlisted control group. As compared to the control group (n = 33), the training group (n = 30) yielded significantly greater reduction in explicit self-criticism after a single session and significantly greater reduction in self-criticism, pain endurance, as well as the explicit inclination to self-injure after the one-week online training. The reduction in explicit self-criticism and inclination to self-injure was maintained at the 2-week follow-up. These findings provide novel evidence supporting the efficacy of using a brief online self-compassion intervention to reduce NSSI correlates and symptoms.

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Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00130 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0013

Author(s):

Sofia Carlucci ◽

Nelly Carrasco ◽

Maria Santini-Araujo ◽

Ana Parise ◽

Leonardo Conti ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Deformity Correction ◽

Hallux Valgus Angle ◽

Chevron Osteotomy ◽

Metatarsal Angle ◽

Valgus Angle ◽

Akin Osteotomy ◽

American Orthopaedic

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The use of minimally invasive techniques for hallux valgus may provide complete deformity correction with minor soft tissue damage, which reduces morbidity and shortens recovery. In this way, some open osteotomies were adapted to percutaneous approaches, with good outcomes reported. The minimally invasive chevron-Akin (MICA) described by Vernois and Redfern in 2011, combines benefits of percutaneous approaches with a stable internal fixation. Since 2015 we have adapted this technique, by adding a percutaneous adductor tenotomy to dispense with the Akin osteotomy. The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a minimally invasive chevron osteotomy and a percutaneous adductor tendon release. Methods: This was a prospective cohort study. A total of 38 feet with moderate hallux valgus underwent the procedure and were followed up for a minimum 12 months (SD 1.10). The median age was 58 years (IQR 52 - 65), 36 women and 2 men. Radiological parameters were compared at preoperatory and at the last follow-up and included: Hallux Valgus Angle (HVA), Inter- Metatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and first metatarsal shortening. Time to consolidation was also assessed. For clinical evaluation the American Orthopaedic Foot & Ankle Society score (AOFAS) was evaluated. Complications during the follow up were reported. Patients in which another procedure in the hallux was performed, with previous surgeries or not completed 1 year follow-up were excluded. Results: Radiologic postoperative parameters demonstrated to achieved correction. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and distal metatarsal articular angle. Shortening of the first metatarsus was a mean 7.02 mm (IQR 1.24 - 10,27). The mean AOFAS score increased from 58.23 (SD 9.02) pre-operatively to 97.15 (SD 4.72) post-operatively (p< 0.001). Complications reported were 2 superficial infections, 1 broken screw, 1 screw extraction. Five patients referred metatarsalgia after surgery and 1 presented a fourth metatarsal stress fracture. Only one patient presented lost of correction in the first postoperative week and needed a second surgery. Conclusion: Our series of hallux valgus correction with a minimally invasive chevron osteotomy combined with the adductor tendon release shows good clinical and radiological outcomes, and results are comparable to series with the additional Akin osteotomy. Comparative studies are needed for major evidence.

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